Get the free Continuity of Care Request Form - Health Net

Continuity of Care Request Form Medical Plan: 18186766654 (fax) or 18186765161 (fax) Cal Disconnect Plan: 18669220783 (fax) Today's date: Form must be completed fully to avoid a processing delay.

How to fill out continuity of care request

How to fill out continuity of care request

1. To fill out a continuity of care request, follow these steps:
2. Contact your current healthcare provider and ask for a continuity of care form.
3. Fill out the form with your personal details, including your name, address, contact information, and healthcare provider information.
4. Provide a detailed explanation of why you need continuity of care, citing any ongoing medical conditions or treatments that require uninterrupted care.
5. Attach any relevant medical documents or records that support your request for continuity of care.
6. Submit the completed form along with the supporting documents to your current healthcare provider.
7. Follow up with your healthcare provider to ensure that your request has been processed and to receive confirmation of your continuity of care arrangement.

Who needs continuity of care request?

1. Anyone who is currently receiving medical treatment or has ongoing medical conditions that require consistent and uninterrupted care may need to fill out a continuity of care request. This includes individuals with chronic illnesses, pregnant women, individuals with disabilities, and those who recently underwent surgery or hospitalization.

For pdfFiller’s FAQs

How can I send continuity of care request to be eSigned by others?

To distribute your continuity of care request, simply send it to others and receive the eSigned document back instantly. Post or email a PDF that you've notarized online. Doing so requires never leaving your account.

How do I make changes in continuity of care request?

The editing procedure is simple with pdfFiller. Open your continuity of care request in the editor. You may also add photos, draw arrows and lines, insert sticky notes and text boxes, and more.

How do I fill out continuity of care request using my mobile device?

On your mobile device, use the pdfFiller mobile app to complete and sign continuity of care request. Visit our website (https://edit-pdf-ios-android.pdffiller.com/) to discover more about our mobile applications, the features you'll have access to, and how to get started.

What is continuity of care request?

Continuity of care request is a formal request made by a patient to continue receiving a particular treatment or seeing a specific healthcare provider despite changes in insurance coverage or network.

Who is required to file continuity of care request?

Patients who wish to continue seeing a particular healthcare provider or receiving a specific treatment that may not be covered under their new insurance plan are required to file continuity of care requests.

How to fill out continuity of care request?

Continuity of care requests can be filled out by contacting the insurance company's customer service department and requesting the necessary forms. The forms will typically require information about the patient, the current healthcare provider, the treatment being received, and the reason for the request.

What is the purpose of continuity of care request?

The purpose of continuity of care requests is to ensure that patients can continue receiving necessary treatment without interruption due to changes in insurance coverage or network.

What information must be reported on continuity of care request?

Information such as patient's details, current healthcare provider, treatment details, and the reason for the request must be reported on continuity of care request.