Patient Forms

Member Services

Patient Forms

Patient Forms

Medical Case Management involves an in-depth care management program for patients with catastrophic or chronic illness or injury and helps in ensuring compliance, complete communication, and communication with all involved parties. Having your own Registered Nurse, for medical case management, with clinical and medical nurse consulting experience to act as your advocate, is a free benefit to you through your benefit plan.

In order to work with you and your providers to assure all are on the same page of your care needs, and to be able to answer your questions as they arise, your Nurse Consultant will need a Professional Consent form signed by you. By signing at the X and returning this form, your Nurse Consultant will be able to talk to your providers and request copies of your records, as they are needed.

There may be times when you may want to share information with family members and the Family Consent form will allow your Nurse Consultant to do so. Please list the names of those persons that you are willing to allow MRC to talk to and sign this form at the X and return or submit the form.

If you have any questions about either of these consent forms, please contact your Nurse Consultant before signing them.

Professional Consent Form

Family Consent Form

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