Transfer Of Medical Information. The "Transfer of Medical Information" form must be completed prior to accessing Guest Membership Benefits. This form is the primary means by which the Member's medical information is communicated between the HMO and the Host HMO. This form will assist Providers in coordinating the Member's care during the time away from home and upon return. After the Member has completed and signed the "Transfer of Medical Information" form, the form will be completed by the HMO or the Host Primary Care Physician, as appropriate. The form will be processed through the Guest Membership Program. A Guest Membership Coordinator is responsible for forwarding the form between the HMO and Host HMO. Failure to sign and date the "Transfer of Medical Information" form will result in a denial of Guest Membership Benefits.
Appears in 4 contracts
Samples: Individual Hmo Subscriber Agreement, Hmo Subscriber Agreement, Hmo Subscriber Agreement
