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PHYSICIAN SELECTION / CHANGE FORM One of the advantages of being a Group Health Cooperative or Group Health Options, Inc. member is that you get to choose your own personal physician. Doing so is

How to fill out physician selection change form

How to Fill Out Physician Selection Change Form?

1. Begin by gathering all the necessary information: You will need the current physician's name and information, as well as the name and information of the new physician you wish to select. Make sure to have your personal details handy as well, such as your name, contact information, and any relevant identification numbers.
2. Obtain the form: You can usually obtain the physician selection change form from your healthcare provider's office or website. If it is not readily available, you can contact the provider's customer service department for assistance.
3. Read the instructions carefully: Before filling out the form, take the time to read and understand the instructions provided. This will ensure that you provide all the necessary information and complete the form correctly. If you have any questions, do not hesitate to reach out to your healthcare provider for clarification.
4. Provide personal information: Start by filling in your personal information accurately. This may include your full name, date of birth, address, phone number, and any other requested details. Double-check for errors before proceeding.
5. Indicate the current physician: Provide the information of your current physician in the designated section of the form. This typically includes their name, contact information, and any other details required.
6. Select the new physician: In the appropriate section, input the name and information of the healthcare professional you wish to select as your new physician. Include their full name, practice or clinic name, contact details, and any other relevant information.
7. Sign and date the form: Once you have filled out all the necessary sections, carefully review the form to ensure accuracy. Sign and date the form as indicated, confirming that the information provided is true and accurate to the best of your knowledge.

Who needs physician selection change form?

1. Individuals who wish to change their current physician: If you are no longer satisfied with your current physician or if you have moved to a new area and need to find a new healthcare provider, you may need to fill out a physician selection change form. This form allows you to inform your healthcare provider of your decision and provide the necessary information regarding your new physician.
2. Patients who have experienced a change in their healthcare coverage: In some cases, changes in healthcare coverage plans may require individuals to switch their primary care physician. If your insurance plan no longer covers your current physician or if you have switched insurance providers, you may need to complete a physician selection change form to update your healthcare provider's records.
3. Individuals who are joining a new healthcare network: If you are joining a new healthcare network or enrolling in a different medical group, you may be required to select a new primary care physician. By completing a physician selection change form, you can inform your new healthcare network of your preferred physician and ensure a smooth transition of your medical records.

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What is physician selection change form?

The physician selection change form is a document used to update the chosen physician or medical provider for healthcare services.

Who is required to file physician selection change form?

Any individual who wishes to change their selected physician or medical provider for healthcare services must file the physician selection change form.

How to fill out physician selection change form?

To fill out the physician selection change form, individuals must provide their personal information, current physician details, and new physician details, if applicable.

What is the purpose of physician selection change form?

The purpose of the physician selection change form is to ensure accurate and up-to-date records of selected healthcare providers for individuals.

What information must be reported on physician selection change form?

The physician selection change form requires personal information of the individual, current physician details, and new physician details, if applicable.