Get the free Care Coordination Referral Form- HSO - CareOregon

MemberConnections Case Management Referral Form Use this form to refer a Home State Health Plan (Home State) member to our Case Management Services. Date:___Member Name:___ ___ ___ ___MMS ID #:___

How to fill out care coordination referral form

How to fill out care coordination referral form

1. Gather all necessary information such as patient demographics, medical history, current medications, and insurance information.
2. Fill out the referral form completely and accurately, ensuring all required fields are completed.
3. Include any relevant supporting documentation such as test results, treatment plans, or other medical records.
4. Submit the completed referral form to the designated care coordination team or department.
5. Follow up with the care coordination team to ensure the referral is processed in a timely manner.

Who needs care coordination referral form?

1. Patients requiring complex medical care involving multiple providers
2. Patients transitioning between different levels of care (e.g. hospital to home)
3. Patients with chronic conditions requiring ongoing coordination of services
4. Patients with special needs or disabilities requiring additional support and resources

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What is care coordination referral form?

The care coordination referral form is a document used to refer patients to different healthcare providers or services to ensure they receive comprehensive and coordinated care.

Who is required to file care coordination referral form?

Healthcare providers, social workers, case managers, or other professionals involved in a patient's care may be required to file the care coordination referral form.

How to fill out care coordination referral form?

To fill out the care coordination referral form, one must provide detailed information about the patient's medical history, current condition, and the reason for the referral.

What is the purpose of care coordination referral form?

The purpose of the care coordination referral form is to facilitate communication and collaboration between healthcare providers to ensure the patient receives the appropriate care.

What information must be reported on care coordination referral form?

The care coordination referral form may require information such as patient demographics, medical history, current medications, test results, and the reason for the referral.