bloom healthcare

Confirmation of Main Doctor or Other Healthcare Professional Form

DISCLAIMER

  • Your benefits will NOT change, and you can visit any doctor, other health care professional, or hospital.

    Whether or not you complete this form or select a doctor or other health care professional through Medicare.gov, you remain eligible to receive the same Medicare benefits and you still have the right to use any doctor, other health care professional, or hospital that accepts Medicare, at any time. If you have questions, feel free to ask your doctor or other health care professional or Bloom Healthcare at 720-923-1302, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about DCEs. TTY users should call 1-877-486-2048.

  • Completing the form below or selecting a doctor or other health care professional through Medicare.gov is your choice AND you can change your mind. If you choose to complete this form or select a doctor or other health care professional through Medicare.gov you should do so yourself. No one else should complete this for you.
  • No one is allowed to attempt to influence your choice to complete this form or select a doctor or other health care professional through Medicare.gov by offering or withholding anything in exchange for you to complete or not complete the form or to make a selection online. If you feel pressured to sign or not sign this form or to make a selection online, please call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • Importante: esta informacion esta disponibles en espanol, solicitalo llamando al (720) 923-1302.
  • You can also get more information about DCEs at the CMS
    Website

    • CONFIRM
    By signing this form, I am confirming that my main doctor or other healthcare professional I receive routine medical care from is Physician Housecalls d/b/a BLOOM HEALTHCARE

    Note: If the names listed above and in the attached letter are incorrect do not sign this form. If you would like to receive a new form with a different doctor, other healthcare professional, or practice listed, please call Bloom Healthcare at (720) 923-1302 to request a new form. Completing and returning this form is voluntary. It won’t affect your Medicare benefits.

    Additional Services
    Chronic Care Management
    Palliative Care
    Dementia Care
    Care Transitions
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    See What Our Patients Have To Say

    “ Michelle Jenkins has been my mother’s primary care provider for the past 3+ years. Her attention to detail, the communication and follow up she provides and her thorough understanding of my mother’s needs is remarkable. She clearly cares about Mom and it shows! ”

    ~ Chuck F.

    “ We couldn’t be better taken care of than we are at Bloom! We are so grateful and thankful to be under their care. Our provider is the best! ”

    ~ Mr. & Mrs. F.

    My aging mother was falling through the cracks, in and out of assisted livings, rehabs after falls etc. I found Bloom and they came in and stabilized all! John and Angela as PA's were so caring and thorough. The staff at Bloom was so responsive, answering all questions promptly, and explaining things well to my mom. We were able to keep my mom home for awhile, but as she aged Bloom followed her to assisted living and beyond with an amazing continuum of care. I highly recommend Bloom, they are a great teammate in caring for our seniors, and a great resource especially during days of Covid!!

    ~ Susan G

    Bloom is an incredible organization. They provide high quality care to patients and particularly serve those patients living alone at home or those living in a senior living community. The Bloom Team is empathetic and compassionate and always work towards treating the whole patient and takes into consideration the patient’s living environment and social dynamics. The Team also works diligently to collaborate with other providers and services involved in the care of those patients. The patient is always their priority. Thank you for all you do Bloom!

    ~ Jim M.

    Since moving my mother to assisted living we have been using Bloom Healthcare to manage her care. She can still go see specialists as needed but Bloom has been wonderful to work with. I can always call for a concern and they follow through doing blood work or x-rays in her room then calling in needed prescriptions. They manage her med refills, and oversee her care at a level that brings me much peace. They are good at keeping me informed of what is needed and happening for my mother. Thank you!!

    ~ Marjie C
    Bloom Healthcare Physician smilling with patient
    Bloom Healthcare nurses discussing plans for patients
    Bloom Healthcare doctor going over results with patient
    Bloom Healthcare Physicians meeting and discussing plans
    Bloom Healthcare physician checking patients heart rate
    Would you like to learn more?

    We Would Love To Show You How We Can Help

    We understand that choices like this can prove difficult for yourself or for your loved ones. We would love to share with you the entire process and tell you how we can help.

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