Get Combined Mce Behavioral Health Provider/primary Care Provider Communication Form 2012-2025

Filling out the Combined MCE Behavioral Health Provider/Primary Care Provider Communication Form is essential for ensuring effective communication between healthcare providers. This guide offers a step-by-step approach to help users complete the form accurately and efficiently online.

Follow the steps to successfully complete the communication form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member's name, date of birth (DOB), and member ID number in the designated fields. Ensure that all details are accurate to facilitate smooth communication between providers.
3. Attach a signed copy of the release of information (ROI) to this form. Specify the date of expiration of the ROI in the provided space.
4. Section A must be completed by the behavioral health (BH) provider. Here, list all behavioral health problems and/or diagnoses the patient is being treated for.
5. The BH provider will also need to document all medications the patient is taking, including both prescribed and over-the-counter (OTC) medications with their respective dosages and frequencies.
6. If applicable, indicate any behavioral health (mental health/substance abuse) issues the patient is facing. Include any special concerns, such as abnormal lab results, that are relevant to the patient's care.
7. Section B is to be completed by the primary care provider. Write down the medical problems and/or diagnoses for which the patient is being treated.
8. As with the BH provider, the primary care provider must list all medications the patient is currently taking, with the same level of detail as outlined before.
9. Include any substance abuse problems if relevant, and delineate any special concerns the primary care provider may have regarding the patient's health.
10. Both the primary care provider and the behavioral health clinician must provide their signatures, names, and site details in the signature blocks provided on the form.
11. Finally, ensure that the date of completion for both sections is filled out accurately. Once all sections are complete, users can save changes, download, print, or share the completed form as needed.

Complete your Combined MCE Behavioral Health Provider/Primary Care Provider Communication Form online today.