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Please complete the information above the dotted line and return with your packet to the Children's Program. Do not send to other providers. Many managed care health insurance companies will require

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What is healthcare coordination form?

The healthcare coordination form is a document used to keep track of medical treatments and services provided to a patient by different healthcare providers.

Who is required to file healthcare coordination form?

Healthcare providers such as doctors, hospitals, and clinics are required to file healthcare coordination forms.

How to fill out healthcare coordination form?

Healthcare providers must accurately record all medical treatments and services provided to the patient, along with dates, locations, and other relevant information.

What is the purpose of healthcare coordination form?

The purpose of healthcare coordination form is to ensure that all healthcare providers are aware of the treatments and services received by a patient, in order to provide proper care and avoid duplication of services.

What information must be reported on healthcare coordination form?

The healthcare coordination form must include details of all medical treatments, services, and consultations received by the patient from different healthcare providers.

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