Get the free Transition of Care Request Form - Moda Health

For internal use only Dept./ext. Transition of care request Patient name Date of birth (mm/dd/YYY) Date received ID no. Patient phone Provider/Physician Contact Provider/Physician phone Facility (if

How to fill out transition of care request

How to fill out a transition of care request:

1. Start by gathering all necessary information: To complete a transition of care request, you will need to collect relevant details about the patient, their current healthcare provider, and the desired new healthcare provider. This may include their personal information, medical history, insurance details, and any specific reasons or needs for the transition.
2. Contact the new healthcare provider: Reach out to the desired new healthcare provider and inform them about your intention to transfer care. Ask them if they have a specific form or process to follow for the transition of care request. They may provide you with a form to fill out or guide you through their preferred procedure.
3. Obtain the transition of care form: If the new healthcare provider has a specific form, make sure to acquire it. This form is usually designed to capture essential information about the patient's medical history, current treatment, and any other relevant details that will help facilitate a smooth transfer of care.
4. Complete the form accurately and thoroughly: Fill out the transition of care form diligently, ensuring that all required fields are properly completed. Be sure to provide accurate and up-to-date information, including any medications, allergies, and ongoing treatments or therapies. Clearly outline the reasons or needs for the transition of care to assist the new healthcare provider in understanding the patient's situation.
5. Attach any necessary documents: If there are any relevant medical documents that support the transition of care request, such as test results, X-rays, or other diagnostic records, make sure to include them. These additional documents can provide valuable insights into the patient's medical history and aid the new healthcare provider in delivering appropriate care.
6. Review and verify the information provided: Before submitting the transition of care request, carefully review all the information you have filled out. Ensure that there are no errors or omissions that could potentially impede the transfer process. Double-check contact details and supporting documents to avoid any confusion or delays.
7. Submit the completed request: Once you have confirmed that everything is accurate and all necessary elements are included, submit the transition of care request to the new healthcare provider. Follow any specific submission instructions provided by the healthcare facility or provider, such as mailing the form or dropping it off in person.

Who needs a transition of care request?

Transition of care requests can be applicable to various individuals who are seeking to transfer their healthcare from one provider to another. Some examples of those who may require a transition of care request include:

1. Patients who are moving to a new location: When individuals relocate or switch cities, they often need to find a new healthcare provider in their new area. A transition of care request is necessary to transfer their medical records and ensure continuity of care.
2. Individuals dissatisfied with current healthcare providers: Patients who are unsatisfied or unhappy with their current healthcare provider may wish to switch to a new one. By submitting a transition of care request, they can facilitate a smooth transfer and begin receiving care from a provider they feel more comfortable with.
3. Patients seeking specialized care: In situations where a patient requires specialized care that their current healthcare provider cannot offer, a transition of care request may be necessary. This allows them to be transferred to a healthcare provider or facility that can address their specific medical needs more effectively.

Remember, the specific circumstances that necessitate a transition of care request can vary between individuals. It is important to consult with the new healthcare provider and follow their guidance to ensure a successful transition.

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What is transition of care request?

A transition of care request is a formal process for transferring a patient's care from one healthcare provider to another.

Who is required to file transition of care request?

Both the sending provider and receiving provider are required to file a transition of care request.

How to fill out transition of care request?

Providers must provide detailed information about the patient's medical history, current medications, and treatment plan in the transition of care request form.

What is the purpose of transition of care request?

The purpose of the transition of care request is to ensure continuity of care for the patient and facilitate a smooth transfer of medical information between healthcare providers.

What information must be reported on transition of care request?

The transition of care request must include the patient's demographic information, medical history, current medications, treatment plan, and any relevant test results.