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Rev. 6/2015 Continuation of Care Request Form Date: Form completed by: Phone #: REASON FOR REQUEST: o Member newly enrolled with AmeriHealth PA o Provider no longer participates with the AmeriHealth
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How to fill out reason for request
How to fill out reason for request:
01
Begin by clearly stating the purpose of your request.
02
Provide relevant details and supporting information to justify your request.
03
Be concise and to the point, avoiding unnecessary fluff or irrelevant information.
04
Use a polite and professional tone throughout your explanation.
05
Double-check your spelling and grammar before submitting your reason for request.
Who needs a reason for request?
01
Individuals who are submitting a formal request for approval or permission, such as employees requesting time off or students requesting a change in class schedule.
02
Organizations or businesses that require employees or members to provide a reason for specific requests, to ensure transparency and accountability.
03
Government agencies or institutions that have established procedures in place which mandate the inclusion of a reason for request in order to streamline their decision-making process.
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