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Panel Release Form - Providers - Prestige Health Choice Panel Release Form

Panel Release Form - Providers - Prestige Health Choice Panel Release Form 2025

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The document is a Panel Release Form used by providers to formally terminate a member from their practice. It outlines the necessary information required for the termination, including reasons for release, provider details, and an affirmation of compliance with specific protocols regarding patient termination. The form emphasizes the need for documentation of attempts to maintain the physician-patient relationship and ensures that members are assisted in finding new providers.

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