Get the free CD-171400 Health Services Reentry Provision of

CD171400 Health Services Reentry Provision of Information to Probation and Parole Division and/or Community Health Care Providers Alisha Tafoya Lucero, Cabinet SecretaryIssued: 05/09/02 Effective:

How to fill out cd-171400 health services reentry

How to fill out cd-171400 health services reentry

1. Obtain the CD-171400 form from the appropriate health service department or website.
2. Fill in your personal information at the top of the form, including your name, date of birth, and contact information.
3. Provide details about your health insurance coverage, if applicable.
4. Indicate the specific health services you are reapplying for by checking the appropriate boxes.
5. Include any required documentation, such as medical records or previous service records.
6. Review the form for completeness and accuracy.
7. Sign and date the form at the bottom.
8. Submit the completed form to the specified health services office either in person or via mail.

Who needs cd-171400 health services reentry?

1. Individuals who have previously received health services and are seeking to re-enter or continue those services.
2. People who have experienced a change in their health status that requires reassessment for health services.
3. Patients transitioning back to health services after a significant lapse or interruption in care.

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What is cd-171400 health services reentry?

CD-171400 health services reentry is a form used by healthcare providers to report and manage the reentry of health services for individuals who have been previously receiving care and are now returning to the service system.

Who is required to file cd-171400 health services reentry?

Healthcare providers and facilities that are planning to readmit or reintegrate patients back into health services are required to file the CD-171400 form.

How to fill out cd-171400 health services reentry?

To fill out CD-171400, providers should gather all necessary patient information, follow the instructions on the form carefully, and ensure that all sections are completed accurately before submission.

What is the purpose of cd-171400 health services reentry?

The purpose of CD-171400 health services reentry is to facilitate the seamless reintegration of patients into healthcare services, ensuring that their needs are met and that providers have the relevant information for effective care.

What information must be reported on cd-171400 health services reentry?

The information that must be reported includes patient identification details, previous health service records, reasons for reentry, and any necessary medical information relevant to ongoing care.