Care continuity form 2026

See details

4.8 out of 5

51 votes

The document outlines the Transition of Care and Continuity of Care Request Form for FirstCare Health Plans. It explains the processes that allow members to continue receiving medical and behavioral services from non-participating providers during a transition period, or at in-network levels when network changes occur. Members must apply within 30 days of enrollment or network changes, detailing their ongoing treatment needs. The document also provides examples of qualifying conditions and emphasizes the importance of completing the form accurately to avoid interruptions in care.

Here's how it works

01. Edit your care continuity form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send care request via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out care continuity form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the care continuity form in the editor.
Begin by filling out the general information section, including your employer details, policy number, and enrollment date. Ensure all fields are completed accurately.
Provide patient information such as name, social security number, birth date, and relationship to the employee. This is crucial for identifying the individual requiring care.
Answer the eligibility questions regarding pregnancy status, ongoing treatments, and any scheduled surgeries. Be thorough; if a question does not apply, indicate 'N/A'.
Complete the healthcare professional information section with details about the current provider and treatment being received. This helps in assessing your transition needs.
Review all entries for accuracy before submitting. Use our platform’s features to save your progress or make edits as needed.

Start using our platform today to complete your care continuity form easily and efficiently!

See more care continuity form versions

We've got more versions of the care continuity form form. Select the right care continuity form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (51 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I sign my care continuity transition online?

Log in to your DocHub account and import your care continuity transition to our editor using one of its upload options - from your device, cloud storage, secure URL, or your DocHub folders if you have already managed your form before. Open our editor, click the Sign button in the top toolbar, and choose your signing method. You can use a picture of your handwritten signature, draw it, type in your name, or utilize a QR code as an alternative.

How do you complete transition request form on iOS?

You need only a web connection and a web browser to complete your transition request form by using an iOS phone. Open the DocHub website and authenticate. Then, add your file or choose it from the list in your dashboard. Then use our editing tools to complete your form and save all your changes. You can also send it to a specified recipient straight away.

What is the continuity of care in nursing process?

Maintaining the continuity of care requires that the nurse, and other members of the healthcare team, identify current client needs and then move the client to the appropriate clinical area, to the appropriate level of care, and to the appropriate healthcare facility in a timely and effective manner.

What does continuity mean in care?

Continuity of care can be defined as the extent to which a person experiences an ongoing relationship with a clinical team, or member of a clinical team. It means coordinated clinical care, that progresses smoothly as the patient moves between different parts of the health service.

What is an example of continuity in care?

If Your Health Plan Changes and You Lose Your Doctor, Medical Group, or Hospital. You may also qualify for continuity of care if your health plan changes, and you are required to switch to a new plan. This is called new enrollee continuity of care.

care transition form

Care continuity form pdf Care continuity form online UnitedHealthcare reimbursement claim form pdf Cigna Continuity of Care form unitedhealthcare 1095-a form online United HealthCare Continuity of Care form Cigna continuity of care pregnancy Continuity of Care form BCBS

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

What is a continuity of care form?

Continuity of Care is designed to allow a beneficiary to complete treatment with an existing provider and/or support the smooth transition of services to a new provider. If you believe you or a beneficiary that you serve are eligible for Continuity of Care, please complete this form and.

What is considered continuity of care?

Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patients experience of a continuous caring relationship with an identified health care professional.

What is a continuity of care plan?

But in some cases, you may be able to keep your doctor, medical group, or hospital for a limited time. This is called continuity of care. To receive continuity of care, you must call your health plan to ask for continuity of care. Also, your doctor, medical group, or hospital must agree to keep you as a patient.

What is an example of continuity of care?

Promoting continuity of care includes sharing thorough and concise patient medical information amongst providers and building trust between patients and their healthcare team. It also includes ensuring a patient has safe, coordinated transitions between different healthcare facilities and providers.

What is patient care continuity?

Continuity of care is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.