<DATE>

<MEMBER NAME>

< ADDRESS>

Dear <MEMBER NAME>:

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

Enclosed is a copy of your care plan with your goals, services, and supports as we discussed along with an extra signature page. Please sign and return the signature page and other forms 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.

Feel free to contact me with any questions or concerns. Sincerely,

<CARE COORDINATOR NAME>

HealthPartners® Inspire, Care Coordinator

Phone: <XXX-XXX-XXXX>

Toll-Free: <XXX-XXX-XXXX>

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

HPCare_107525 DHS Approved 1/25/18