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Primary Care Provider Form
LARIMER COUNTY EMPLOYEE AND SPOUSE INSTRUCTIONS
If you were not able to receive a Catapult Health Preventive Checkup this year, you may have your Primary Care Provider
report
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What is primary care provider form?
The primary care provider form is a document that designates a healthcare provider as the main point of contact for a patient's medical care.
Who is required to file primary care provider form?
Patients are required to file the primary care provider form to designate their main healthcare provider.
How to fill out primary care provider form?
To fill out the primary care provider form, patients need to provide their personal information, insurance details, and the contact information of their chosen healthcare provider.
What is the purpose of primary care provider form?
The purpose of the primary care provider form is to ensure that patients have a designated healthcare provider overseeing their medical care.
What information must be reported on primary care provider form?
The primary care provider form must include the patient's name, date of birth, insurance information, and the contact information of their chosen healthcare provider.
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