Get the free DIRECT ACCESS TREATMENT EXTENSION REQUEST TER to CHP

DIRECT ACCESS TREATMENT EXTENSION REQUEST (TER) to CHP For KP members in WA employer groups Please note if: Urgent Request: Date: Phone: CHP Decision rendered within 72 hours of receipt of request.

How to fill out direct access treatment extension

How to fill out direct access treatment extension:

1. Begin by gathering all necessary documents and information. This may include your personal details, insurance information, and any relevant medical records or treatment plans.
2. Access the direct access treatment extension form. This can usually be downloaded from your insurance provider's website or obtained from your healthcare provider.
3. Start by filling out your personal information accurately and completely. This may include your name, address, contact information, and insurance policy details.
4. Move on to the section where you provide details about the treatment you require. Be specific and concise, outlining the nature of your condition or illness and the type of treatment you are requesting.
5. Ensure that you include any relevant medical records or documentation that supports your need for the direct access treatment extension. This could include doctor's notes, test results, or treatment plans.
6. If required, provide additional information about any previous treatments you have undergone for the same condition. This can help insurance providers understand the context and urgency of your request.
7. Double-check all the information you have provided before submitting the form. Make sure there are no errors or missing details that could delay the processing of your request.
8. Sign and date the form, indicating that all the information you have provided is true and accurate to the best of your knowledge.

Who needs direct access treatment extension:

1. Individuals who require ongoing or specialized treatment for a medical condition may need a direct access treatment extension. This can include procedures such as rehabilitation, physiotherapy, or psychological counseling.
2. Patients who have exhausted the initial authorized treatment sessions allowed by their insurance plan may need a direct access treatment extension to continue receiving the necessary care.
3. People who experience unexpected setbacks or complications in their recovery process may require a direct access treatment extension to ensure they receive the appropriate treatment for an extended period.

Remember, it is essential to consult with your healthcare provider or insurance company for specific guidelines and instructions on how to fill out the direct access treatment extension form.

For pdfFiller’s FAQs

What is direct access treatment extension?

Direct access treatment extension is an option for individuals to extend their access to specific medical treatments without needing a referral from a primary care physician.

Who is required to file direct access treatment extension?

Individuals who wish to receive certain medical treatments directly from a specialist without a referral are required to file a direct access treatment extension.

How to fill out direct access treatment extension?

To fill out a direct access treatment extension, individuals need to submit a form specifying the treatment they are seeking and the specialist they wish to see.

What is the purpose of direct access treatment extension?

The purpose of direct access treatment extension is to streamline the process for individuals seeking specific medical treatments by allowing them to go directly to a specialist.

What information must be reported on direct access treatment extension?

The information required on a direct access treatment extension includes the type of treatment sought, the specialist being requested, and the reason for seeking direct access.

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