Get the free CARE MANAGEMENT REFERRAL FORM - Arizona Medicare

CARE MANAGEMENT REFERRAL Format to:Banner network (480) 6552500All other networks (480) 6552544Phone:Banner network (602) 7477990All other networks (800) 4468331 option 3Email:Banner network: BHNPopHealthSpec

How to fill out care management referral form

How to fill out care management referral form

1. To fill out a care management referral form, follow these steps:
2. Start by providing the necessary contact information of the person being referred, such as their name, address, phone number, and email.
3. Next, include their demographic details, such as age, gender, and marital status.
4. Specify the reason for the referral, including the individual's current medical or mental health condition that necessitates care management.
5. Provide relevant medical history, including any known allergies, past surgeries, or ongoing treatments.
6. Include information about the individual's primary care physician or healthcare provider, if applicable.
7. If there are any additional healthcare professionals involved in the individual's care, mention their names and contact information.
8. Describe the individual's support network, including family members, friends, or other caregivers who are involved in their care.
9. Indicate any specific goals or outcomes the individual hopes to achieve through care management.
10. If the referral is coming from a healthcare provider, they may need to include their professional credentials and contact information.
11. Before submitting the form, review all the information provided for accuracy and completeness.
12. Submit the filled-out care management referral form through the designated channels, which may include mailing it to the relevant care management department or submitting it online through a secure portal.

Who needs care management referral form?

1. A care management referral form is typically needed for individuals who require coordinated care and support services.
2. This form is commonly used for individuals with complex medical or mental health conditions, chronic illnesses, or disabilities.
3. It is often required for individuals who would benefit from additional assistance in managing their healthcare needs, accessing community resources, or coordinating care between multiple healthcare providers.
4. Care management referral forms can be used by healthcare providers, social workers, case managers, or other professionals responsible for coordinating and advocating for individuals in need of care management services.

For pdfFiller’s FAQs

What is care management referral form?

Care management referral form is a document used to refer individuals to a care management program for assistance with their health and social needs.

Who is required to file care management referral form?

Healthcare providers, social workers, or other professionals involved in a patient's care may be required to file a care management referral form.

How to fill out care management referral form?

Care management referral forms can usually be filled out online or on paper, providing details about the patient's condition, needs, and contact information.

What is the purpose of care management referral form?

The purpose of care management referral form is to connect individuals to the appropriate resources and support services to address their healthcare and social needs.

What information must be reported on care management referral form?

Information such as patient demographics, medical history, current health status, care needs, and contact details are typically reported on a care management referral form.

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