Get the free HealthCare Transition of Care/Continuity of Care Request Form

This document outlines the process and requirements for applying for Transition of Care or Continuity of Care under CIGNA Health Care, including eligibility criteria and examples of qualifying conditions.

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How to fill out HealthCare Transition of Care/Continuity of Care Request Form

1. Obtain the HealthCare Transition of Care/Continuity of Care Request Form from your healthcare provider or online.
2. Fill out your personal information at the top of the form, including your name, date of birth, and contact information.
3. Specify the type of care transition or continuity of care you are requesting.
4. Provide details about your current healthcare providers and the services you are receiving.
5. Enter the information for the new healthcare provider you wish to transition to, including their name, address, and contact number.
6. Indicate the reason for the transition of care or request for continuity of care.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form to authorize the request.
9. Submit the form to your current healthcare provider or the designated office as instructed.

Who needs HealthCare Transition of Care/Continuity of Care Request Form?

1. Patients who are changing healthcare providers.
2. Individuals transitioning from one care setting to another, such as from hospital to home.
3. Persons requiring ongoing care that needs to be maintained during a transition.
4. Caregivers or family members managing the care of patients who need continuity.

For pdfFiller’s FAQs

What is HealthCare Transition of Care/Continuity of Care Request Form?

The HealthCare Transition of Care/Continuity of Care Request Form is a document used by healthcare providers to ensure a seamless transition of care for patients between different settings or levels of care. It facilitates the sharing of crucial patient information among providers to maintain continuity in treatment.

Who is required to file HealthCare Transition of Care/Continuity of Care Request Form?

Healthcare providers, including physicians, nurses, and other clinical staff involved in a patient's care, are typically required to file the Transition of Care/Continuity of Care Request Form when transferring a patient to another healthcare setting or provider.

How to fill out HealthCare Transition of Care/Continuity of Care Request Form?

To fill out the form, start by collecting the necessary patient information such as demographics, medical history, and current treatments. Include details about the reason for the transition, summary of care, and any follow-up appointments. Ensure all sections are completed accurately and sign where required.

What is the purpose of HealthCare Transition of Care/Continuity of Care Request Form?

The purpose of the form is to ensure that all relevant health information is communicated effectively during a transition of care, thereby reducing the risk of errors and improving patient outcomes by providing continuous care without interruption.

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

The information that must be reported includes patient identity details, contact information, medical history, medications, allergies, the reason for the transition, and a summary of care provided, as well as any special instructions for the receiving provider.