Get Continuity Of Care Form - Anthem

Completing the Continuity Of Care Form - Anthem is an important step in ensuring a smooth transition of your healthcare needs. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the Continuity Of Care Form online.

1. Click the ‘Get Form’ button to access and open the Continuity Of Care Form for editing.
2. Begin by entering the subscriber's name and subscriber ID number in the designated fields. This identifies the insurance policyholder.
3. Next, input the patient's name and patient ID number, ensuring that this information matches the records.
4. Fill in the daytime phone number and home phone number. Providing accurate contact info ensures communication regarding your care.
5. List the current primary care physician or attending physician, followed by the new primary care physician or attending physician you wish to transition to.
6. Indicate if you have an appointment with a specialist in the next six months. If yes, fill in the type of specialist and their name, phone number, and the date of the visit.
7. Answer whether you are currently receiving any of the specified services such as oxygen, IV medication, home therapy, rehab treatment, medical equipment, or dialysis. If yes, provide the company name for each service.
8. Indicate if you have any scheduled hospitalizations, surgeries, or procedures by answering yes or no. If yes, include relevant details.
9. State if you have been hospitalized or visited the emergency room in the past six months and provide details if applicable.
10. Specify if you are currently pregnant and include the name of your OB physician and due date if applicable.
11. Utilize the 'Other Needs/Comments' section for any additional information or specific requirements related to your care.
12. After completing the form, ensure that all fields are filled with the appropriate information, then save your changes. You may download, print, or share the form as necessary before submitting it.

Start filling out your Continuity Of Care Form online today to ensure your healthcare needs are met without interruption.