Get the free Transition of Care Form - Coventry Health Care of Kansas

Attached please find the Transition of Care Form. This form, once completed, will help transition your care to your new network and help identify whether preauthorization is needed for a medical service.

How to fill out transition of care form

How to fill out a transition of care form:

1. Collect all necessary personal information: Begin by gathering the patient's full name, date of birth, address, contact information (phone number, email), and insurance details.
2. Document the current medical history: Include the patient's past diagnoses, current medications, allergies, and any ongoing treatments or therapies.
3. Provide details about the referring healthcare provider: Record the name, address, phone number, and any other relevant information about the healthcare professional or facility referring the patient for further care.
4. Include information about the receiving healthcare provider: Fill in the details of the healthcare provider or facility where the patient will be transitioning to, including name, address, phone number, and any specific instructions or preferences they may have.
5. Document the reason for the transition: Explain why the patient is being referred or transferred to another healthcare provider. Include any relevant medical conditions, concerns, or treatment goals.
6. Provide a detailed summary of the patient's current condition: Describe the symptoms, test results, or any relevant medical history that led to the decision to transfer care.
7. Include information about ongoing treatments and medications: List all current medications, dosages, and schedules, as well as any upcoming or ongoing treatments such as surgeries, therapies, or procedures.
8. Add any additional relevant medical documents: Attach copies of any test results, imaging scans, laboratory reports, or other relevant medical records that may be necessary for the receiving healthcare provider.
9. Obtain necessary signatures and consents: Ensure that all required signatures are obtained from the patient or their legal representative, acknowledging the transfer of care and releasing relevant medical information.
10. Keep a copy for your records: Make a copy of the completed form for your files and securely transmit the original to the receiving healthcare provider.

Who needs a transition of care form?

1. Patients transitioning to a new healthcare provider: Individuals who are moving their care from one healthcare professional or facility to another may need a transition of care form. This can include referrals from primary care doctors to specialists, transfers from hospitals to rehabilitation centers, or any other circumstances where a patient's ongoing care is being transferred.
2. Healthcare professionals and facilities involved in the transition: Both the referring healthcare provider and the receiving healthcare provider need access to the patient's medical information. The transition of care form ensures that all necessary information is accurately and securely transferred between providers, enabling continuity of care and proper coordination of treatment plans.

For pdfFiller’s FAQs

What is transition of care form?

Transition of care form is a document that is used to facilitate the transfer of a patient's care from one healthcare setting to another, ensuring continuity and coordination of care.

Who is required to file transition of care form?

Healthcare providers, including hospitals, clinics, and long-term care facilities, are generally required to file the transition of care form when transferring a patient's care.

How to fill out transition of care form?

The specific instructions for filling out the transition of care form may vary depending on the healthcare provider and the form used. Generally, it requires providing information about the patient's current condition, medical history, medications, and any specific care instructions for the receiving healthcare provider.

What is the purpose of transition of care form?

The purpose of the transition of care form is to ensure that critical patient information is accurately and efficiently transferred between healthcare settings, allowing for the continuation of safe and effective care.

What information must be reported on transition of care form?

The transition of care form typically includes information such as the patient's demographic data, medical diagnoses, current medications, allergies, recent test results, treatment plans, and any relevant discharge summaries or care plans.

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