Get Primary Care Physician Selection/change Of Address Form - Hpsm

Filling out the Primary Care Physician Selection/Change Of Address Form - Hpsm online is a straightforward process that allows users to update healthcare details efficiently. This guide provides clear, step-by-step instructions for ensuring your form is completed accurately for yourself or members of your household.

Follow the steps to complete the form accurately

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the member information section. You will need to enter the last name, first name, and HPSM I.D. number. Additionally, specify the gender and date of birth. Ensure that all provided details are accurate.
3. Indicate your primary language in the designated section, as this information can assist in communication with healthcare providers.
4. In the program enrollment section, check the box next to the program you are currently enrolled in: CareAdvantage, CareAdvantage CMC, HealthWorx, Healthy Kids, Medi-Cal, or San Mateo County ACE.
5. Fill out the change of address section if you are updating your address. Print your new street address, city, apartment or unit number (if applicable), state, and zip code accurately.
6. Provide your home telephone and cell phone numbers to ensure reliable contact information.
7. For the PCP selection/change section, select your primary care physician from the provider list provided. You should choose two options in case your first choice is unavailable.
8. Review the statement regarding your agreement to seek care only through your chosen primary care physician unless emergency care is needed. Make sure to confirm your understanding by checking the box.
9. Sign the form at the bottom, indicating your agreement and understanding of the terms outlined. Make sure to include the date of signature.
10. After completing the form, review all the information to confirm its accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your Primary Care Physician Selection/Change Of Address Form online today for a smoother healthcare experience.