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Transition of Care Request Form For up to 90 days, Dean Health Plan (DHP) on behalf of the HHS Healthy Plan will consider for approval medical services with a specialty provider who does not participate

How to fill out transition of care request

How to fill out a transition of care request:

1. Start by gathering all necessary information: Before filling out the transition of care request, collect all relevant medical records, discharge summaries, and any other documents that will support the need for the request.
2. Identify the purpose of the request: Determine the reason for the transition of care request. It could be due to a change in healthcare providers, a transfer of care between facilities, or a need for additional medical services.
3. Complete the patient information section: Provide accurate and up-to-date personal information, such as name, date of birth, contact information, and insurance details. This will ensure proper identification and billing processes.
4. Indicate the current healthcare provider: Clearly state the name and contact information of the current healthcare provider or facility. This will help the receiving party to communicate and coordinate the transition effectively.
5. Specify the desired healthcare provider or facility: Clearly mention the name and contact information of the desired healthcare provider or facility where the transition should take place. This will ensure a smooth transfer of care.
6. Include relevant medical history: Provide a comprehensive medical history, including any recent diagnoses, treatments, medications, and allergies. This will help the receiving healthcare provider to have a better understanding of the patient's current health status.
7. Describe the reason for the transition: Provide a detailed explanation of why the transition of care is necessary. This could include the need for advanced medical services, specialized treatment, or a recommendation from the current healthcare provider.
8. Attach supporting documents: Attach all relevant medical records, test results, and discharge summaries to support the transition of care request. This will provide the receiving healthcare provider with essential information for proper treatment planning.
9. Review and sign the request: Double-check all the information provided in the request form for accuracy and completeness. Sign the form to authorize the release of medical information necessary for the transition of care.

Who needs a transition of care request?

A transition of care request is typically required in situations where there is a change in healthcare providers, a transfer of care between medical facilities, or a need for additional specialized medical services. Patients who are transitioning from one healthcare provider or facility to another, seeking a second opinion, or undergoing a change in health status may require a transition of care request. It is important to consult with the current healthcare provider or insurance company to ascertain the specific circumstances that necessitate the need for a transition of care request.

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What is transition of care request?

Transition of care request is the process of transferring a patient's care from one healthcare provider to another, ensuring continuity of care.

Who is required to file transition of care request?

Healthcare providers, such as hospitals and clinics, are required to file transition of care request when a patient is being transferred to a different provider.

How to fill out transition of care request?

Transition of care request can be filled out by providing all necessary information about the patient's medical history, current treatment plan, and contact information for the transferring and receiving providers.

What is the purpose of transition of care request?

The purpose of transition of care request is to ensure a smooth and coordinated transfer of care for the patient, minimizing any disruptions or gaps in treatment.

What information must be reported on transition of care request?

Information such as patient's medical history, current medications, treatment plan, contact information for providers, and any special instructions must be reported on transition of care request.