Get the free Clinic/pcp selection form - Community Health Plan of Washington
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CUSTOMER SERVICE: 1-800-440-1561 FAX: 206-652-7085 ATTN: ELIGIBILITY COORDINATOR PCP SELECTION FORM ? Healthy Options ? Basic Health ? CHIP ? Disability Lifeline ? Washington Health ? Medicare From
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How to fill out clinicpcp selection form
How to fill out clinicpcp selection form:
01
Start by carefully reading the instructions provided on the form. Make sure you understand what information is required and why.
02
Begin by entering your personal information accurately and completely. This may include your name, address, contact details, and any other relevant details requested.
03
Next, provide any necessary medical history information as requested. This could include previous diagnoses, current medications, allergies, and any other pertinent details.
04
Consider your preferences for your primary care physician (PCP). If the form asks for your preferred PCP, make sure to mention any specific requirements or requests you may have, such as location, gender preference, or language spoken.
05
If there is a section for insurance information, ensure that you provide all the necessary details accurately. This may include your insurance provider's name, ID number, and any additional information requested.
06
Review your filled-out form for any errors or omissions. Double-check for accuracy and completeness before submitting it.
07
Follow the instructions provided to submit the form. This may involve mailing it, faxing it, or submitting it online through a secure portal.
Who needs clinicpcp selection form?
01
Anyone seeking healthcare services from a medical clinic or facility may need to fill out a clinicpcp selection form.
02
Individuals who are new to the clinic or facility and do not have a designated primary care physician assigned may be required to fill out this form.
03
Existing patients who wish to change their primary care physician or update their preferences may also need to complete the clinicpcp selection form.
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