Get the free Continuity of Care Form - Memorial Hermann Health System

Continuity of Care Form Continuity of care will be issued under special circumstances to allow members to continue treatment with a nonplan provider(s) for a period of time following the date of enrollment. Please

How to fill out continuity of care form

How to fill out continuity of care form

1. Step 1: Gather all relevant medical records, including previous treatment plans, medications, test results, and any other important documents.
2. Step 2: Start by filling out personal information, such as your name, contact details, and date of birth.
3. Step 3: Provide details about your current healthcare provider, including their name, address, and contact information.
4. Step 4: Indicate the reason for requesting continuity of care and briefly explain your medical condition or health concerns.
5. Step 5: Describe the desired outcome of the continuity of care, such as ongoing medication management or continued treatment for a specific condition.
6. Step 6: Attach copies of relevant medical records, if required by the form.
7. Step 7: Review the completed form for accuracy and completeness.
8. Step 8: Sign and date the form to certify the information provided.
9. Step 9: Submit the form to the appropriate healthcare authority or organization as instructed, either in person, via mail, or online.
10. Step 10: Keep a copy of the completed form for your records.

Who needs continuity of care form?

1. The continuity of care form is needed by individuals who are switching healthcare providers, seeking specialized care from a different provider, or transitioning from one healthcare setting to another.
2. It is also required for individuals with complex medical conditions or chronic illnesses who need to ensure that their medical information and treatment plans are shared accurately between different healthcare providers.

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What is continuity of care form?

Continuity of care form is a document that ensures seamless healthcare services for patients transitioning between providers or facilities.

Who is required to file continuity of care form?

Healthcare providers, facilities, or organizations involved in a patient's care are required to file continuity of care form.

How to fill out continuity of care form?

The continuity of care form can be filled out by providing detailed information about the patient's medical history, current treatment plan, and any special instructions for continuity of care.

What is the purpose of continuity of care form?

The purpose of continuity of care form is to ensure that patients receive uninterrupted and coordinated healthcare services during transitions in their care.

What information must be reported on continuity of care form?

The continuity of care form should include patient demographics, medical history, current medications, treatment plan, allergies, and any special care instructions.