Enrollment Forms

Thank you for your interest in Bluestone! Here you’ll find everything you need to enroll for patient care with Bluestone, in addition to a few other helpful forms. To be eligible for Bluestone services, patients must be in a residential community or program that partners with Bluestone. Please talk about your eligibility with community staff, and look through our enrollment information for more about Bluestone.

To enroll in Bluestone services, please submit the following:

Required enrollment form

• Complete our Electronic Enrollment
• Paper Enrollment Forms: Patient Enrollment Form, Authorization for Release of Health Information and Consent for Services

Share files with us securely: If you need to securely share documents with us, you can do so HERE.

Additional documentation

• Community Face Sheet (obtain from community)
• Medical Power of Attorney, Health Care Directive or Guardianship paperwork, if in place
• Any of the following information that you authorize to be released to Bluestone:
  • Notes from four most recent provider visits
  • Hospital discharges within last two years
  • Labs and imaging within last two years
• Any additional health insurance information

Submitting enrollment forms to Bluestone Physician Services:

All forms must be completed and signed by the patient, medical power of attorney or guardian and submitted to Bluestone Physician Services before care can begin.

Questions about enrollment? Contact the enrollment coordinator at 877-599-1039 or email Enrollment@BluestoneMD.com

Minnesota/Wisconsin/Florida
Mail: Bluestone Physician Services
270 Main Street North, Suite 300
Stillwater, MN  55082

Fax: 855-306-1167

Bluestone Bridge™ and Patient Portal

Once enrolled, make sure to register for access to the Bluestone Bridge™ and Patient Portal. The Bluestone Bridge gives you the ability to securely communicate with your provider team, community nursing staff and other family members. Registering for the Patient Portal gives patients and designated healthcare agents access to important information like medical history, test results, billing statements and more.

Other helpful forms

• Health Care Home Information Sheet
• Chronic Care Management
• HIPAA Privacy Notice
• POLST* (Physician Orders for Life-Sustaining Treatment)
• Influenza Consent Form
• Minnesota Health Care Directives
• Wisconsin Advance Directive Resources
• Patient Portal Consent
• Release of Patient Information to Bluestone
• Release of Patient Information to Bluestone (Electronic Version)
• Release of Patient Information from Bluestone: Minnesota and Wisconsin
• Release of Patient Information from Bluestone: Florida

* What is POLST?  Physician Orders for Life-Sustaining Treatment (POLST) is an approach to end-of-life planning based on conversations between patients, loved ones, and medical providers. The POLST form/process is designed to ensure that patients can choose the treatments they want and that their wishes are honored by medical providers.