Get the free Care Coordination Referral Form - okhca.org

HCA Approved 04/30/2019Care Coordination Referral Form Phone 18772526002 Fax 14055303217Referral by: Phone: Referral date: Referral Source Primary Care ProviderCaseworker/DC plannerSpecialty ProviderCommunity

How to fill out care coordination referral form

How to fill out care coordination referral form

1. Start by obtaining a copy of the care coordination referral form.
2. Read the instructions and guidelines provided with the form to understand the requirements.
3. Fill in the patient's personal information section, including their name, contact details, and date of birth.
4. Provide the details of the referring healthcare provider, including their name, contact information, and provider ID.
5. Describe the reason for the referral in detail, including any relevant medical information or diagnoses.
6. Indicate the specific services or specialties required for the patient's care coordination.
7. Attach any necessary supporting documentation or medical records to the referral form.
8. Review the completed form for accuracy and completeness.
9. Submit the care coordination referral form to the designated recipient, following the specified submission method.
10. Keep a copy of the referral form for your records.

Who needs care coordination referral form?

1. Any healthcare provider who wishes to refer a patient for care coordination may need to fill out a care coordination referral form. This form is often used when coordinating care between multiple healthcare providers or transferring a patient to a different healthcare facility. It helps ensure that all relevant information is communicated effectively and that the patient's care needs are appropriately addressed.

For pdfFiller’s FAQs

What is care coordination referral form?

The care coordination referral form is a document used to refer a patient to different healthcare providers in order to coordinate care for the patient.

Who is required to file care coordination referral form?

Healthcare providers, such as doctors or social workers, are required to file the care coordination referral form for their patients.

How to fill out care coordination referral form?

The care coordination referral form can be filled out by providing the patient's information, medical history, current healthcare needs, and desired outcomes.

What is the purpose of care coordination referral form?

The purpose of the care coordination referral form is to ensure seamless communication and coordination among healthcare providers involved in a patient's care.

What information must be reported on care coordination referral form?

The care coordination referral form must include the patient's name, contact information, medical conditions, current medications, and treatment plan.

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