Get the free REQUEST FOR CONTINUATION OF CARE

This form is a request to continue care with a non-network provider and to receive in-network reimbursement levels. It must be completed by the patient and their attending physician and submitted

How to fill out request for continuation of

How to fill out REQUEST FOR CONTINUATION OF CARE

1. Obtain the REQUEST FOR CONTINUATION OF CARE form from your healthcare provider or the relevant organization.
2. Fill in your personal details, including your full name, date of birth, and contact information.
3. Provide the details of your current healthcare provider, including their name, address, and phone number.
4. Indicate the reason for requesting continuation of care, specifying any ongoing treatments or medications.
5. Include information about your previous care, such as dates of service and any relevant medical history.
6. Sign and date the form to confirm the information provided is accurate.
7. Submit the completed form to your healthcare provider or the organization handling your case.

Who needs REQUEST FOR CONTINUATION OF CARE?

1. Individuals who are currently receiving medical treatment and require ongoing support or care.
2. Patients transitioning between healthcare providers who need to ensure continuity of their medical care.
3. People moving to a new location and need to maintain their healthcare services without interruption.
4. Those who have chronic conditions that necessitate ongoing medical attention.

For pdfFiller’s FAQs

What is REQUEST FOR CONTINUATION OF CARE?

REQUEST FOR CONTINUATION OF CARE is a formal request made by a healthcare provider or patient to ensure that ongoing medical services and support are provided after a transition in care, such as a discharge from a hospital or transfer between healthcare facilities.

Who is required to file REQUEST FOR CONTINUATION OF CARE?

Typically, the healthcare provider responsible for the patient's care, such as a physician or case manager, is required to file the REQUEST FOR CONTINUATION OF CARE. In some cases, patients may also initiate the request.

How to fill out REQUEST FOR CONTINUATION OF CARE?

To fill out a REQUEST FOR CONTINUATION OF CARE, you must complete the designated form, providing information such as patient details, current medical conditions, specific care needs, and any relevant medical history. It's important to ensure that all sections are thoroughly filled out and signed as required.

What is the purpose of REQUEST FOR CONTINUATION OF CARE?

The purpose of the REQUEST FOR CONTINUATION OF CARE is to facilitate seamless transitions in healthcare, ensuring that patients receive the necessary follow-up care, avoid gaps in treatment, and maintain continuity in their medical management.

What information must be reported on REQUEST FOR CONTINUATION OF CARE?

The information that must be reported on the REQUEST FOR CONTINUATION OF CARE includes patient identifiers, details about the current treatment plan, medical history, specific healthcare needs, and contact information for follow-up services.