CareSource Behavioral Health Coordination Form
The CareSource Coordination of Care Form facilitates effective collaboration between behavioral health and physical healthcare providers. It ensures the patient receives comprehensive care based on their medical and behavioral health needs. This form helps streamline treatment and support for individuals requiring multi-faceted health interventions.
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How do I fill this out?
To fill out the CareSource Coordination of Care Form, begin by entering the patient's information in the designated fields. Next, provide details regarding the patient's behavioral and physical health providers and any current interventions or medications. Finally, ensure that the patient signs the form to authorize the release of their health information.
How to fill out the CareSource Behavioral Health Coordination Form?
1
Enter the patient's name and birth date.
2
List the behavioral and physical healthcare providers involved.
3
Document the current interventions and medications.
4
Select adherence levels for medications and appointments.
5
Have the patient sign and date the form.
Who needs the CareSource Behavioral Health Coordination Form?
1
Behavioral health providers need this form to coordinate care plans with physical health providers.
2
Primary care physicians use this form to understand the behavioral health interventions their patients are receiving.
3
Case managers benefit from this form to track patient diagnoses and treatment interventions.
4
Patients may need this form to authorize the sharing of their health information between providers.
5
Administrative staff use this form to ensure all protected health information is documented correctly for compliance.
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1
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What are the instructions for submitting this form?
To submit the CareSource Coordination of Care Form, please email the completed form to Indiana_BH@caresource.com or fax it to (937) 396-3964. If you prefer, you can also deliver a physical copy to your primary care provider's office. Ensure that you retain a copy for your records. Always confirm with your provider that they have received your submission.
What are the important dates for this form in 2024 and 2025?
The CareSource Coordination of Care Form was issued and approved on 3/11/21. Regular updates and reviews are conducted; please ensure you are using the most current version when submitting. Keep an eye for any upcoming changes in 2024 and 2025 regarding procedural updates.
What is the purpose of this form?
The purpose of the CareSource Coordination of Care Form is to facilitate communication between behavioral health and physical healthcare providers. It serves as a formal documentation tool to ensure relevant health information is shared, which is critical for the patient's overall treatment. This form is essential for providing integrated care, thereby enhancing patient outcomes.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Includes fields for the patient's name, date of birth, and ID numbers.
- 2. Provider Information: Lists the behavioral and physical healthcare providers involved in the patient's care.
- 3. Treatment Details: Captures diagnostic information, interventions, medications prescribed, and adherence levels.
- 4. Patient Authorization: Requires the patient's signature for health information release, including any specific disclosures.
- 5. Submission Instructions: Provides guidance on how to submit the completed form via fax or email.
What happens if I fail to submit this form?
Failure to submit the CareSource Coordination of Care Form can lead to a lack of integrated care for the patient. Providers may miss critical information that is necessary for informed decision-making concerning treatment plans. Consequently, this may adversely affect the patient's health outcomes.
- Inadequate Care Coordination: Without the form, communication between providers may break down, impairing patient treatment.
- Delay in Treatment: The absence of shared information may delay necessary interventions for the patient.
- Increased Risk of Errors: Important health background may not be known, leading to potential medication errors or misdiagnoses.
How do I know when to use this form?
- 1. New Patient Engagement: Use this form for new patients who require multi-disciplinary care from the start.
- 2. Treatment Updates: Utilize the form to report updates in treatment or any changes to the healthcare providers involved.
- 3. Authorization for Information Sharing: This form serves as an authorization tool for sharing health information between providers and with the patient.
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