Magellan Complete Care of Florida (MCC of FL)

Child health assessment

Magellan Complete Care, your health plan, wants to help you or your child feel better and enjoy a healthy life.

These health questions will help us to better understand how you or your child is feeling. It will help us know what services and resources you will need to stay healthy and feel well. The questions will take you about 15 minutes to complete. If you do not understand any of the questions or need help with the form, please call us at 800-327-8613.

As your or your child’s health plan it is key that we work very closely with your doctors. We make sure you get the care you need. If you give us the OK, we can share this information with your or your child’s doctors. This will make sure you your child gets good care and help your (your child’s) doctors talk to each other. Without your OK, we will not share any information with anyone.

 

Fields marked with an * are required. 

Please fill out the following form.
Do you agree for us to share your answers with your doctors?
About You/Your Child
Sex
Did anyone offer you something to join the plan? *
Do you have a way to get to your (your child's) medical appointments? *
How do you like to talk with your doctors about your (your child's) health? *
Where do you (or your child) currently live? *
Who do you (or your child) live with? *
About/Your Child's Physical Health
Do you have any concerns about your (your child's) overall health? *
How much do you think your (your child's) overall health has harmed learning and work at school over the last 3 months? *
Do you (your child) have any of the following
Are you (your child) pregnant right now?
About Care You/Your Child Receives
How many times have you (your child) been seen in the Emergency Room in the last 3 months? *
How many times have you (your child) been admitted to the hospital in the past 3 months? *
Have you (your child) had any major falls or injuries in the last 6 months? *
Do you (your child) use any medical equipment, such as glucometer, nebulizer, wheelchair, hospital bed? *
Do you (your child) currently need or use medicine prescribed by a doctor (other than vitamins) for ANY medical, behavioral or other health condition? *
Do these medicines help you manage your (your child's) health conditions?
Are your (your child's) vaccines up-to-date? *
Have you (your child) had any of the following health screenings in last 12 months?