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RESPIRATORY SYNOVIAL VIRUS (RSV) PROPHYLAXIS Fax completed form to: 888-466-2778 PATIENT INFORMATION Last Name Street Address Telephone (+Area Code) Date of Birth Parent/Guardian Include copies of
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How to fill out the tansition of care form:

01
Start by gathering all necessary information, such as the patient's personal details, medical history, and current medications.
02
Ensure that you have accurate information about the patient's previous healthcare provider and the new healthcare provider they will be transitioning to.
03
Fill out the form sections that require details about the patient's current health condition, any ongoing treatments, and any upcoming medical appointments or procedures.
04
Provide as much detail as possible regarding the patient's allergies, past surgeries, and any known medical conditions or chronic illnesses.
05
If applicable, include information about the patient's mental health, behavioral health, or substance abuse history.
06
Double-check all entries for accuracy and completeness before signing and dating the form.
07
Submit the filled-out tansition of care form to the appropriate healthcare office or facility.

Who needs the tansition of care form:

01
Individuals who are transitioning from one healthcare provider to another.
02
Patients who have been recently discharged from a hospital and need to transfer their care to another healthcare facility.
03
Patients who are switching primary care providers or seeking specialty care from a different clinic or hospital.
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The transition of care form is a document that is used to capture and communicate essential information when a patient moves from one healthcare setting to another, such as from a hospital to a nursing home or from a nursing home to home care.
Healthcare providers, such as hospitals, nursing homes, and home health agencies, are typically required to file the transition of care form when a patient is being transferred to their care.
The specific instructions for filling out the transition of care form may vary depending on the healthcare organization or system. Generally, the form will require information about the patient's medical history, current medications, treatment plans, and any special instructions for the receiving healthcare provider. It is important to accurately and comprehensively complete the form to ensure a smooth transition for the patient.
The purpose of the transition of care form is to provide continuity of care for the patient during the transfer process. It helps ensure that important medical information is communicated effectively between healthcare providers, reducing the risk of medical errors and improving patient outcomes.
The information that must be reported on the transition of care form typically includes the patient's demographic information, medical history, current medications, allergies, recent procedures or surgeries, discharge instructions, and any follow-up appointments or tests that are needed.
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