Get the free Continuity of Care Request Form

This form is designed for members whose healthcare provider is leaving their plan, allowing them to request continuity of care to avoid disruption in their medical treatment. It is crucial for members currently receiving ongoing care or with scheduled services to ensure they can continue treatment during the transition to a new provider.

How to fill out continuity of care request

How to fill out continuity of care request

1. Gather necessary patient information such as name, date of birth, and insurance details.
2. Collect medical records and relevant documentation from the previous healthcare provider.
3. Fill out the continuity of care request form with details about the patient's medical history and current treatment plan.
4. Specify the reason for the request and any urgent care needed from the new provider.
5. Submit the completed form along with the necessary documentation to the new healthcare provider or insurance company.

Who needs continuity of care request?

1. Patients who are changing healthcare providers.
2. Individuals transitioning from one healthcare setting to another, such as from a hospital to outpatient care.
3. People needing ongoing treatment for chronic conditions or specialized care.

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What is continuity of care request?

A continuity of care request is a formal request made by a patient or their authorized representative to ensure that their healthcare needs are met without interruption when transitioning between different care providers or health plans.

Who is required to file continuity of care request?

Patients who are undergoing active treatment and are changing healthcare providers or health plans are typically required to file a continuity of care request to maintain their access to necessary services.

How to fill out continuity of care request?

To fill out a continuity of care request, patients must obtain the appropriate form from their new health plan, provide information about their current treatment, the healthcare providers involved, and any relevant medical history.

What is the purpose of continuity of care request?

The purpose of a continuity of care request is to facilitate uninterrupted access to necessary medical services when a patient switches healthcare providers or plans, ensuring that care remains consistent and effective.

What information must be reported on continuity of care request?

The continuity of care request must report the patient's personal information, details of their current medical treatment, names and contact information of current healthcare providers, and any specific services or medications required.