The Vermont Notice of Intent to Change Health Care Provider is a form used by individuals, families, and businesses in Vermont to notify their current health care provider of their intention to switch providers. This document is also known as a Change of Provider Notice, or COIN. There are two types of NOTICE forms: a Short Form for individuals and families and a Long Form for businesses. The Short Form is used to provide basic information that includes the names of the current health care provider and the new provider, the date of the change, and contact information for both parties. The Long Form requires more detailed information, such as the reason for the change, a description of the services to be provided by the new provider, and other relevant information. Both forms must be signed by the current health care provider and by the individual or business representative making the change. The completed form must then be sent to the new health care provider. The new provider must acknowledge receipt of the form and provide a copy to the individual or business representative.
Vermont Notice of Intent To Change Health Care Provider
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How to fill out Vermont Notice Of Intent To Change Health Care Provider?
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