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Franklin County PCP Change Form Attention: Ann Stone or Lottie Jones Fax: 919-496-8137 Phone: 919-496-5721 Re: PCP change for CA Medicaid OR Health Choice Date: Patient name: DOB: Medicaid ID number/Health
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How to fill out franklin county pcp change

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How to fill out Franklin County PCP change:

01
Start by obtaining the necessary form for the Franklin County PCP change. This form can usually be found on the official website of Franklin County or obtained from the county office.
02
Carefully read the instructions provided on the form to understand the requirements and process involved in filling it out.
03
Begin by entering your personal information, such as your full name, address, contact details, and any other required identifiers.
04
If applicable, indicate your current PCP (Primary Care Physician) details, including their name, address, and contact information.
05
Mention the reason for the PCP change in the designated section, providing a brief explanation or any additional details required.
06
Include the name and contact information of your preferred new PCP in the appropriate section.
07
Sign and date the form at the designated areas to acknowledge your consent and agreement.
08
Review the completed form to ensure all the necessary information has been accurately provided.
09
Make a copy of the form for your personal records before submitting it to the specified address or office.
10
Wait for the confirmation or response from Franklin County regarding your PCP change request.

Who needs Franklin County PCP change:

01
Individuals residing in Franklin County, who wish to switch their Primary Care Physician to a new provider.
02
Those who are dissatisfied with their current PCP and would like to establish care with a different doctor within Franklin County.
03
Individuals who have relocated to Franklin County and need to transfer their healthcare to a local Primary Care Physician.
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Franklin County PCP change refers to updating Primary Care Provider information for healthcare services in Franklin County.
Individuals enrolled in a healthcare plan that requires notification of PCP changes are required to file Franklin County PCP change.
Franklin County PCP change can typically be filled out online through the healthcare provider's portal or by contacting the insurance company directly.
The purpose of Franklin County PCP change is to ensure that accurate Primary Care Provider information is on file for individuals seeking healthcare services.
Information such as the new PCP's name, contact information, and any relevant identification numbers must be reported on Franklin County PCP change form.
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