FirstHealth of the Carolinas

For Affiliate Providers

Thank you for agreeing to serve as an affiliate provider for FirstHealth EAP.  We will send you a referral form so that you know the client has approval to utilize your services as EAP.  The client is responsible for contacting the affiliate provider to schedule the initial appointment.  Please contact EAP if you do not hear from the client within two weeks of receiving the referral.

Necessary forms are posted here for your convenience.  Please contact us if there are any questions at (910) 715-3444. 

Thank you.

The Client Information Form and the EAP Statement of Understanding should be completed by the client and faxed or mailed back to our office within one week of the first visit at your office.  Please contact our office to receive authorization for more sessions if you plan to see the client after the first visit.

The Affiliate Services Case Closing Report Form and an INVOICE on your letterhead must be returned to us at the close of each affiliate case to receive payment.  It also provides us with critical information concerning the outcome of EAP services.  Cases should be closed within 90 days of the first visit.

The FHC-EAP Referral Acknowledgement form should be completed only if, upon completion of EAP services, you and the client agree to continue services independently (self-referral).

Mailing Address: FirstHealth of the Carolinas
Employee Assistance Program
35 Memorial Drive
Specialty Centers Building
Post Office Box 3000
Pinehurst, NC   28374
Fax: (910) 715-3414

 

 

 


 
 
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