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**Last Revised 6/28/22024; Previous Version 7/27/2020 Follow the instructions (in red). Delete all instructions (in red). Write in clear, plain language (6th grade reading level or below). Complete
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Quin ser mi doctor es un formulario que permite a los pacientes designar a su médico de cabecera o proveedor de atención médica primario.
Cualquier persona que desee seleccionar un médico de cabecera o cambiar su proveedor de atención médica debe presentar este formulario.
Para completar quin ser mi doctor, se debe llenar el formulario con la información del médico seleccionado y los datos del paciente, y luego enviarlo a la entidad correspondiente.
El propósito de quin ser mi doctor es asegurar que los pacientes tengan un médico asignado que coordine su atención médica y maneje su historial de salud.
Se debe reportar el nombre y número de licencia del médico seleccionado, así como la información personal del paciente, como nombre, dirección y número de identificación.
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