RI Continuity of Care Form free printable template

Rhode Island HEALTH Continuity of Care Form Specific Discharging Agency: ADMISSION DATE: DISCHARGE DATE: Referral to: Patient Name: Home Address: Phone: Contact Person Discharging Facility: Phone/Beeper

How to fill out continuity of care form

How to fill out RI Continuity of Care Form

1. Obtain the RI Continuity of Care Form from your healthcare provider or online.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Provide details of the current healthcare provider, including name, address, and phone number.
4. Enter information about the new healthcare provider the patient is transitioning to.
5. Detail the patient's medical history, including diagnoses, medications, allergies, and any special instructions.
6. Sign and date the form to authorize the release of information.
7. Submit the completed form to the new healthcare provider.

Who needs RI Continuity of Care Form?

1. Patients transitioning from one healthcare provider to another.
2. Anyone requiring a transfer of medical records for continuity of care.
3. Healthcare professionals needing comprehensive patient history for new patients.

For pdfFiller’s FAQs

How do I make edits in continuity of care form without leaving Chrome?

Get and add pdfFiller Google Chrome Extension to your browser to edit, fill out and eSign your continuity of care form, which you can open in the editor directly from a Google search page in just one click. Execute your fillable documents from any internet-connected device without leaving Chrome.

How do I edit continuity of care form straight from my smartphone?

The easiest way to edit documents on a mobile device is using pdfFiller’s mobile-native apps for iOS and Android. You can download those from the Apple Store and Google Play, respectively. You can learn more about the apps here. Install and log in to the application to start editing continuity of care form.

How do I edit continuity of care form on an iOS device?

Create, edit, and share continuity of care form from your iOS smartphone with the pdfFiller mobile app. Installing it from the Apple Store takes only a few seconds. You may take advantage of a free trial and select a subscription that meets your needs.

What is RI Continuity of Care Form?

The RI Continuity of Care Form is a document used to ensure that patients receive uninterrupted medical care when changing health care providers or plans.

Who is required to file RI Continuity of Care Form?

The RI Continuity of Care Form must be filed by health care providers, hospitals, and health plans when patients transition to different care arrangements.

How to fill out RI Continuity of Care Form?

To fill out the RI Continuity of Care Form, provide patient information, details of the current health care provider, and a summary of the patient's medical history and ongoing treatment needs.

What is the purpose of RI Continuity of Care Form?

The purpose of the RI Continuity of Care Form is to facilitate smooth transitions in patient care, ensuring that necessary information is communicated among health care providers.

What information must be reported on RI Continuity of Care Form?

The information that must be reported on the RI Continuity of Care Form includes patient demographics, current treatments, medications, upcoming appointments, and any special considerations related to the patient's care.