Form preview

Get the free Transfer of Attending Provider template

Get Form
Department of Labor and Industries Self InsuranceTransfer of Attending Provider Form for Reinsured WorkersClaim No. Employer Date that I changed health care providers: Beginning January 1, 2013, you
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign transfer of attending provider

Edit
Edit your transfer of attending provider form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your transfer of attending provider form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit transfer of attending provider online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Set up an account. If you are a new user, click Start Free Trial and establish a profile.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit transfer of attending provider. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
pdfFiller makes dealing with documents a breeze. Create an account to find out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out transfer of attending provider

Illustration

How to fill out transfer of attending provider

01
Start by gathering all the necessary information such as the patient's personal details, medical history, and current attending provider's information.
02
Begin filling out the transfer of attending provider form by entering the patient's full name, date of birth, address, and contact information.
03
Specify the reason for transferring the attending provider and provide any relevant details or medical records.
04
Include the current attending provider's name, contact information, and any additional details that may be required.
05
Provide the name, contact information, and any supporting documentation of the new attending provider.
06
Review the completed form for accuracy and completeness.
07
Submit the transfer of attending provider form to the appropriate healthcare authority or institution.

Who needs transfer of attending provider?

01
Patients who wish to change their current attending provider.
02
Patients who are moving to a new location and need to transfer their care to a new provider in that area.
03
Patients who are dissatisfied with their current attending provider's care and want to switch to someone else.
04
Patients who require specialized care that is not available with their current attending provider.

What is Transfer of Attending Provider Form?

The Transfer of Attending Provider is a fillable form in MS Word extension that should be submitted to the required address to provide certain information. It needs to be completed and signed, which may be done in hard copy, or with the help of a certain software such as PDFfiller. It lets you complete any PDF or Word document directly in your browser, customize it depending on your purposes and put a legally-binding e-signature. Right away after completion, the user can easily send the Transfer of Attending Provider to the relevant person, or multiple recipients via email or fax. The blank is printable as well due to PDFfiller feature and options proposed for printing out adjustment. Both in digital and physical appearance, your form should have a neat and professional outlook. Also you can save it as the template for later, there's no need to create a new document again. You need just to customize the ready document.

Template Transfer of Attending Provider instructions

Before filling out Transfer of Attending Provider .doc form, remember to prepared all the information required. It's a very important part, because errors can cause unpleasant consequences beginning from re-submission of the whole word form and finishing with missing deadlines and even penalties. You need to be especially careful when working with digits. At a glimpse, this task seems to be quite easy. But nevertheless, it is simple to make a mistake. Some people use some sort of a lifehack saving everything in a separate file or a record book and then attach this information into documents' sample. However, put your best with all efforts and present true and correct data in Transfer of Attending Provider form, and doublecheck it during the process of filling out the required fields. If it appears that some mistakes still persist, you can easily make corrections while using PDFfiller editor without missing deadlines.

How should you fill out the Transfer of Attending Provider template

To be able to start completing the form Transfer of Attending Provider, you will need a blank. If you use PDFfiller for completion and submitting, you can obtain it in several ways:

  • Find the Transfer of Attending Provider form in PDFfiller’s filebase.
  • You can also upload the template from your device in Word or PDF format.
  • Create the writable document to meet your specific purposes in creator tool adding all required objects in the editor.

No matter what option you choose, you will get all the editing tools for your use. The difference is that the Word form from the archive contains the valid fillable fields, you should add them by yourself in the second and third options. However, it is dead simple and makes your sample really convenient to fill out. The fields can be placed on the pages, you can delete them too. There are different types of those fields based on their functions, whether you're typing in text, date, or put checkmarks. There is also a electronic signature field if you need the word file to be signed by other people. You are able to sign it by yourself via signing tool. Once you're good, all you need to do is press the Done button and move to the distribution of the form.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.2
Satisfied
58 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Easy online transfer of attending provider completion using pdfFiller. Also, it allows you to legally eSign your form and change original PDF material. Create a free account and manage documents online.
Create, edit, and share transfer of attending provider from your iOS smartphone with the pdfFiller mobile app. Installing it from the Apple Store takes only a few seconds. You may take advantage of a free trial and select a subscription that meets your needs.
Use the pdfFiller Android app to finish your transfer of attending provider and other documents on your Android phone. The app has all the features you need to manage your documents, like editing content, eSigning, annotating, sharing files, and more. At any time, as long as there is an internet connection.
Transfer of attending provider refers to the process of changing the healthcare provider responsible for a patient's care.
The attending provider or the healthcare facility where the patient is receiving care is required to file the transfer of attending provider.
To fill out the transfer of attending provider, the attending provider must complete a form provided by the healthcare facility with the necessary patient information and the details of the new attending provider.
The purpose of transfer of attending provider is to ensure continuity of care for the patient and to inform all relevant parties about the change in healthcare provider.
The transfer of attending provider form must include the patient's name, date of birth, current provider, new provider, effective date of transfer, reason for transfer, and any other relevant information.
Fill out your transfer of attending provider online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.