Get the free Continuity of Care Form - Western Health Advantage

Continuity of Care REQUEST FORM Mail to: 2349 Gateway Oaks Drive, Suite 100, Sacramento, CA 95833 Send it by secure fax to: 916.568.0126 Questions: 916.563.2250 or 888.563.2250 toll-free or 888.877.5378

How to fill out continuity of care form

How to fill out a continuity of care form:

1. Gather all necessary information: Before starting to fill out the form, make sure to have all relevant information at hand. This may include personal details, medical history, current medications, and any other pertinent information.
2. Review the form: Take a few minutes to carefully read through the form. Understanding the layout and sections of the form will make it easier to complete accurately.
3. Complete personal information: Begin by filling in your personal information. This typically includes your full name, date of birth, address, and contact details. Ensure that all information is correct and up to date.
4. Provide medical history: The continuity of care form will likely require information about your medical history. Fill in details about any existing medical conditions, past surgeries, allergies, and any other relevant medical information.
5. Include current medications: List all current medications you are taking, including the dosage and frequency. It's important to be as specific as possible to ensure proper continuity of care.
6. Add contact information for healthcare providers: The form may ask for contact information for your current healthcare providers. Include the names, addresses, phone numbers, and any other necessary details to facilitate communication between healthcare professionals.
7. Include emergency contact details: Provide the contact information of a person to be reached in case of an emergency. Make sure to include their name, relationship to you, and their contact numbers.
8. Sign and date the form: At the end of the form, there will likely be a section for your signature and date. Make sure to review all the information you have provided before signing and dating the form.

Who needs a continuity of care form?

A continuity of care form is needed for individuals who are transitioning between healthcare providers or facilities. This can include patients moving from one hospital to another, changing primary care doctors, or transferring care to a specialist. The form ensures that the new healthcare provider has access to all relevant medical information, allowing for a smooth transition in the provision of care. Additionally, patients who have complex medical histories or chronic conditions may also benefit from having a continuity of care form to ensure that all healthcare providers are well-informed and able to provide appropriate care.

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What is continuity of care form?

Continuity of care form is a document that ensures the smooth transition of care for patients when there is a change in healthcare providers.

Who is required to file continuity of care form?

Healthcare providers and facilities are required to file continuity of care forms.

How to fill out continuity of care form?

To fill out a continuity of care form, healthcare providers must include patient information, medical history, current medications, and treatment plans.

What is the purpose of continuity of care form?

The purpose of continuity of care form is to provide important medical information to ensure the continuous and safe care of patients.

What information must be reported on continuity of care form?

Patient demographics, medical history, current medications, treatment plans, and any other relevant information must be reported on continuity of care form.