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Case Management/Care Coordination Referral Form
MOLINA HEALTHCARE CASE MANAGEMENT
Molina Healthcare Case Managers are available to provide information and assist members to navigate the care
system
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How to fill out case managementcare coordination referral
How to fill out case managementcare coordination referral
01
Step 1: Obtain the case management/care coordination referral form.
02
Step 2: Fill in the patient's personal information, including name, address, and contact details.
03
Step 3: Provide the patient's medical history, including any diagnosed conditions, medications, and allergies.
04
Step 4: Specify the reason for the referral and the desired outcome or goal.
05
Step 5: Include any relevant supporting documentation, such as test results or medical reports.
06
Step 6: Complete any additional sections or requirements specified by the referring party.
07
Step 7: Double-check the referral form for any errors or missing information.
08
Step 8: Submit the completed referral form to the designated recipient or agency.
Who needs case managementcare coordination referral?
01
Patients with complex medical conditions requiring coordinated care from multiple healthcare providers.
02
Patients who are transitioning between different healthcare settings, such as from hospital to home or from one specialty to another.
03
Patients with chronic illnesses that require ongoing monitoring and management.
04
Patients who could benefit from assistance in accessing healthcare services, resources, and support.
05
Patients who require coordination and collaboration among various healthcare professionals to ensure continuity of care.
06
Patients who need help navigating the healthcare system and understanding their treatment options.
07
Patients who would benefit from comprehensive assessment, planning, and implementation of care plans.
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What is case managementcare coordination referral?
Case management/care coordination referral is a process where individuals are referred to services or resources to help them manage their health and social needs.
Who is required to file case managementcare coordination referral?
Healthcare providers, social workers, or other professionals involved in a person's care may be required to file the referral.
How to fill out case managementcare coordination referral?
The referral form typically requires information about the individual's needs, current health status, and desired outcomes.
What is the purpose of case managementcare coordination referral?
The purpose is to ensure that individuals receive appropriate care and support to help them manage their health and social needs.
What information must be reported on case managementcare coordination referral?
Information such as the individual's medical history, current medications, and any existing support services may need to be reported.
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