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PPO Member Request for Transitional Care Benefits and Release of Information
Please complete this form if you are currently receiving medical care from physician(s) that are not listed in your provider
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01
Start by making a list of all your healthcare providers, including doctors, specialists, and therapists.
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What is coordinating your medical care?
Coordinating your medical care involves ensuring that all healthcare providers involved in your treatment communicate and work together to provide the best possible care.
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The patient or their designated representative is typically required to file coordinating your medical care.
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To fill out coordinating your medical care, you will need to provide information about your healthcare providers, treatment plans, and any medications you are taking.
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The purpose of coordinating your medical care is to ensure that all aspects of your treatment are managed effectively and that you receive comprehensive care.
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Information such as your medical history, current medications, treatment plans, and contact information for healthcare providers must be reported on coordinating your medical care.
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