Get the free Transition of Care Request Form

This document serves as a request for Transition of Care, allowing members to continue receiving treatment from non-participating providers when changing health care coverage.

How to fill out transition of care request

How to fill out Transition of Care Request Form

1. Start by downloading the Transition of Care Request Form from your healthcare provider's website or obtaining a physical copy from their office.
2. Fill in your personal information, including your name, address, date of birth, and insurance details at the top of the form.
3. Provide information about your current healthcare provider, including their name, address, and contact information.
4. Specify the reason for the transition of care and include any relevant medical history or conditions that the new provider should be aware of.
5. Indicate any specific services or support you require from the new provider.
6. Sign and date the form to authorize the release of your medical information to the new provider.
7. Submit the completed form to your current provider to initiate the transition process.

Who needs Transition of Care Request Form?

1. Individuals who are changing healthcare providers due to relocation, dissatisfaction with current care, or the need for specialized services.
2. Patients transitioning from one care setting to another, such as from hospital to home or from one specialist to another.

For pdfFiller’s FAQs

What is Transition of Care Request Form?

The Transition of Care Request Form is a document used to facilitate the transfer of a patient’s healthcare from one provider to another, ensuring continuity of care during transitions.

Who is required to file Transition of Care Request Form?

Typically, the healthcare provider or the patient’s primary care physician is required to file the Transition of Care Request Form when a patient changes their healthcare provider or facility.

How to fill out Transition of Care Request Form?

To fill out the Transition of Care Request Form, provide patient identifying information, details about the previous and new providers, relevant medical history, and specific requests for ongoing care.

What is the purpose of Transition of Care Request Form?

The purpose of the Transition of Care Request Form is to ensure that all relevant medical information is communicated effectively to the new healthcare provider, enabling them to provide appropriate care for the patient.

What information must be reported on Transition of Care Request Form?

The information that must be reported on the Transition of Care Request Form includes patient demographics, medical history, details of current medications, information about previous treatments, and any specific care instructions.