Get the free Continuation of Care Form (To be used when a provider ...

Continuation of Care Form (To be used when a provider is no longer contracted with Anthem BCBS Network) Our goal is to provide benefits for continuity of care for any new member of Anthem Blue Cross

How to fill out continuation of care form

How to fill out continuation of care form

1. Obtain a copy of the continuation of care form from the healthcare provider or facility.
2. Fill out all personal information such as name, date of birth, address, and contact information.
3. Provide details about your current healthcare provider and any previous providers you have seen.
4. Include information about your medical history, current medications, and any known allergies.
5. Sign and date the form to certify that the information provided is accurate.

Who needs continuation of care form?

1. Patients who are transitioning between healthcare providers or facilities.
2. Patients who require ongoing care from multiple providers.
3. Patients who have complex medical conditions that require coordination of care.

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What is continuation of care form?

Continuation of care form is a document that ensures seamless healthcare services for a patient when transitioning between different healthcare providers or facilities.

Who is required to file continuation of care form?

Healthcare providers, facilities, or caregivers responsible for the ongoing medical treatment of a patient are required to file the continuation of care form.

How to fill out continuation of care form?

Continuation of care form needs to be completed with the patient's medical history, current treatment plan, medications, and any special instructions for future care providers.

What is the purpose of continuation of care form?

The purpose of continuation of care form is to ensure continuity of medical care and prevent any disruptions in treatment for the patient.

What information must be reported on continuation of care form?

Information such as patient's medical history, current treatment plan, medications, allergies, and any specific requirements for future care must be reported on the continuation of care form.