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Transition of Care Form
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Your health and wellbeing are important to us. If you or your covered dependent(s) have an unstable or serious
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How to fill out transition of care form
How to fill out transition of care form
01
To fill out a transition of care form, follow the steps below:
1. Start by filling in the patient's personal information, such as name, date of birth, and contact details.
02
Provide the details of the healthcare provider or facility that the patient is transitioning from, including their name, address, and contact information.
03
Fill in the information about the healthcare provider or facility that the patient is transitioning to. Include their name, address, and contact details.
04
Record the reason for the transition of care, such as a change in health condition or transfer to a different healthcare setting.
05
Document any medications the patient is currently taking, including the name, dosage, and frequency of each medication.
06
Mention any allergies or adverse reactions the patient may have to specific medications or substances.
07
Include a summary of the patient's current health status, including any diagnosed conditions or ongoing treatments.
08
Provide information about any recent diagnostic tests or procedures the patient has undergone.
09
Mention any ongoing medical equipment or assistive devices the patient requires.
10
Finally, review the completed form for accuracy and completeness before submitting it to the appropriate healthcare providers.
Who needs transition of care form?
01
The transition of care form can be useful for individuals who are transitioning from one healthcare provider or facility to another.
02
It is commonly used when patients are being discharged from a hospital and need to continue their care with another healthcare professional or facility.
03
Patients who are moving to a different city or state and require medical care in their new location may also need to fill out a transition of care form.
04
Additionally, individuals who are transferring from a primary care physician to a specialist or vice versa may be asked to complete this form to ensure a smooth transfer of their care.
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