GA Laureate Medical Group Continuity of Care Request Form 2020-2025 free printable template

CONTINUITY OF CARE REQUEST FORM ___ Patient Name___ Patient Date of Birth (MM/DD/YYYY)___ Requesters Name___ Requesting Facility/Provider:___ Facility Phone___ Facility Fax___ Laureate Medical Group

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How to fill out GA Laureate Medical Group Continuity of Care Request

1. Obtain the GA Laureate Medical Group Continuity of Care Request form from the official website or medical office.
2. Fill in the patient's personal information, including full name, date of birth, and contact details in the designated fields.
3. Provide the names and contact information of the previous healthcare providers from whom the records are being requested.
4. Specify the type of medical records you are requesting (e.g., physical therapy records, lab results, etc.).
5. Indicate the reason for the request in the appropriate section.
6. Sign and date the form to authorize the release of information.
7. Submit the completed form to the GA Laureate Medical Group via email, fax, or in person, depending on their submission guidelines.

Who needs GA Laureate Medical Group Continuity of Care Request?

1. Patients seeking to transfer their medical records to GA Laureate Medical Group.
2. Individuals who have received treatment from other healthcare providers and want to ensure continuity of care.
3. Healthcare professionals requesting necessary patient information for ongoing treatment.

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What is GA Laureate Medical Group Continuity of Care Request?

The GA Laureate Medical Group Continuity of Care Request is a formal process used to ensure that a patient's medical care is effectively transitioned from one provider to another, allowing for ongoing treatment and management of health conditions.

Who is required to file GA Laureate Medical Group Continuity of Care Request?

Typically, the request must be filed by patients transitioning to new healthcare providers or by healthcare professionals acting on behalf of the patient to facilitate continuity of care.

How to fill out GA Laureate Medical Group Continuity of Care Request?

To fill out the GA Laureate Medical Group Continuity of Care Request, individuals should provide their personal information, details of the previous and new healthcare providers, and specific medical needs or services required for continued care.

What is the purpose of GA Laureate Medical Group Continuity of Care Request?

The purpose of the request is to ensure that there is no disruption in medical services during the transition between healthcare providers, thereby safeguarding the patient's health and treatment continuity.

What information must be reported on GA Laureate Medical Group Continuity of Care Request?

The request must include the patient's identification details, contact information, names and contact information for current and new healthcare providers, medical history relevant to the patient's ongoing care, and any specific treatment requirements.