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Continuity of Care Form (For Colorado and Nevada use only) To help ensure that your care is not disrupted, please complete the entire form below. Only complete this form if you are receiving ongoing

How to fill out continuity of care form

How to fill out a continuity of care form:

1. Start by filling out your personal information. This includes your full name, address, phone number, date of birth, and any other relevant contact information.
2. Next, provide your primary care physician's details. This includes their name, address, phone number, and any other necessary contact information. Make sure you accurately fill in this information to ensure proper continuity of care.
3. Indicate any specialists or healthcare providers that you regularly visit. This includes their name, specialty, contact information, and the frequency of your visits. It's crucial to include all relevant healthcare professionals to ensure seamless coordination of care.
4. If you have any medical conditions, allergies, or medications, provide complete and accurate information. This includes the name of the condition or allergies, the medications you're taking, the dosage, and any special instructions.
5. Include any upcoming appointments or procedures that you have scheduled. This information helps to provide a complete picture of your healthcare needs and ensures that proper arrangements are made for your upcoming visits.

Who needs a continuity of care form?

1. Patients who are transitioning between healthcare providers or facilities. This could be due to a change in insurance, relocation, or any other reason that requires a switch in healthcare providers.
2. Individuals with complex medical conditions who require ongoing care from multiple healthcare professionals. A continuity of care form helps to ensure that all providers are aware of the patient's medical history and can coordinate care effectively.
3. Patients who are being discharged from a hospital or other healthcare facility. A continuity of care form helps to provide comprehensive information about the patient's condition, treatment plan, medications, and any other relevant details to ensure a smooth transition from hospital to home care.

In summary, a continuity of care form should be filled out accurately and thoroughly to provide complete information about your personal details, healthcare providers, medical conditions, appointments, and any other relevant information. This form is typically needed by patients transitioning between healthcare providers or facilities, individuals with complex medical conditions, and patients being discharged from a healthcare facility.

For pdfFiller’s FAQs

What is continuity of care form?

Continuity of care form is a document that outlines the ongoing medical treatment and services provided to a patient.

Who is required to file continuity of care form?

Healthcare providers and facilities are required to file continuity of care forms for their patients.

How to fill out continuity of care form?

The continuity of care form must be filled out with detailed information about the patient's medical history, current treatment plan, and any recommendations for future care.

What is the purpose of continuity of care form?

The purpose of continuity of care form is to ensure that patients receive proper and consistent medical care as they transition between different healthcare providers or facilities.

What information must be reported on continuity of care form?

Information such as patient demographics, medical history, medications, treatment plans, and any recent tests or procedures must be reported on continuity of care form.

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