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This document outlines the procedures and policies regarding obtaining and managing consent for Health Home services, ensuring that Community Health Connections Members have the necessary permissions on file to facilitate care coordination. It details the consent process, including the DOH 5055 form, and the roles of various providers in the Health Home program, as well as guidelines for documentation, updating, and withdrawal of consent.
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How to fill out health home consent

01
Gather all necessary personal information such as full name, date of birth, and contact details.
02
Read the health home consent form carefully to understand all terms and conditions.
03
Fill out the sections that require your personal information accurately.
04
Indicate your consent by signing and dating the form.
05
If applicable, ensure a guardian or representative also signs the form on your behalf.
06
Submit the completed form to the appropriate health home agency.

Who needs health home consent?

01
Individuals seeking services from a health home.
02
Parents or guardians of minors who require health home services.
03
Patients with chronic conditions that need coordinated care.
04
Individuals transitioning from institutional care to community-based care.
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Health home consent is a documented agreement that allows individuals to participate in health home services, enabling coordinated care and support for various health needs.
Individuals seeking health home services are required to file health home consent, as well as providers facilitating the care.
To fill out health home consent, individuals need to provide personal information, details of their health needs, and sign the document to confirm their agreement to partake in health home services.
The purpose of health home consent is to ensure that individuals understand and agree to the coordinated health services provided to them, enhancing their care experience.
Health home consent must report personal identification information, description of services required, and acknowledgment of the individual's rights and responsibilities.
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Relevant keywords

Health Home Consent Form DOH 5055 Care Coordination Community Health Connections Patient Consent HIPAA Compliance Health Care Providers Privacy Regulations Mental Hygiene Law

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