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EMPOWERING MINDS RESOURCE CENTERRevised 3/29/17TARGETED CASE MANAGEMENT REFERRAL FORM Date of Referral:DEMOGRAPHIC INFORMATION Address: City: Zip Code: State:Youth Name: Youth Phone: Cell Phone: M/Gender: DOB:MA×Parent/Legal

How to fill out cco referral final 6-11-15

How to fill out cco referral final 6-11-15

1. To fill out the CCO referral form, follow these steps: 1. Gather all relevant information about the person requiring the referral, including their name, contact information, and any specific concerns or conditions.
2. Identify the appropriate CCO provider for the individual. This may involve researching different CCOs in the area and determining which one best meets the person's needs.
3. Obtain a copy of the CCO referral form. This form can usually be obtained from the CCO provider directly, or it may be available on their website.
4. Carefully fill out all sections of the referral form. Ensure that all required fields are completed accurately and thoroughly.
5. Attach any supporting documentation or relevant medical records to the referral form, if necessary. This may include lab results, diagnostic reports, or previous treatment records.
6. Review the completed referral form to ensure all information is accurate and complete. Double-check for any errors or missing details.
7. Submit the referral form to the designated contact at the chosen CCO provider. This may be done in person, by mail, or electronically, depending on the provider's preferred method of submission.
8. Follow up with the CCO provider to confirm receipt of the referral and to inquire about any additional steps or documentation required.
9. Keep a copy of the referral form and any supporting documentation for your own records.
10. If necessary, advocate for the person requiring the referral throughout the referral process, including following up with the CCO provider if there are delays or concerns.
11. Once the referral is approved, provide the person requiring the referral with all necessary details and instructions for accessing CCO services.

Who needs cco referral final 6-11-15?

1. Anyone who meets the eligibility criteria for CCO services may need a CCO referral. The specific eligibility requirements may vary depending on the region and the specific CCO provider. Generally, individuals who require specialized medical care, ongoing treatment, or coordination of multiple healthcare services may benefit from a CCO referral. This may include individuals with chronic conditions, complex medical needs, or those who require a higher level of care and support. It is best to consult with a healthcare professional or the chosen CCO provider to determine if a referral is necessary for a particular individual.

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What is cco referral final 6-11-15?

CCO referral final 6-11-15 is a document used to refer patients to a Coordinated Care Organization (CCO) for healthcare services.

Who is required to file cco referral final 6-11-15?

Healthcare providers and organizations are required to file CCO referral final 6-11-15 for their patients.

How to fill out cco referral final 6-11-15?

To fill out CCO referral final 6-11-15, providers need to include patient information, reason for referral, and any relevant medical records.

What is the purpose of cco referral final 6-11-15?

The purpose of CCO referral final 6-11-15 is to ensure patients receive appropriate care and services through a Coordinated Care Organization.

What information must be reported on cco referral final 6-11-15?

Information such as patient demographics, medical history, reason for referral, and provider details must be reported on CCO referral final 6-11-15.