Care Coordination Resources
UCare Connect and UCare Connect + Medicare
Care Coordinators foster ongoing primary and preventative care, create a person-centered support plan and assist with communication between all members of the interdisciplinary care team.
To find product-specific tools and forms, select the desired plan from the "Please select" drop-down and click "Select Plan" to explore each category and its contents.
Connect Requirements Grid (Revised 7/1/2024)
UCare Connect and UCare Connect + Medicare
Appointment Reminder Letter (Revised 5/20/2024)
Provider Engagement Letter (Revised 7/6/2022)
Support Plan Letter (Revised 6/14/2024)
Support Plan Signature Letter (Revised 6/14/2024)
Unable to Reach Member Letter (Revised 1/1/2024) | Hmong | Somali | Spanish
Unable to Reach Member Letter - Support Staff (New 7/1/2024)
UCare Connect
Change of Care Coordinator Letter (Revised 8/26/2022) | Hmong | Somali | Spanish
Health Resource Letter (Revised 2/28/2023)
PCP/ICT Fax Support Plan Cover Sheet (Revised 6/1/2024)
PCP/ICT Support Plan Cover Letter (Revised 1/1/2024)
Refusal Letter (New 1/5/2022)
Welcome Letter (Revised 8/2/2022)
Welcome Letter (Waiver) (New 8/2/2022)
UCare Connect + Medicare
Change of Care Coordination Letter (Revised 8/26/2022)
Health Resource Letter (Revised 2/28/2023)
PCP/ICT Fax Support Plan Cover Sheet (Revised 6/1/2024)
PCP/ICT Support Plan Cover Letter (Revised 1/1/2024)
Refusal Letter (New 1/5/2022)
Welcome Letter (Revised 8/2/2022)
Welcome Letter (Waiver) (New 8/2/2022)
Assessment and Support Plan Forms
2024 Monthly Activity Log (Revised 1/30/2024)
Refusal Support Plan (Revised 6/20/2024) Word | PDF
Support Plan Member Signature Page (New 5/15/2023)
Support Plan Signature Sheet - MnCHOICES (New 10/2/2023)
Support Plan (Revised 4/17/2023) | Word | PDF
Transfer Member Heath Risk Assessment (Revised 10/31/2023) Word | PDF
UTR Support Plan (Revised 6/20/2024) | Word | PDF
Other Forms
Death Notification Form (Revised 3/27/2024)
Primary Care Clinic Change Request
Release of Information Form (Revised 5/23/2024)
Support Plan Translation Request (New 7/1/2024)
Transition of Care Log (Revised 12/30/2022)
TOC Log Instructions (Revised 12/27/2022)
Transition of Care (TOC) Notification to PCP (Revised 6/3/2024)
Transition of Care Talking Points