Get Coordination Of Care And Release Of Information Between ... - Dhhr Wv

This guide provides step-by-step instructions on how to effectively fill out the Coordination Of Care And Release Of Information Between / Provider and BH Provider form online. This document is essential for facilitating communication between behavioral health providers and prescribing physicians, ensuring you receive comprehensive care.

Follow the steps to complete your form online effectively.

1. Click the ‘Get Form’ button to access and open the Coordination Of Care And Release Of Information form in your browser.
2. Begin filling in the patient’s identifying information. Start with the patient's name, Medicaid ID number, and date of birth.
3. In the 'Patient Authorization' section, clearly write the names of the providers authorized to release and receive protected health information.
4. Check the appropriate boxes in the 'Disclosure may include the following verbal or written information' section to specify what information can be shared.
5. Complete the additional details on current medications and treatment modalities.
6. Ensure that you include the dates related to the authorization and treatment, including the expiration date for the consent.
7. Review all provided information for accuracy before signing and dating the form.
8. Finally, save your changes, and choose to download, print, or share the completed form as needed.

Start filling out your Coordination Of Care And Release Of Information form online to ensure seamless communication between your care providers.