Enrollment in Health Network

[1] [2]

Health Network Enrollment Packet [English] [3]

[2]Health Network Enrollment Packet [Creole] [4]

[5]Health Network Enrollment Packet [Portuguese] [6]

[7]Health Network Enrollment Packet [Spanish] [8]

Enrollment is free and must be initiated by the clinic. A patient cannot enroll him/herself.

The 3 things required for enrollment are:

1. CONSENT FOR RELEASE OF MEDICAL INFORMATION section (signed and dated)
      
2. PARTICIPANT INFORMATION SHEET section (including the patient’s working phone number(s) and intended address)
      
3. Medical records and/or summary of next steps
      

Please fax completed Enrollment Packets to: 512.327.6140

Once we receive this paperwork, we will verify the information and initiate case management. It is critical that you fill this enrollment packet out as completely as possible so that MCN staff can provide the best possible service to you and your patients. We recommend enrolling patients in anticipation of their departure; having a patient enrolled ahead of time will enable us to direct that patient to their next clinic before the patient leaves your area. Only patients enrolled will be followed. Health Network has been designed to facilitate the continuity of care for these mobile patients, not only in the U.S., but around the world.

Informational Videos about Health Network