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Primary Care Provider Change Form (Priority Partners) FOR PROVIDER USE ONLY6704 Curtis Court Glen Burnie, MD 21060Complete this form and fax to the Enrollment Department at 4107625218 or return by

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What is primary care provider change?

Primary care provider change is when a person switches or updates their primary care physician or medical provider.

Who is required to file primary care provider change?

Any individual who wishes to change their primary care provider is required to file a primary care provider change form.

How to fill out primary care provider change?

To fill out a primary care provider change form, individuals need to provide their current primary care provider information, as well as the new provider's contact details.

What is the purpose of primary care provider change?

The purpose of primary care provider change is to ensure that individuals receive medical care from a provider that best meets their needs and preferences.

What information must be reported on primary care provider change?

Information such as current primary care provider name, new provider name, contact information, and reason for the change must be reported on the primary care provider change form.

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