Get Turn This Page Over - Magellan Complete Care Of Fl

Filling out the Turn This Page Over form for Magellan Complete Care Of Florida is an important step in managing your protected health information (PHI). This guide will provide clear instructions to help you navigate through the form's components with ease and confidence.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In Part 1, enter the enrollee's last name, first name, middle initial, ID number, date of birth (formatted as MM/DD/YYYY), address, phone number (including area code), city, state, and zip code. Select whether you are the enrollee or have legal authority to act on behalf of the enrollee.
3. In Part 2, acknowledge that Magellan may give out the enrollee's PHI for managing mental health and/or drug and alcohol treatment for Florida Medicaid.
4. In Part 3, specify who the PHI can be shared with by providing their name, address, phone number, city, state, and zip code.
5. In Part 4, indicate the types of PHI that can be shared by checking relevant boxes, including HIV/AIDS, alcohol/substance abuse records, and sexual/physical/mental abuse.
6. In Part 5, explain why you want this information shared.
7. In Part 6, specify when the consent will end by providing a date or stating a specific condition.
8. In Part 7, review your rights regarding sharing and revoking consent for PHI.
9. In Part 8, the enrollee must sign and date the form to give their consent.
10. If applicable, in Part 9, have the authorized representative sign and complete the necessary information, ensuring legal authority is established.
11. Once all sections are completed, review for accuracy, then save the changes, download, print, or share the completed form as needed.

Complete the Turn This Page Over form online for effective management of your protected health information.