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Form DMS-2609 - Primary Care Physician Selection and Change Form

Form DMS-2609 - Primary Care Physician Selection and Change Form-2025

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The document is a form for Arkansas Medicaid members to select or change their primary care physician (PCP). It collects personal information about the member, allows them to list their preferred PCPs, and provides options for reasons behind the request for assignment or change. The form requires signatures from the member or their legal guardian.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Member Information section. Enter your first name, last name, middle initial, Medicaid ID number, Social Security number, birth date, mailing address, city, state, zip code, home phone, cell phone, and email address.
In the Requested New Doctor section, list your top three preferred primary care physicians. For each doctor, provide their full name and Medicaid Provider ID number. Also include the date of assignment for each choice.
Next, indicate your reason for requesting a change in doctor by selecting at least one option from the provided list. You can also specify any other reasons in the space provided.
Finally, sign the form in the Signatures section. If you are a legal guardian signing for a minor, ensure to print both your name and that of the member along with the date.

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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 do I switch to a new primary care doctor?

If youve already found another doctor, you can have records transferred to them directly. There may be a charge for a transfer of your medical records. This is an acceptable practice, but the amount can vary from office to office.

How do you transfer from one doctor to another?

Tips for choosing your primary care doctor Ask around. Map it out. Make sure youve got coverage. Do a quality check. Call or visit your potential doctors office. Ask about logistics. Keep your needs in mind. Get to know the doctor.

How do you change your primary care physician at UnitedHealthcare?

A Primary Care Provider (or ) is the main health care professional who takes care of you. You can update your on the website or call the Member Services number on the back of your UnitedHealthcare member ID card. A new ID card will be mailed to you once the change is completed.

How to change primary care doctor on Aetna?

There are two steps to change your : Log in to your member website. You can search for a by ZIP code, language spoken and other preferences. Call the toll-free Member Services number on your ID card. We can change your for you or help you choose one thats right for you.

How to change primary care physician humana?

Changing your : If you want to change your online log on to your Humana.com account or by calling Member Services at 1-800-448-3810 (TTY:711). We will make your change on the date you call. The effective date will automatically be the first of the following month, unless a retroactive request is made.

How to change primary care physician UnitedHealthcare app?

Heres a three-step plan for switching primary care providers: Step 1: Find a New Physician. You dont want to leave your current primary care provider until you have found a new physician. Step 2: Make Sure You Have Your Medical Records. Step 3: Connect with Your New Office. Get Help Switching Primary Care Providers.

How do you change your primary care physician?

How to Change Your Primary Care Physician: A Step-by-Step Guide Step 1: Identify Your Reasons for Change. Step 2: Research Potential New PCPs. Step 3: Schedule a Consultation. Step 4: Transfer Your Medical Records. Step 6: Schedule Your First Appointment. Step 7: Complete a Trial Period.

Form DMS-2609 - Primary Care Physician Selection and Change Form-2025

Here's how it works

How to use or fill out Form DMS-2609 - Primary Care Physician Selection and Change Form with DocHub

Complete this form in 5 minutes or less

Got questions?

How do I switch to a new primary care doctor?

How do you transfer from one doctor to another?

How do you change your primary care physician at UnitedHealthcare?

How to change primary care doctor on Aetna?

How to change primary care physician humana?

People also ask

How to change primary care physician UnitedHealthcare app?

How do you change your primary care physician?

Related links

Try more PDF tools

Form DMS-2609 - Primary Care Physician Selection and Change Form-2025

Here's how it works

How to use or fill out Form DMS-2609 - Primary Care Physician Selection and Change Form with DocHub

Complete this form in 5 minutes or less

Got questions?

How do I switch to a new primary care doctor?

How do you transfer from one doctor to another?

How do you change your primary care physician at UnitedHealthcare?

How to change primary care doctor on Aetna?

How to change primary care physician humana?

Related Searches

People also ask

How to change primary care physician UnitedHealthcare app?

How do you change your primary care physician?

Related links

Try more PDF tools