Get the free Care Coordination Referral Form (Health First Colorado Region 7)

Care Coordination Referral Form (Health First Colorado Region 7) 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 agency.
2. Fill out the patient's personal information, including name, date of birth, address, and contact information.
3. Provide details about the referring healthcare provider, including name, contact information, and reason for referral.
4. Include information about the patient's medical history, current medications, and any relevant medical conditions that require care coordination.
5. Specify the type of care coordination services needed and any other relevant information for the receiving healthcare provider.

Who needs care coordination referral form?

1. Patients who require assistance in coordinating their healthcare services from multiple providers.
2. Healthcare providers who are referring patients for care coordination services.

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What is care coordination referral form?

Care coordination referral form is a document used to refer a patient to different healthcare providers to ensure the continuity and effectiveness of their care.

Who is required to file care coordination referral form?

Healthcare providers and professionals involved in the care of a patient are required to file a 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 demographics, medical history, current medications, and reason for the referral.

What is the purpose of care coordination referral form?

The purpose of care coordination referral form is to facilitate communication between healthcare providers, ensure appropriate care is provided to the patient, and coordinate services effectively.

What information must be reported on care coordination referral form?

Information such as patient demographics, medical history, current medications, reason for the referral, and contact information of referring and receiving providers must be reported on care coordination referral form.