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Care Management Referral Form Florida Blue Clinical Resources Please Forward Referral Request via Email or Fax You will receive confirmation of your referral no later than next business day. Email

How to fill out care management referral form

How to fill out care management referral form

1. Obtain the care management referral form from the appropriate source (such as a healthcare provider, social worker, or case manager).
2. Fill out the patient's personal information including name, address, phone number, and date of birth.
3. Provide details about the patient's medical history, current health issues, and any medications they are taking.
4. Specify the reason for requesting care management services and any specific goals or concerns for the patient's care.
5. Obtain necessary signatures from the patient or their legal guardian, as well as from the referring healthcare provider.
6. Submit the completed care management referral form to the designated contact or department as instructed.

Who needs care management referral form?

1. Individuals who require coordinated care for complex or chronic health conditions.
2. Patients who would benefit from assistance in managing their healthcare needs and accessing resources.
3. Healthcare providers, social workers, or case managers who identify patients in need of additional support and services.

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What is care management referral form?

The care management referral form is a document that is used to refer patients to a care management program.

Who is required to file care management referral form?

Healthcare providers, social workers, or case managers may be required to file the care management referral form.

How to fill out care management referral form?

The care management referral form can be filled out by providing detailed information about the patient's medical history, current needs, and any relevant contact information.

What is the purpose of care management referral form?

The purpose of the care management referral form is to ensure that patients receive the appropriate care and support through a structured care management program.

What information must be reported on care management referral form?

Information such as the patient's medical history, current health status, support needs, and contact information must be reported on the care management referral form.