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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 reside in a community that partners with Bluestone providers. Please talk about your eligibility with community staff, and look through our enrollment information for more about Bluestone.

  • Enrollment Information: Details about Bluestone, enrollment checklist, glossary of terms, FAQs and notice of privacy practices

To enroll in Bluestone services, please submit the following:

Three required enrollment forms

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

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 651-342-4281 or email Enrollment@BluestoneMD.com.

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

Fax: 855-306-1167

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

Fax: 888-972-8297

Florida
Mail: Bluestone Physician Services
10150 Highland Manor Dr, Suite 240
Tampa, FL 33610

Fax: 855-523-3935

Electronic enrollment: Florida DocuSign

Bluestone Bridge™ and Patient Portal Registration for Families:

The Bluestone Bridge is a secure online tool that brings all patient caregivers together in one place. You can communicate seamlessly with your Bluestone provider team, community nursing staff and other family members.

The Patient Portal is an additional resource provided by Bluestone. The portal is the place for patients or their designated healthcare agent to find everything from a detailed medical history to test results to billing statements. Important messages that require a response will also come through the portal.

Watch this short video to learn more about registering for the Bluestone Bridge.

Other helpful forms:

* 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.

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