Get Gateway Health Member Outreach Form 2018

Filling out the Gateway Health Member Outreach Form online is a straightforward process that can help ensure members receive the necessary support and services. This guide provides detailed, step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to complete the Gateway Health Member Outreach Form online.

1. Click ‘Get Form’ button to access the outreach document and open it for editing.
2. Begin by entering the required information in the designated fields. Fill in the member name, age, and date of birth. Ensure this information is accurate, as it is vital for identification purposes.
3. If the member is under 21 years old, provide the date of their last screening. Input the Gateway Health ID number next, which is essential for the processing of the outreach request.
4. Enter the parent or guardian's name and the relationship to the member. This information is critical for confirming contacts.
5. Next, provide the primary care provider (PCP) name and their corresponding provider ID number. Include the contact person for the PCP and their phone number for any related communications.
6. Fill in the phone number where the member can be reached, as well as the date the form has been sent to Gateway Health Plan (GHP).
7. Indicate the reason for the referral from the list provided, making sure to select all that apply. Include any relevant dates for screenings, test results, or appointments related to the member's health needs.
8. In the additional information section, provide any other relevant details that could assist in the outreach process. This could include specific health issues or circumstances that need to be considered.
9. Once all fields are filled out, you can save the changes to the form, or choose to download, print, or share it as necessary. Ensure that all information is accurate before finalizing.

Complete your Gateway Health Member Outreach Form online today to ensure prompt assistance and support.