Get the free Disease Management Referral - Nebraska Total Care

2525 N. 117th Avenue Suite 100 Omaha, NE 68164Disease Management Referral Patient Name DOB Clinician Name Date Baseline PHQ9 Results History: New EpisodeEstablished Case Total Symptoms: Total Score:

How to fill out disease management referral

How to fill out disease management referral

1. Obtain the disease management referral form from the healthcare provider or insurance company.
2. Fill in the patient's personal information, such as name, date of birth, and contact information.
3. Specify the referring healthcare provider's name, contact information, and any relevant identification numbers.
4. Provide detailed information about the patient's medical condition, including the diagnosis, relevant medical history, and current symptoms.
5. Indicate the desired disease management program or specialist, if applicable.
6. Include any additional information or documentation that may be required, such as laboratory test results or medical records.
7. Review the completed referral form for accuracy and completeness.
8. Submit the filled-out referral form to the designated recipient, usually the disease management program coordinator or the insurance company.
9. Keep a copy of the referral form for your records.
10. Follow up with the healthcare provider or insurance company to ensure that the referral has been received and processed.

Who needs disease management referral?

1. Disease management referral is typically needed for patients who require specialized care and support for chronic or complex medical conditions.
2. Examples of individuals who may benefit from disease management referral include:
3. - Patients with chronic diseases such as diabetes, asthma, heart disease, or cancer.
4. - Individuals with multiple health conditions that require coordinated care and monitoring.
5. - Patients who have recently undergone surgery or a major medical procedure.
6. - Individuals who need assistance in managing their medication regimens.
7. - Patients with mental health conditions that require ongoing treatment and support.
8. - Individuals who are at high risk for developing certain medical conditions, such as genetic predispositions or lifestyle factors.

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What is disease management referral?

Disease management referral is a process where a healthcare provider refers a patient to a program or service that helps them manage their chronic condition or disease.

Who is required to file disease management referral?

Healthcare providers are required to file disease management referral for their patients who could benefit from additional support in managing their health conditions.

How to fill out disease management referral?

Disease management referral can be filled out by providing relevant patient information, medical history, current health condition, and the reason for the referral.

What is the purpose of disease management referral?

The purpose of disease management referral is to ensure that patients receive the necessary support and resources to effectively manage their chronic conditions or diseases.

What information must be reported on disease management referral?

Information such as patient demographics, medical history, current health status, and the reason for the referral must be reported on disease management referral.