<DATE>

<MEMBER NAME>

M< ADDRESS>

Dear <MEMBER NAME>:

Thank you for taking the time to talk with <CARE COORDINATOR NAME>. The information you shared is important to help me know how to best support you in the way you want to be supported.

Enclosed are two copies of your care plan with your goals, supports and interventions as you discussed with <CARE COORDINATOR NAME>. One Copy is for you. Please sign the signature page of the care plan and other forms and return it in the envelope provided within 14 days. If you have any questions or there's anything you need help with right away, please call me at <XXX-XXX-XXXX>, otherwise you can expect a follow up phone call regarding your goals, services, and support.

I will also share your care plan with <PROVIDER NAME>.

I look forward to talking with you again.

Sincerely,

<CARE COORDINATOR NAME>

HealthPartners® Inspire, Care Coordinator

Phone: <XXX-XXX-XXXX>

Toll-Free: <XXX-XXX-XXXX>

Enclosures: Two Care Plans, Signature Page, SNBC Appeal Rights, Business Card, Self-addressed stamped envelope, Authorization to Disclose Form, Medical Record Release of Information Form, Statement of Nondiscrimination for Health Plan members [OTHER DOCUMENTS AS NEEDED]

HPCare_107523 DHS Approved 1/25/18