Get the free Continuity of Care Form - Kent Hospital

Care New England Butler Hospital Kent Hospital Women & Infants Hospital of RI VIA of Care New England Rhode Island Department of Health Continuity of Care Form Patient Name: Home Address: Insurer:

How to fill out continuity of care form

How to fill out a continuity of care form:

1. Begin by obtaining a copy of the continuity of care form. This form is typically provided by your healthcare provider or insurance company. If you are unsure where to find the form, contact your healthcare provider's office or your insurance company's customer service.
2. Start by entering your personal information on the form. This may include your name, date of birth, gender, contact information, and any identification numbers provided by your healthcare provider or insurance company.
3. Next, provide information about your current healthcare provider(s). Include their names, addresses, and contact information. If you have multiple healthcare providers, list them all accordingly.
4. Indicate the reason for your request for continuity of care. This could be due to a change in insurance coverage, a change in healthcare providers, or any other circumstances that require the transfer of your medical records and ongoing medical care.
5. Specify the type of care you are seeking continuity for. This could include primary care, specialty care, ongoing treatment, or any specific medical conditions.
6. If applicable, provide information about any medications you are currently taking or any medical devices that are essential to your care. Include the names of the medications, dosages, and frequencies.
7. Sign and date the form. Depending on the requirements of your healthcare provider, you may need to have the form notarized or witnessed by a trusted individual.

Who needs continuity of care form?

1. Patients who are transitioning from one healthcare provider to another may need a continuity of care form. This ensures that their medical records, treatment plans, and ongoing care are properly transferred and maintained.
2. Individuals who are changing insurance providers may also require a continuity of care form. This allows the new insurance company to understand the medical needs of the patient and continue providing the necessary care.
3. Patients who have complex medical conditions and require ongoing treatment may need a continuity of care form. This helps to ensure that their specific needs and treatment plans are understood and continued by new healthcare providers.

It is important to consult with your healthcare provider or insurance company to determine if you need a continuity of care form and to understand any specific requirements or processes involved in completing the form.

For pdfFiller’s FAQs

What is continuity of care form?

The continuity of care form is a document used to ensure that patients receive appropriate and uninterrupted medical care during transitions between healthcare providers or healthcare settings.

Who is required to file continuity of care form?

Healthcare providers and facilities, such as hospitals and clinics, are typically required to file the continuity of care form when a patient is being transferred or referred to another provider or facility.

How to fill out continuity of care form?

The specific instructions for filling out the continuity of care form may vary depending on the healthcare system or organization. Generally, it involves providing information about the patient's medical history, current treatment plan, medications, and any special care needs. It is important to follow the instructions provided by the healthcare provider or facility when filling out the form.

What is the purpose of continuity of care form?

The purpose of the continuity of care form is to ensure that essential medical information is shared between healthcare providers or facilities during the transfer or referral process. This helps to maintain the continuity and quality of care for the patient and reduces the risk of errors or gaps in treatment.

What information must be reported on continuity of care form?

The information requested on the continuity of care form may include the patient's demographic information, medical history, current diagnosis, treatment plan, medications, allergies, and any specific care needs. The form may also require information about the referring healthcare provider or facility, as well as the receiving provider or facility.

How can I send continuity of care form to be eSigned by others?

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How do I make changes in continuity of care form?

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