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Get Kaiser Permanente Northwest Treatment Extension Request
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How to fill out the Kaiser Permanente Northwest Treatment Extension Request online
Filling out the Kaiser Permanente Northwest Treatment Extension Request form online can streamline the process for obtaining additional treatment authorizations. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.
Follow the steps to complete the treatment extension request form.
- Click the 'Get Form' button to access the treatment extension request form and load it in your document editor.
- Fill in the referring Kaiser clinician's details, including name and contact information, as well as the treating CHP provider's information and phone number.
- Indicate the initial KP referral by checking the appropriate box and provide the initial KP authorization number.
- Enter the patient’s name, Kaiser ID number, and fax number.
- Check the appropriate treatment types requested: chiropractic, acupuncture, or naturopathic.
- Fill in the number of authorized treatments used and the total number of treatments received this calendar year.
- For the request for additional treatments, select the type of treatment and specify the number of additional treatments requested, indicating the desired dates.
- Document the initial complaints and pain scores, using an outcome assessment tool to provide objective findings and diagnosis related to the referral.
- Outline the treatment provided, including the number of sessions, modalities used, exercises, and any patient education efforts.
- Describe the patient's response to treatment, current complaints, pain scores, and objective findings.
- Provide an expected outcome or prognosis based on your professional assessment.
- Sign and date the form to complete the submission process.
- After completing, save changes, and choose to download, print, or share the form as needed.
Begin your document submission process online now.
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To submit prior authorization to Kaiser Permanente Washington, providers can utilize their online portal or send a fax, depending on the specific requirement. Be sure to include all necessary details to facilitate a swift approval process. Understanding how to fill out the Kaiser Permanente Northwest Treatment Extension Request can streamline your experience and minimize delays.