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Ohio Department of Medicaid Utilization Management Program for Hospital Services The following named individual will be responsible for communication with Ohio Department of Medicaid, or their contractual
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How to fill out change of hospital contact
How to Fill Out Change of Hospital Contact?
01
Obtain the necessary form from your current hospital's administration office or website.
02
Fill in your personal details such as your name, date of birth, social security number, and current contact information.
03
Indicate the reason for requesting the change of hospital contact and specify the new contact information you would like to update.
04
If applicable, provide any supporting documentation such as a copy of your identification or proof of address.
05
Check the form for accuracy and completeness before submitting it to the hospital administration.
06
Follow any additional instructions provided by the hospital, such as submitting the form in person or via mail.
Who Needs Change of Hospital Contact?
01
Patients who have moved to a new address and need to update their contact information with the hospital.
02
Individuals who have changed their phone number or email address and need to ensure the hospital can reach them.
03
Family members or caregivers who are responsible for communicating with the hospital on behalf of a patient and need to update their own contact information.
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