Get Triangle Pediatric Center

Filling out the Triangle Pediatric Center form is an essential step for initiating a primary care provider (PCP) change. This guide provides straightforward instructions to help you navigate the online form effectively.

Follow the steps to complete your PCP change request.

1. Click ‘Get Form’ button to obtain the form and access it for completion.
2. Enter the date in the designated field to indicate when you are submitting the form.
3. Fill in the patient's name carefully, ensuring correct spelling as this is critical for processing.
4. Provide the patient's date of birth in the specified format to avoid any discrepancies.
5. Include the Medicaid ID number or Health Choice Recipient ID in the relevant space for identification purposes.
6. Sign the form as either the parent or recipient, ensuring that the signature is clear and matches the name entered.
7. Specify the current PCP's name that you wish to change from in the appropriate section.
8. Indicate the new PCP's name in the designated field where it prompts you to enter the new provider information.
9. Review all entries for accuracy to ensure there are no mistakes that could delay processing.
10. Once complete, save any changes you have made, download a copy for your records, and prepare to print or share the form as necessary.

Complete your PCP change request online today and ensure your healthcare needs are met seamlessly.