Get the free Continuation of Care Form

This form is used to request continuation of care benefits for individuals receiving ongoing treatment for certain acute medical or chronic conditions, allowing them to continue care with a non-network

How to fill out continuation of care form

How to fill out Continuation of Care Form

1. Start with patient identification: Fill in the patient's name, date of birth, and contact information.
2. Include the primary care physician's details: Write down the physician's name, practice location, and contact number.
3. List the patient's medical history: Summarize relevant medical conditions, surgeries, allergies, and medications.
4. Document the reason for the transfer or referral: Provide a clear explanation of why the Continuation of Care Form is necessary.
5. Fill out the section for current treatments: Note any ongoing treatments or therapies the patient is undergoing.
6. Include supporting documents: Attach any relevant lab results, imaging studies, or other documentation that might assist in continuity of care.
7. Sign and date the form: Ensure that the form is signed by the appropriate parties indicating consent and acknowledgment.

Who needs Continuation of Care Form?

1. Patients transitioning from one healthcare provider to another.
2. Individuals moving to a different level of care, such as hospital discharge to outpatient services.
3. Patients requiring specialized care from a different provider for specific medical conditions.
4. Caregivers or family members managing a patient's health during transitions.
5. Healthcare providers needing to share patient information securely for continuity of treatment.

People Also Ask about

What does continuity mean in care?

What is Continuity of care? Continuity of care means seeing the same doctor or healthcare professional consistently, so they get to know you, your health history, and your preferences. It helps to build trust and improve the quality of your care.

What is a cont of care?

Continuity of care is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.

What are examples of continuity of care?

› Patients who are considered to be a “continuing care patient”, are defined as follows: – Undergoing a course of treatment or surgery for a serious and complex condition[2]from the provider or facility; – Undergoing a course of institutional or inpatient care from the provider or facility; – Scheduled to undergo a non

What is the purpose of a continuity of care document?

Continuity of Care Documents (CCDs) are standardized electronic documents designed to summarize a patient's health information to facilitate seamless communication and coordination among healthcare providers during transitions of care.

How to provide continuity of care?

Ensuring effective care transitions Simple practices like using clear notes, consistent documentation and regular check-ins between care professionals all help to ensure that crucial details are not lost in the shuffle, so the care journey maintains continuity, even when there's a change in care provider.

What are some examples of continuity?

The polynomial functions, exponential functions, graphs of sin x and cos x are examples of a continuous function over the set of all real numbers.

What is an example of continuity of care?

An example of continuity of care is a patient consistently seeing the same primary care physician who monitors their health over several years.

For pdfFiller’s FAQs

What is Continuation of Care Form?

The Continuation of Care Form is a document used in healthcare to facilitate the smooth transition of patients from one care setting to another, ensuring that essential information about the patient’s care and treatment is communicated effectively.

Who is required to file Continuation of Care Form?

Healthcare providers, including hospitals, clinics, and physicians, are typically required to file the Continuation of Care Form when a patient is referred to another provider or is discharged from a healthcare facility.

How to fill out Continuation of Care Form?

To fill out the Continuation of Care Form, the provider needs to gather relevant patient information, including medical history, treatment plans, and medications. They should complete all sections clearly and accurately, ensuring that the form is signed and dated before submitting it to the receiving provider.

What is the purpose of Continuation of Care Form?

The purpose of the Continuation of Care Form is to ensure continuity of care by providing detailed information about a patient’s healthcare needs, treatment history, and ongoing care requirements, facilitating better communication among healthcare providers.

What information must be reported on Continuation of Care Form?

The information that must be reported on the Continuation of Care Form includes the patient's personal details, medical history, diagnoses, current medications, treatment plans, allergies, and any special considerations that the receiving provider should be aware of.