Get Discharge Consultation Documentation Fax Form - Ambetter

Filling out the Discharge Consultation Documentation Fax Form - Ambetter is an essential process for ensuring that all necessary information is communicated effectively following discharge. This guide provides clear, step-by-step instructions to make the online completion of the form straightforward and user-friendly.

Follow the steps to accurately complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in an appropriate editor.
2. Begin with the member’s details by entering their full name, date of birth, and member ID number in the respective fields. Ensure accuracy to avoid any delays in processing.
3. Fill in the parent or guardian’s name if applicable, along with their address and contact phone number.
4. Indicate the best time to reach the member or the parent/guardian to facilitate follow-up communications.
5. Include the emergency contact details or any additional points of contact for the member.
6. Enter the name and phone number of the outpatient therapist assigned to the member.
7. Specify the date of the member's next appointment, ensuring that it is scheduled appropriately.
8. If applicable, complete the case manager’s details including their name and phone number.
9. Enter the psychiatrist’s name and phone number, along with the date of their next appointment.
10. Answer whether the member has medication to last until the follow-up by selecting 'Yes' or 'No'.
11. List any other follow-up appointments including the name/type of provider and their appointment date.
12. Indicate if the member attended a 510 (Bridge) appointment during the discharge process by selecting 'Yes' or 'No'. If yes, provide the name of the staff conducting the 510 and their phone number, as well as the date and time of the appointment.
13. Provide the name and contact phone number of the member’s medical provider or primary care physician.
14. Fill in the discharge diagnosis with all relevant diagnosis numbers as appropriate.
15. Document any medications the member receives at discharge.
16. Specify the discharge disposition, i.e., where the member will be staying post-discharge.
17. Finally, ensure the signatures of both facility staff and the member or guardian are provided, along with the date of admission/discharge and the time of discharge.
18. Once all fields are completed, save the changes, and decide whether to download, print, or share the form as required.

Complete your documents online today to ensure smooth processing and follow-up.