Get the free Health Coordination Referral Form for UnitedHealthcare Community Plan of Hawaii. Hea...

Please fax completed form to: 8448826985 Or mail to:UnitedHealthcare Community Plan 1132 Bishop Street, Suite 400 Honolulu, HI 96813 Customer Service 8889808728Phone:Health coordination referral form REFERRAL

How to fill out health coordination referral form

How to fill out health coordination referral form

1. Obtain the health coordination referral form from the appropriate source, such as your healthcare provider or insurance company.
2. Fill in your personal information, including name, date of birth, address, and contact information.
3. Provide details about your current health condition or the reason for the referral.
4. Include any relevant medical history or information about previous treatments.
5. Sign and date the form to authorize the referral and release of your medical information.

Who needs health coordination referral form?

1. Individuals who require specialized medical care or services from a healthcare provider outside of their primary care physician's network.
2. Patients who are seeking a second opinion or consultation from a specialist.
3. Those who are transferring to a new healthcare facility or provider and need to continue their treatment or care.

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What is health coordination referral form?

The health coordination referral form is a document used to coordinate health services for a patient.

Who is required to file health coordination referral form?

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

How to fill out health coordination referral form?

To fill out the health coordination referral form, fill in the patient's information, medical history, and the requested services.

What is the purpose of health coordination referral form?

The purpose of the health coordination referral form is to ensure that patients receive the appropriate health services and support.

What information must be reported on health coordination referral form?

The health coordination referral form must include the patient's name, date of birth, medical history, and the requested services.