Get ready to apply
State of Alaska Department of Health
Cancer Case Management
What you get
A case manager helps you organize cancer care, benefits, providers and practical services. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Fax to 877-265-9549
- Your time
- About 30 minutes
- Last checked
- Aug 27, 2026
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open the application PDF ↗ Checked Aug 27, 2026Fax it to 877-265-9549.
What the form asks for
Case Management Referral FormFromREPatient NamePatient SSNAddress / City / State / ZipDOBPhone (W)Phone (H)Subscriber NameSubscriber NumberPlanDate of ReferralContactContact PhonePrimary DiagnosisSecondary DiagnosisCurrent issuesPrimary Care PhysicianPrimary Care Physician PhonePhysician Specialist if applicableSpecialtySpecialist PhoneReason for referralExpectationsOther
After you send
A Comagine Health nurse case manager will contact the recipient and/or family. If you have not heard back in two weeks, write and ask whether it arrived.