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Chronic Care Management Consent Form Your provider recommends you join a Chronic Care Management program. Your provider believes that you would benefit from a Chronic Care Management (CCM) program,

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How to fill out chronic care management consent

1. Gather all necessary documents such as patient's personal information, medical history, and contact information.
2. Explain the purpose and benefits of chronic care management to the patient.
3. Provide the consent form to the patient and ensure they fully understand its contents.
4. Have the patient read and review the consent form carefully.
5. Answer any questions or concerns the patient may have regarding the consent form.
6. Once the patient is ready, ask them to sign and date the consent form.
7. Make a copy of the signed consent form for your records.
8. Ensure the patient receives a copy of the signed consent form as well.
9. Store the consent form securely and keep it readily accessible for future reference.
10. Inform the patient that they have the right to revoke their consent at any time and provide them with the necessary information on how to do so.

Who needs chronic care management consent?

1. Patients who have been diagnosed with chronic conditions such as diabetes, heart disease, or chronic pain.
2. Patients who require ongoing medical supervision and care.
3. Patients who are interested in receiving additional support and management of their chronic condition.
4. Patients who are eligible for chronic care management services as determined by their healthcare provider.
5. Patients who understand and agree to actively participate in chronic care management services.
6. Patients who wish to benefit from the coordination of their healthcare services and improved communication with their healthcare team.

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