Get Inpatient Coverage Form - First Choice Health

Filling out the Inpatient Coverage Form - First Choice Health online is an essential process for practitioners who need to secure inpatient coverage through a participating provider. This guide provides clear and supportive instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the 'Get Form' button to access the form and open it in your preferred document editor.
2. In the first section, provide the name of the First Choice Health participating practitioner who is willing to offer inpatient coverage on your behalf. Ensure the name is correctly spelled and clearly printed.
3. Next, enter the FCH designated hospital(s) where the participating practitioner listed in Step 2 holds admitting privileges. Double-check that the hospital names are accurate.
4. Repeat the process in the following section for a second First Choice Health participating practitioner who will provide inpatient coverage. Fill in their name clearly.
5. Again, list the FCH designated hospital(s) where this second participating practitioner has admitting privileges. Ensure all details are correct.
6. In the 'Name of Applicant' section, print your full name as it should appear on the document. This helps in personalizing your application.
7. Sign the form where indicated to authenticate your request and provide the date of signing to finalize the submission.
8. After all fields are filled, verify your entries for accuracy. You can now save changes, download, print, or share the completed form as required.

Now that you have the necessary steps, start filling out the Inpatient Coverage Form online.