SoFHA
Patient Forms

United Healthcare Community PCP Change


Description:

The United Healthcare Community PCP change form.


Code:

13.303

Issued:

07/20/2021

Revision:

1

Revised:

N/A

Primary Care Physician Change Request

For urgent requests, please call Customer Service toll free at 1-800-690-1606.


Member Information











PCP Information



Your signature will be required at your next office visit.