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Kaiser Permanent Insurance CompanyEGeorgiaSA
MPLOutofArea Preferred Provider OrganizationEPLSA
NONDISCRIMINATION NOTICE
Kaiser Permanent Insurance Company (EPIC) complies with applicable federal civil
rights
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How to fill out getting care away from
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Step 1: Start by gathering all necessary paperwork and documentation related to the care you need away from.
02
Step 2: Fill out the personal information section with your name, address, contact information, and any other required details.
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Step 3: Provide information about the type of care you are seeking away from, including the specific services or treatments you require.
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Step 4: If applicable, include any details about your current healthcare provider or facility, such as their contact information or medical records.
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Step 5: Clearly state the reasons why you need care away from, including any medical conditions, limitations, or special circumstances.
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Step 6: Specify the duration and frequency of the care you are requesting away from, as well as any preferred locations or providers.
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Step 7: Review the completed form for accuracy and completeness, making sure all sections are filled out correctly.
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Step 8: Sign and date the form, indicating your consent and understanding of the information provided.
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Step 9: Submit the filled-out form through the designated method outlined in the instructions, such as by mail or online submission.
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Step 10: Keep a copy of the completed form for your records and follow up as necessary to ensure your request for care away from is processed.
Who needs getting care away from?
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Anyone who requires specialized medical or healthcare services that are not available locally may need to seek care away from.
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Individuals with complex medical conditions that require advanced treatments or procedures may also need to travel to access specialized care.
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Patients who have been referred to specific healthcare providers or facilities in other locations may need to receive care away from their usual area.
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Those seeking second opinions, experimental treatments, or participation in clinical trials may also need care away from.
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Additionally, individuals who require long-term care away from their homes due to disability, rehabilitation, or ongoing medical treatments may fall under this category.
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