Get the free CONTINUITY OF CARE REQUEST DATE - Daytona State College - daytonastate

Please complete the Continuity of Care and Release of Protected Health Information (PHI) Forms & return to DHCP, Case MGMT, Fax 3866154058 or mail to DHCP, Post Office Box 9910, Attn: Case Management,

How to fill out continuity of care request

How to fill out a continuity of care request:

1. Contact your healthcare provider's office and request a continuity of care form.
2. Fill out the patient information section, including your name, address, phone number, and date of birth.
3. Indicate the name of your current healthcare provider and their contact information.
4. Specify the date you plan to switch healthcare providers or any upcoming changes in your healthcare coverage.
5. Explain the reason for your continuity of care request, such as ongoing medical conditions, ongoing treatments or therapies, or the need for important medical records to be shared between providers.
6. Provide any relevant medical history, including diagnoses, medications, and any other pertinent information that would be important for your new healthcare provider to have.
7. Sign and date the form.
8. Submit the completed form to your current healthcare provider's office or the appropriate party as directed.

Who needs a continuity of care request?

1. Patients who are switching healthcare providers or insurance plans may need a continuity of care request.
2. Patients with ongoing medical conditions or chronic illnesses that require ongoing treatment or specialized care can benefit from continuity of care.
3. Individuals who require the transfer of medical records, test results, or treatment plans between healthcare providers may also need a continuity of care request.

For pdfFiller’s FAQs

What is continuity of care request?

Continuity of care request is a process by which a patient can request to continue receiving care from a specific healthcare provider even if they are no longer in-network.

Who is required to file continuity of care request?

Patients who are receiving ongoing treatment from a healthcare provider who is no longer in their insurance network are required to file a continuity of care request.

How to fill out continuity of care request?

To fill out a continuity of care request, patients can typically contact their insurance company directly and request the necessary forms, which must be completed and submitted with supporting documentation.

What is the purpose of continuity of care request?

The purpose of continuity of care request is to ensure that patients can continue to receive treatment from a healthcare provider with whom they have an established relationship, even if that provider is no longer in-network.

What information must be reported on continuity of care request?

The continuity of care request typically requires information such as the patient's name, insurance information, healthcare provider's name, reason for the request, and details of the ongoing treatment.

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