Get the free Care Coordination Referral Form (Health First Colorado Region 6)

Care Coordination Referral Form (Health First Colorado Region 6) Please use this form when referring Health First Colorado (Colorado's Medicaid Program) members to CCA for care coordination services.

How to fill out care coordination referral form

How to fill out care coordination referral form

1. Obtain the care coordination referral form from the appropriate healthcare provider or facility.
2. Fill in the patient's personal information, including name, date of birth, address, and contact information.
3. Provide details about the reason for the referral and the specific care coordination services needed.
4. Include any relevant medical history, diagnoses, and current medications for the patient.
5. Review the completed form for accuracy and completeness before submitting it to the care coordination team.

Who needs care coordination referral form?

1. Patients who require assistance in coordinating their care across multiple healthcare providers or settings.
2. Healthcare providers who are referring a patient for specialized care management services.

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What is care coordination referral form?

Care coordination referral form is a document used to request services and support for a patient from multiple healthcare providers.

Who is required to file care coordination referral form?

Healthcare providers, case managers, or social workers are typically required to file the care coordination referral form.

How to fill out care coordination referral form?

Care coordination referral form can be filled out by providing the patient's information, medical history, reason for referral, and requested services.

What is the purpose of care coordination referral form?

The purpose of care coordination referral form is to facilitate communication and collaboration among healthcare providers to ensure comprehensive care for the patient.

What information must be reported on care coordination referral form?

Information such as patient demographics, medical history, current health issues, requested services, and referring provider details must be reported on the care coordination referral form.