Get the free Continuity of Care Form - Anthem

Continuity of Care Form (For Colorado and Nevada use only) To help ensure that your care is not disrupted, please complete the entire form below. Only complete this form if you are receiving ongoing

How to fill out continuity of care form

How to fill out continuity of care form:

1. Begin by obtaining a copy of the continuity of care form from your healthcare provider or insurance company.
2. Carefully read the instructions and familiarize yourself with the required information and sections of the form.
3. Fill in your personal information accurately, including your full name, date of birth, address, and contact details.
4. Provide details about your primary healthcare provider, including their name, specialty, and contact information.
5. Indicate the reason for needing continuity of care, such as a recent change of healthcare provider or a medical condition requiring ongoing treatment.
6. List any current medications you are taking, including the name, dosage, and frequency.
7. Include any relevant medical history or diagnoses that are important for the receiving healthcare provider to be aware of.
8. If you have any known allergies or sensitivities, make sure to note them on the form.
9. If applicable, provide information about any upcoming appointments or scheduled medical procedures.
10. Sign and date the form to certify the accuracy of the information provided.

Who needs continuity of care form:

1. Patients who are transitioning from one healthcare provider to another, such as switching primary care doctors or specialists.
2. Individuals who have recently relocated and need to transfer their medical information to a new provider.
3. Patients who require ongoing treatment or management of a chronic condition and want to ensure seamless care across different healthcare providers or facilities.

For pdfFiller’s FAQs

What is continuity of care form?

The continuity of care form is a document used to ensure smooth and uninterrupted healthcare services for patients who are transitioning between different healthcare providers or facilities.

Who is required to file continuity of care form?

The patients or their healthcare providers are typically required to fill out and file the continuity of care form when there is a need for a patient to transition to a new healthcare provider or facility.

How to fill out continuity of care form?

To fill out the continuity of care form, you typically need to provide details about the patient's medical history, current treatment plans, any ongoing conditions or illnesses, medication information, and contact details for both the previous and new healthcare providers or facilities.

What is the purpose of continuity of care form?

The purpose of the continuity of care form is to ensure that there is a clear and comprehensive transfer of medical information between healthcare providers or facilities, allowing for continuity and quality of care for the patient.

What information must be reported on continuity of care form?

The continuity of care form generally requires information about the patient's demographic details, medical conditions, medications, treatments, allergies, recent laboratory results, and contact information for both the previous and new healthcare providers.

How can I get continuity of care form?

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