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Transition Coverage Request Personal and confidential ECHO Category TURF This form applies to fully insured commercial Traditional (non-HMO) members in California. On the other side of this form,

How to fill out transition of care form

How to fill out transition of care form:

1. Start by gathering all relevant medical information and documents, including discharge summaries, medication lists, and test results.
2. Review the transition of care form carefully to understand the specific information it requires and any instructions provided.
3. Fill in personal details such as your name, date of birth, contact information, and insurance information.
4. Provide details about your primary care physician or healthcare provider, including their name, contact information, and any other relevant information.
5. Fill in details about your recent hospitalization or healthcare facility stay, including the dates, name of the facility, and reason for hospitalization.
6. Include information about any surgeries, procedures, or tests you underwent during the hospitalization or healthcare facility stay.
7. Provide a comprehensive list of all medications you are currently taking, including the name, dosage, frequency, and any specific instructions.
8. Mention any allergies or sensitivities you have to medications, food, or other substances.
9. Include information about any chronic conditions or health concerns you have and any recent changes in your health status.
10. Sign and date the transition of care form to verify the accuracy and completeness of the information provided.

Who needs transition of care form:

1. Patients who have been recently hospitalized or received care in a healthcare facility and are transitioning to another setting, such as home or another healthcare facility.
2. Individuals who have undergone surgery or a medical procedure and require follow-up care.
3. Patients with chronic conditions or complex medical needs who are transitioning between healthcare providers or settings.
4. Older adults or individuals with multiple healthcare providers who need to ensure the coordination of care and communication among their healthcare team.
5. Individuals who are being discharged from a mental health facility and require ongoing psychiatric or counseling services.
6. Patients who are transitioning from pediatric to adult healthcare services.
7. Anyone who wants to ensure that their medical information, treatment plan, and medication details are accurately communicated to their healthcare providers for continuity of care.

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