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/Connect + Medicare Care Coordination Requirements Grid (Revised 10/1/2024)
UCare Connect and UCare Connect + Medicare
Appointment Reminder Letter (Revised 5/20/2024)
Health Resource Letter (Revised 11/4/2024) Hmong | Somali | Spanish
Provider Engagement Letter (Revised 7/6/2022)
PCP/ICT Support Plan Fax Cover Sheet (Revised 9/17/2024)
PCP/ICT/Support Plan Cover Letter (Revised 11/15/2024)
Support Plan Letter (Revised 6/14/2024) Arabic | Hmong | Russian | Somali | Spanish | Vietnamese
Support Plan Signature Letter (Revised 6/14/2024) Arabic | Hmong | Russian | Somali | Spanish | Vietnamese
Unable to Reach Letter (Revised 11/6/2024) | Hmong | Somali | Spanish
Unable to Reach Member Letter - Support Staff (New 7/1/2024) | Hmong | Somali | Spanish
UCare Connect
Change in Care Coordinator Letter (Revised 8/26/2022) | Hmong | Somali | Spanish
Refusal Letter (New 1/5/2022)
Welcome Letter (Revised 9/3/2024) | Hmong | Somali | Spanish
Welcome Letter (Waiver) (New 8/2/2022)
UCare Connect + Medicare
Change in Care Coordination Letter (Revised 8/26/2022) | Hmong | Somali | Spanish
Refusal Letter (New 1/5/2022)
Welcome Letter (Revised 9/3/2024) | Hmong | Somali | Spanish
Welcome Letter (Waiver) (New 8/2/2022)
Assessment and Support Plan Forms
2025 Monthly Activity Log (Revised 1/1/2025)
Refusal Support Plan (Revised 12/6/2024) Word | PDF
Transfer Member Heath Risk Assessment (Revised 1/1/2025) Word | PDF
UTR Support Plan (Revised 12/6/2024) | Word | PDF
Other Forms
Death Notification Form (Revised 8/1/2024)
Primary Care Clinic Change Request
Release of Information Form (Revised 7/3/2024)
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