Escalation Recovery Scheduling

Submit a scheduling request for escalated members.

Complete this form to submit an urgent escalation request. Our team will review your submission and respond promptly to ensure you receive the support you need.

Reference Code *

Enter the reference code in the format SMCS-XXXXX-XXXXX.

Member ID *

I understand that this form should not include medical information or other protected health information.

Information verified.

Member

Member ID

Borough

Zone

Care Manager

Last Visit

Six-Month Due Date

Choose an available scheduling date.

Only dates currently available for this member's borough and zone can be selected. Once you select an available date, submit the scheduling request to send it to our team for follow-up.

Support Available

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Submit a scheduling request for escalated members.

Information verified.

Choose an available scheduling date.

Complete your scheduling request.

Need immediate assistance?