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Case Management Physician Referral Form Fax: 215-238-7063 Member information *Name: *ID #: *DOB: *Preferred contact telephone #: the Best time to reach member: a.m. p.m. Pertinent data *Diagnosis:

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What is case management physician referral?

Case management physician referral is a process in which a physician refers a patient to a case management program. This program helps coordinate and manage the patient's healthcare and treatment plans.

Who is required to file case management physician referral?

The referring physician is responsible for filing the case management physician referral. They are required to provide the necessary information and documentation to initiate the referral process.

How to fill out case management physician referral?

To fill out a case management physician referral, the referring physician needs to provide the patient's relevant medical history, current health condition, and any specific needs or goals for the case management program. They also need to include their own contact information and any supporting documents or test results.

What is the purpose of case management physician referral?

The purpose of case management physician referral is to ensure comprehensive and coordinated care for patients who require additional assistance or support. It helps improve the patient's overall health outcomes by connecting them with resources, services, and healthcare professionals who can address their specific needs.

What information must be reported on case management physician referral?

The case management physician referral should include the patient's identifying information, medical history, current health condition, and any known diagnoses or treatments. It should also mention the reason for the referral, the desired outcomes, and any relevant supporting documents.

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