Provider Referral Forms
These frequently requested referral forms are provided for the convenience of community providers.
Provider Resources
Hospital Affiliation Verifications
For hospital affiliation verifications, please access NAMSS resources.
For instructions on using NAMSS PASS, please click here.
Medical Records
Contact Medical Records for patient documents such as medical history/chart.
Phone: (360) 417-7136
Fax: (360) 417-7674
Medical Staff Services
Sally Rowland, CPMSM, CPCS
Credentialing Specialist
Phone: (360) 417-7711
Marisa Bleck
Credentialing Specialist
Phone: (360) 417-7336
Fax: (360) 417-7082
Office: 939 Caroline Street, Port Angeles, WA 98362
Hours: Monday – Friday, 7:00 am – 3:30 pm
Payer Enrollment
Joanna Weber
Director, Revenue Cycle Management
Phone: (360) 417-7796
Fax: (360) 417-7342
Stacy L. Nikodym
Credentialing, Contracting and Reimbursement Analyst
Phone: (360) 565-9237
Fax: (360) 565-9241
Office: 519 S. Peabody Street, Suite 4 or PO Box 850, Port Angeles, WA 98362
Hours: Monday – Friday, 7:30 am – 4:00 pm