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Download and complete the official Libin Programs referral form. Ensure all required fields are filled out prior to submission.
Incomplete forms may delay clinical review.
Submit the completed referral form and supporting documents using the secure upload form below.
đź”’ All submissions are transmitted securely and reviewed by authorized clinical staff only.
đź”’ Secure encrypted transmission
Documentation is reviewed by clinical leadership
Screening may be scheduled if indicated
Acceptance determination provided
Admission scheduling coordinated
🛡️ Referral sources will be contacted regarding status and next steps.
We accept major Minnesota health programs to ensure accessible care for eligible adults.
Minnesota Health Care Programs
Blue Cross Blue Shield (PMAP)
Participating PMAP plan
Participating PMAP plan
Participating PMAP plan
