PASSPORT. Transition to CF Adult Care
|
|
|
- Beverley Brown
- 5 years ago
- Views:
Transcription
1 PASSPORT Transition to CF Adult Care
2 Authors: Lead Author: Mary McGuire, MSW Co-Author: Patricia Settle, MS, RD This transition program was made in collaboration with The University of Arizona Pediatric Pulmonary Center and the Tucson CF Center Team. Graphic Design: Amanda Sharpe, BS, University of Arizona Pediatric Pulmonary Center Acknowledgements: We would like to sincerely thank all of our patients and their family members, as well as our Tucson CF Center Team and our University of Arizona Pediatric Pulmonary Center Nutrition and Social Work trainees, for their input, feedback and support during the creation of this transition passport program. Copyright University of Arizona Pediatric Pulmonary Center. This project was supported in full by The University of Arizona Pediatric Pulmonary Center, Project T72MC00012 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, United States Department of Health and Human Services.
3 this passport belongs to: date received: estimated date of completion: date completed:
4 Welcome to your Transition Passport! You are receiving this passport so we can begin working with you on becoming more independent with your CF care. The goal of this passport is help prepare you to be independent and take ownership of your life as a young adult. Your passport includes several different areas of focus ranging from your daily CF treatment and nutritional/medication needs to career and future planning. As you master each section, just as in a passport, you can place a stamp on that particular page. Your CF team and parents/ caregivers will be working with you during clinic visits, admissions and at home to support you in applying the information and skills needed for your transition to adulthood. Once you have completed all the checkpoints in your passport, please review it with your CF team. Becoming an adult is an exciting time, and your CF team wants to help you make the most of it, which includes living the healthiest life possible. Ready, Set, Go!
5 table of contents Having Cystic Fibrosis (CF)...1 Respiratory Treatment...2 Medications and Vitamins...3 Nutrition...4 Exercise...5 CF Ownership...6 Knowing Your Body...7 Relationships and Reproduction...8 Mental Health...9 CF Resources...10 Self Advocacy...11 Medical Appointments and Refilling Medications...12 Insurance...13 Future Planning...14 Career/ Employment...15 Transitioning From Pediatric to Adult Care...16
6 having cystic fibrosis (CF) I am able to explain what CF is and how it affects my body I know the guidelines for having contact with others diagnosed with CF I know what precautions to take to decrease risk for infections I am aware of my specific CF mutations I am aware of the various CF studies and trials available to me I am aware that some people diagnosed with CF need a lung transplant, and I have discussed this topic with my CF doctors to determine if or when this might be a treatment option for me - 1 -
7 respiratory treatment I can describe what I should be doing for my recommended CF treatments and how often I should be doing them I know how to properly clean and sterilize all my treatment equipment I am able to describe why I am doing my CF treatments and how it helps me If I have questions about my respiratory treatments or need assistance with equipment, I know whom to contact - 2 -
8 medications and vitamins I know the names and dosages of the medications/vitamins prescribed to me I know why I am taking them and how they help me I am aware of any possible side effects of my medications I am aware of any allergies I have to specific medications I know why it is important for my CF team to check my vitamin A, D, and E levels annually - 3 -
9 nutrition I know why good nutrition is important; why I need more calories; foods highest in calories; and how to include them in my diet I know what BMI stands for; how it is used to follow nutritional status; and the relationship between BMI and lung function I know why I need enzymes; how they work to help nutrient absorption and digestion; and how and when to take them I know what CFRD is; the importance of checking my glucose levels annually; and how blood sugar should be controlled with insulin and healthy meal planning if I have CFRD I am able to create and plan a week of meals/snacks for myself or my family including purchasing foods and cooking the meal - 4 -
10 exercise I am aware of the short and long term benefits of exercise I exercise for at least 30 minutes, 4 times per week - 5 -
11 cf ownership I know why it is important to take an ownership role in my CF care I know the benefits of taking care of my health and the consequences of not taking care of my health If I have a port, I have discussed the benefits and risks of having a port and proper port care with my pulmonologist - 6 -
12 knowing your body I know what symptoms my body has when it is sick and how this is different from when it is feeling well I know the importance of monitoring my stools I know what stool changes I should discuss with my CF team I know my blood type I know when I should go to the emergency room for CF symptoms and when I should schedule a sick clinic visit for non-emergency symptoms - 7 -
13 relationships and reproduction I understand the difference between healthy, unhealthy and abusive relationships I feel comfortable talking about my feelings, wants and needs in relationships If I plan on becoming sexually active, I have discussed safer sex practices with my parents/guardians and/or my doctor I am aware of community resources if I have questions or need resources regarding relationships and/or safer sex practices I am aware of the possible effects of CF on fertility and the reproductive system - 8 -
14 mental health I am aware of community resources for food, clothing, employment, housing and mental health services I am aware of any history of family medical or psychiatric concerns I am aware of signs and symptoms of anxiety and depression I am aware of signs and symptoms of substance abuse I am aware of the effects illegal drugs, smoking tobacco and alcohol can have on my body (short term and long term) I am aware of how to seek help if I experience anxiety, depression, substance abuse/dependence or any other mental health concerns I know what self care is and why it is important - 9 -
15 cf resources I know each member of my CF team and the role of each person I am aware of online supports and resources specific to CF I am aware of the CF legal hotline and how they can help me
16 self advocacy I know what it means to advocate for myself and my needs I feel confident in being able to advocate for myself and my needs I know who I can count on for support as I transition toward adulthood, and I have talked with them about how they can support me as I transition I know that after I turn 18, I need to complete a medical release of information if I want my family or friends to be able to receive information about my medical care I have discussed advance directives with my CF team I am aware of how to request copies of my medical records and how to request a transfer of my records to another location if I move to another provider or another city/state/country
17 medical appointments and refilling medications I have the contact information for my doctors and pharmacies used for my medications (names/numbers/addresses) I have practiced scheduling my own doctor and dentist appointments I know how often I should see my primary care doctor, eye doctor, dentist, CF team and any other specialty doctors I have practiced calling in my medication refills to the pharmacy
18 insurance I know what type of health insurance I have, why it important to have health insurance, and at what age I will need to get my own insurance I know the current co-pays required for my doctor visits, medications, lab work, and hospital admissions If I had questions about my insurance coverage, I know whom to contact for answers I am aware of medication patient assistance programs I am aware of the CF services pharmacy and how can they help me
19 future planning I have a sense of purpose for my life and know my spiritual beliefs about life I have thought about my future goals and where I want to be within the next six months, year and five years with my goals I have created a daily/weekly/monthly/yearly schedule to accomplish my CF tasks and personal goals (and I have scheduled time for fun)
20 career and employment I have explored careers/jobs and discussed my interests with my school counselor/family/friends/cf Team I am aware of scholarships available and of the Disability Resource Center (DRC) in colleges and how they can benefit me I have created my resume I know how to search for employment and have practiced employment interviewing skills I know the importance of searching for jobs with benefits (i.e. time off, medical leave, insurance coverage)
21 transitioning from pediatric to adult care I understand the different expectations between my CF pediatric care team and adult care team I have scheduled a time to tour the adult inpatient floor and meet the charge nurse and inpatient social worker I have scheduled a time to meet with the CF adult pulmonologist to discuss my ongoing adult CF care needs
22 conclusion Congratulations in preparing for your transition to adulthood! Although this is the end of your transition passport to adulthood for your CF care, this is just the beginning of your young adult life. Just remember, part of being a responsible adult is asking for help if you need it. Your CF team is here to support you in your CF health care and growth, so feel free to ask questions and/or voice concerns. You have an exciting life journey ahead of you. Carpe Diem (seize the day)!
23 Questions? Mary McGuire, MSW University of Arizona Pediatric Pulmonary Center Social Work Faculty PEDIATRIC PULMONARY CENTER
ACTIVITIES OF DAILY LIVING (ADL)
ACTIVITIES OF DAILY LIVING (ADL) BEHAVIORAL DEFINITIONS 1 Demonstrates substandard hygiene and grooming, as evidenced by strong body odor, disheveled hair, or dirty clothing 2 Fails to use basic hygiene
MATER ADULT HOSPITAL CYSTIC FIBROSIS UNIT INFORMATION BOOKLET
MATER ADULT HOSPITAL CYSTIC FIBROSIS UNIT INFORMATION BOOKLET Changing hospitals can be a difficult and uncertain time. This package is designed to give you all the information you need to make the process
TALK. Health. The right dose. May is Mental Health Month. 4 tips for people who use antidepressants
VOLTEE PARA ESPAÑOL! SPRING 2016 Health THE KEY TO A GOOD LIFE TALK IS A GREAT PLAN May is Mental Health Month. Everyone deserves good mental health. Whether you have a minor mental health condition that
Health Home Flow Hypothetical Patient Scenario
Health Home Flow Hypothetical Patient Scenario Client Background: Soozie SoonerCare Soozie is a single female, age 42, 5'6" tall 215 pounds. She smokes 2 packs of cigarettes a day. At age 24, Soozie was
Lung Transplant Evaluation
If you have any questions, please ask any member of the Transplant Team. Lung Transplant Evaluation Welcome to the Lung Transplant Program at Northwestern Memorial Hospital. A lung transplant can be a
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease This booklet has been written to answer questions that many patients and family members ask about their care during their hospital stay. It will explain the experiences
Consents. Youth s strengths and concerns on transfer (to be completed by youth, parent/family and/or health care team)
Youth/ Family Family Practitioner Adult Specialist ON TRAC TRANSITION CLINICAL PATHWAY (COMPLEX) DATE INITIATED / / DD MM YYYY DATE LAST CLINIC VISIT / / DD MM YYYY Preferred Name Date of Birth PHN# Initiating
2. Unlicensed assistive personnel: any personnel to whom nursing tasks are delegated and who work in settings with structured nursing organizations.
XVIII. A. General Information: The judgments that you make in about coordinating and facilitating client care situations have to be based on knowledge. You MUST know your content, and then you can move
Children s Residential Treatment Center Medical Intake Information
Children s Residential Treatment Center Medical Intake Information The following is required at/by intake: q Copy of Current Insurance Cards (Medical, Dental, or Medical Assistance) q Proof of Physical
Your Guide to. Getting Started. at the Clinic
Your Guide to Getting Started at the Clinic 1 University Medical Center New Orleans ID Center - HOP Mission Our mission is to support and promote the health and well-being of people living with HIV by
Kaiser Permanente (No. and So. California) 2018 Union
Kaiser Permanente (No. and So. California) General Information Lifetime Maximum Benefit Annual Maximum Benefit Coinsurance Percentage Precertification Requirements Precertification Penalty Health Savings
Early and Periodic Screening, Diagnosis and Treatment
Early and Periodic Screening, Diagnosis and Treatment 1 Healthchek Ohio Medicaid EPSDT Services Early Periodic Screening Diagnosis Treatment Identify problems early, starting at birth Check children s
New to Medicaid? 22 Medicaid Services You Should Know About
New to Medicaid? 22 Medicaid Services You Should Know About Here Are 22 Medicaid Services You Should Know About This year Connecticut expanded Medicaid healthcare coverage (HUSKY) by raising the maximum
X Name of Patient (Please Print) X Signature of Patient (or Parent/Legal Guardian) X Name of Parent/Legal Guardian (Please Print)
In Office Policies Identification - For the protection of our patients, and to reduce medical identity theft, all patients are required to present a valid insurance ID card and/or driver s license at the
Rehab Centers - Pediatric Specialty Therapy. Pediatric Outpatient Handbook
Rehab Centers - Pediatric Specialty Therapy Pediatric Outpatient Handbook Dear Patient/Parent, Thank you for choosing Hanover Hospital Rehab Centers Pediatric Specialty Therapy for your child s therapy/rehabilitation.
NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11
NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11 28 PCMH 1: Enhance Access and Continuity PCMH 1: Enhance Access and Continuity 20 points provides access to culturally and linguistically
Complete Senior Care Enrollment Agreement
Complete Senior Care Enrollment Agreement I have received the Enrollment Handbook and a copy of the Provider Network and have had the opportunity to ask questions. Name: Address: (First) (Middle) (Last)
IV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
District 186: High School Health Education Syllabus
District 186: High School Health Education Syllabus Philosophy Statement: Health Education is a very important part of a high school students educational experience. Many students in high school do not
HEALTH 30. Course Overview
HEALTH 30 Description This course emphasizes attitudes, attributes and skills along with knowledge-based components to assist juniors to minimize health risks and avoid behaviors which interfere with well
APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS
Appendix 2 NCQA PCMH 2011 and CMS Stage 1 Meaningful Use Requirements 2-1 APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS CMS Meaningful Use Requirements* All Providers Must Meet
Benefits are effective January 01, 2017 through December 31, 2017
Benefits are effective January 01, 2017 through December 31, 2017 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Network & Out-of- Annual Deductible $0 This is the amount
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
Pediatric Patient History
Pediatric Patient History Childs Name: Today s Date: Primary Doctor: Date of Birth: Age: Reason for visit: List all chronic medical problems: List all medication dosages and frequency taken (including
Patient Centered Medical Home 2011
Patient Centered Medical Home 2011 NCQA Standards Rand David, MD, FACP Associate Professor of Medicine Director, Dept. of Ambulatory Care Mount Sinai School of Medicine Elmhurst Hospital Center I have
Nevada County Health and Human Services FY14 Rural Health Care Services Outreach Grant Project Evaluation Report June 30, 2015
Nevada County Health and Human Services FY14 Rural Health Care Services Outreach Grant Project Evaluation Report June 30, 2015 I. Executive Summary The vision of Nevada County Behavioral Health (NCBH)
Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket
KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
SECTION 3. Behavioral Health Core Program Standards. Z. Health Home
SECTION 3 Behavioral Health Core Program Standards Z. Health Home Description Health home is a healthcare delivery approach that focuses on the whole person and provides integrated healthcare coordination
HEALTH MATTERS. Avoid the Flu: Get Vaccinated FALL Know the Signs of Baby Blues. Time for a Checkup. Leaving the Hospital? Questions?
Time for a Checkup Know the Signs of Baby Blues pg 2 pg 5 pg 6 Leaving the Hospital? HEALTH MATTERS FALL 2016 Avoid the Flu: Get Vaccinated Having a flu vaccine is the best way to prevent the flu. It s
Transitioning Adolescents to Adult Care. Beverly Kosmach-Park DNP Clinical Nurse Specialist Children s Hospital of Pittsburgh Pittsburgh, PA USA
Transitioning Adolescents to Adult Care Beverly Kosmach-Park DNP Clinical Nurse Specialist Children s Hospital of Pittsburgh Pittsburgh, PA USA Graft Survival Following Deceased Kidney Transplantation
STANDARDS OF CARE HIV AMBULATORY OUTPATIENT MEDICAL CARE STANDARDS I. DEFINITION OF SERVICES
S OF CARE Oakland Transitional Grant Area Care and Treatment Services J ANUARY 2007 Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA 94612 Tel: 510. 268.7630 Fax: 510.268-7631 AREAS OF
Dr. Albert F. Bravo Gastroenterology / Internal Medicine
Dr. Albert F. Bravo Gastroenterology / Internal Medicine Name: First Middle Last Spouse s name: Email: Please check one: Married Single Widowed Divorced Ethnicity: Race: Language Preferred: Home Address:
Wellness along the Cancer Journey: Palliative Care Revised October 2015
Wellness along the Cancer Journey: Palliative Care Revised October 2015 Chapter 4: Home Care Palliative Care Rev. 10.8.15 Page 366 Home Care Group Discussion True False Not Sure 1. Hospice care is the
Student Participant Health Form
Participant Name: Male Female Birth Age on arrival at program Month/Day/Year To Parent(s)/Guardian(s): Please follow the instructions below. Attach additional information if needed. 1. 2. Complete pages
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH PLANS INC.
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network Providers Annual Maximum Out-of-Pocket Amount $2,500 The maximum out-of-pocket limit applies to all
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
Benefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN FEATURES Network & Out-of- Annual Deductible This is the amount you have to pay out of pocket before the plan will pay
Patient Name:,, Address: Phones:,, Home Work Cell. Primary Physician: Emergency Contact: Phone#:
Patient Information Patient Name:,, Last First middle initial Address: Phones:,, Home Work Cell Sex: Female Male E-Mail: Date of Birth: / / Mo. Day Year Primary Physician: Marital Status: Single Married
Your Wellness Visit Guide
Your Wellness Visit Guide Prepare for your Annual Wellness Visit or Welcome to Medicare Visit. Let s make the most of your appointment. Annual Wellness Visit Provider Toolkit Caring for Seniors HIGHMARK.COM
Nursing Special Needs: RN Delegation and Care Instructions for Assistive Personnel Based on assessment and care plan
Texas Department of Aging and Disability Services For: : Nursing Special Needs: Delegation and Care Instructions for Assistive Personnel Based on assessment and care plan October 2011 Unlicensed Assistive
People with a Learning Disability. Don t Miss Out! Your Annual Health Check
People with a Learning Disability Don t Miss Out! Your Annual Health Check Contents Why are health checks important? 2 What is a health check? 3 Preparing for your health check 4 While at the health check
Cystic Fibrosis Foundation Patient Registry Annual Data Report 2004
Cystic Fibrosis Foundation Patient Registry Annual Data Report 2004 Suggested citation: Cystic Fibrosis Foundation, Patient Registry 2004 Annual Report, Bethesda, Maryland. 2005 Cystic Fibrosis Foundation
Professional Drivers Health Network. What?
Professional Drivers Health Network What? An Integrated Occupational Health Program The definition - the ability of a worker to function at an optimum level of well-being at a worksite as reflected in
We want to thank you for your interest in the Orion Weight Loss Program. We are looking forward to helping you reach your weight loss goal.
Appointment Date: Appointment Time: Dear Orion Member, We want to thank you for your interest in the Orion Weight Loss Program. We are looking forward to helping you reach your weight loss goal. Enclosed
PARTICIPANT HANDBOOK. City and County of San Francisco Department of Public Health Updated February 2017
PARTICIPANT HANDBOOK City and County of San Francisco Department of Public Health Updated February 2017 www.healthysanfrancisco.org Contents About this Handbook...1 What is Healthy San Francisco?...1 Your
Visitor s guide MOUNTAIN VIEW CAMPUS VISITING GUIDELINES
Visitor s guide MOUNTAIN VIEW CAMPUS VISITING GUIDELINES Welcome to El Camino Hospital. Please take a few moments to look over our visiting guidelines. We offer an open visiting policy At our main hospital,
CLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW
Diplomate: CLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW A. INFORMATION MANAGEMENT 1. Does your practice currently use an electronic medical record system? Yes No 2. If Yes, how long has the
Cystic Fibrosis Unit Admission to hospital
Cystic Fibrosis Unit Admission to hospital Information for families Great Ormond Street Hospital for Children NHS Foundation Trust 2 Children with cystic fibrosis (CF) may from time to time need an admission
Surgical Preadmission Information. Joint Replacement Hip. Knee
Surgical Preadmission Information Joint Replacement Hip Joint Replacement Knee Spine Surgery Planning for Surgery Preoperative Assessments and Tests An appointment for Preoperative Assessments and Tests
PART IIIB DIPLOMA AND CERTIFICATE PROGRAMS CURRICULA
PART IIIB DIPLOMA AND CERTIFICATE PROGRAMS CURRICULA NURSE EDUCATION DEPARTMENT Practical Nurse Education Program (Diploma Program) Objective This professional education program is designed to provide
Specialized On-Demand Education for Home Care Staff
Home Care Association of New Hampshire and RCTCLearn offer Specialized On-Demand Education for Home Care Staff Providing your agency s staff with high quality continuing professional education doesn t
Restoring Nutrition: What to expect during your child s hospital stay
Patient and Family Education Restoring Nutrition: What to expect during your child s hospital stay Coming to the PBMU saved my child s life, no question. And the knowledge we gained during her stay will
NEW EMPLOYEE HEALTH PLAN BENEFIT. Care When You. Need
NEW EMPLOYEE HEALTH PLAN BENEFIT Care When You Care When You Want It Need It What is Access Health? WHAT IS ACCESS HEALTH? Access Health offers cost savings worksite solutions by providing a medical clinic
2017 Summary of Benefits
H5209 004_DSB9 23 16 File & Use 10/14/2016 DHS Approved 10 7 2016 This is a summary of drug and health services covered by Care Wisconsin Medicare Dual Advantage Plan (HMO SNP) January 1, 2017 to December
Take a deep breath for the future
Transition Support Service Take a deep breath for the future Your continued cystic fibrosis (CF) care Life at an adult hospital Introduction Moving on from The Royal Children s Hospital (RCH) can be a
PCMH 2014 Recognition Checklist
1 PCMH1: Patient Centered Access 10.00 points Element A - Patient-Centered Appointment Access ~~ MUST PASS 4.50 points 1 Providing same-day appointments for routine and urgent care (Critical Factor) Policy
Health Care Transition. A Parent, Family and Caregiver s Guide
Health Care Transition A Parent, Family and Caregiver s Guide Health Care Transition A Parent, Family and Caregiver s Guide The N.C. Family to Family Health Information Center A project of The Exceptional
Exclusively for Health Advocate Members. All-in-1 Benefit. Benefits Gateway Personal Dashboard Healthcare Help Wellness Support EAP+Work/Life
Exclusively for Health Advocate Members All-in-1 Benefit Benefits Gateway Benefits Gateway Connect to the right benefit Welcome to HealthAdvocate Health Advocate is a service provided by your employer
Wellness along the Cancer Journey: Caregiving Revised October 2015
Wellness along the Cancer Journey: Caregiving Revised October 2015 Chapter 4: Support for Caregivers Caregivers Rev. 10.8.15 Page 411 Support for Caregivers Circle Of Life: Cancer Education and Wellness
CASE MANAGEMENT POLICY
CASE MANAGEMENT POLICY Subject: Acuity Scale Determination Effective Date: March 21, 1996 Revised: October 25, 2007 Page 1 of 1 PURPOSE: To set a minimum standard across Cooperative agencies regarding
RECUPERATIVE CARE PROGRAM Case Manager Referral Form (TO BE COMPLETED BY SOCIAL SERVICES)
Case Manager Referral Form (TO BE COMPLETED BY SOCIAL SERVICES) PLEASE NOTE: Patient must bring with him/her any needed medications. We share space in facilities that do not allow drug or alcohol use.
PCSP 2016 PCMH 2014 Crosswalk
- Crosswalk 1 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice (PCSP) 2016 standards with NCQA s Patient-Centered Medical Home (PCMH) 2014 standards. The column on the right identifies
Sage Medical Center New Patient Forms
Sage Medical Center New Patient Forms Patient Name: DOB: Providers and Suppliers of Your Medical Care: Please list all providers and suppliers of your medical care such as primary care physicians, specialty
STATE COUNCIL OF EDUCATIONAL RESEARCH AND TRAINING TNCF DRAFT SYLLABUS. Anatomical Positions., Cells and Tissues, PHYSIOLOGY
STATE COUNCIL OF EDUCATIONAL RESEARCH AND TRAINING TNCF 2017 - DRAFT SYLLABUS Subject :Nursing (Vocational) Class : XI TOPIC CONTENT Unit 1 : NURSE AND NURSING AS A PROFESSION Definition of health, Concept
Chest Centre. Welcome to the. Vancouver General Hospital
Welcome to the Chest Centre Vancouver General Hospital 12th Floor, Jim Pattison Pavilion, 899 West 12th Avenue Vancouver BC V5Z 1M9 Tel: 604-875-4111 Welcome to the Chest Centre The Chest Centre comprises
Understanding Health Care in America An introduction for immigrant patients
Patient Education Understanding Health Care in America An introduction for immigrant patients The health care system in the United States is complex. Some parts of the system are different in different
General information guide
Patient information General information guide i Important general information for all patients. Golden Jubilee National Hospital Agamemnon Street Clydebank, G81 4DY (: 0141 951 5000 www.nhsgoldenjubilee.co.uk
Welcome to 5 South Geriatric Psychiatry
Welcome to 5 South Geriatric Psychiatry Toronto Rehab For patients, families and caregivers Welcome to 5 South, the Geriatric Psychiatry Program at Toronto Rehab. This booklet will give you information
BCBSAZ Individual HMO Portfolio ZCS Plan Attachment Neighborhood Network On Exchange
BCBSAZ Individual HMO Portfolio ZCS Plan Attachment Neighborhood Network On Exchange 21016 0118 Suite E PLAN NETWORK Your Plan Network is the Neighborhood Network. The BCBSAZ provider directory of Neighborhood
Infusion Treatment A Patient s Guide
Infusion Treatment A Patient s Guide www.guthrie.org Welcome Thank you for choosing the Guthrie Cancer Center for your medical care. Our team of dedicated professionals will do everything possible to make
Benefit Explanation And Limitations
Benefit Explanation And Limitations SFHP providers supply many medical benefits and services, some of which are itemized on the following pages. For specific information not covered in this table, please
PeachCare for Kids. Handbook
PeachCare for Kids Handbook Table of Contents What is PeachCare for Kids?...2 Who is eligible?...3 How do you apply for PeachCare for Kids?...3 Who will be your child s primary doctor?...4 Your child s
Chapter 12 Benefits and Covered Services
12 Benefits and Covered Services Health Choice Generations covers the same benefits covered under Original Medicare. Sometimes Medicare adds coverage for a new service during the year. Health Choice Generations
Your guide to surgery at Elmhurst Hospital
Your guide to surgery at Elmhurst Hospital Please use this guide to help you know how to prepare for your surgery and what to expect on the day of surgery. Your Guide to Surgery Important information Your
Acute Crisis Units. Shelly Rhodes, Provider Relations Manager
Acute Crisis Units Shelly Rhodes, Provider Relations Manager Shelly.Rhodes@beaconhealthoptions.com Training Agenda Agenda: Transition and Certification Coverage of Services Service Code Definition Documentation
NEW PATIENT INFORMATION: ADULT
NEW PATIENT INFORMATION: ADULT Patient Last Name: Patient First Name: Patient Middle Name: DOB: Sex: M F SSN: Address: City: Zip: Home Phone: Cell Phone: Email: EMERGENCY CONTACT INFORMATION Last Name:
LSU First & WebTPA: Working Together
LSU First & WebTPA: Working Together 2016 LSU First Health Plan Changes 2016 LSU First Health Plan Changes New ID Card Specialty drug copay $150 90 day timely filing period (medical and pharmacy) Home
Cystic Fibrosis Inpatient Guide. Your guide to our adult cystic fibrosis inpatient unit
Cystic Fibrosis Inpatient Guide Your guide to our adult cystic fibrosis inpatient unit St Michael s Hospital is home to the largest adult cystic fibrosis (CF) program in North America. We care for over
COVERED SERVICES. GNOCHC services fall into two broad categories: core services and specialty services.
COVERED SERVICES The array of services described below is provided under the Greater New Orleans Community Health Connection (GNOCHC) Waiver and must be delivered on an outpatient basis. Requests for pre-admission
WEEK DAY LECTURE SUBJECTS CLASS HOURS ORIENTATION. Course Logistics: breaks; schedule etc.
WEEK DAY LECTURE SUBJECTS CLASS HOURS 1 1 ORIENTATION Course Logistics: breaks; schedule etc. Course Overview: review syllabus, assignment, quizzes, recitation NCLEX Test plan and format; How to study;
Paramedic Care: Principles & Practice. Volume 2 Patient Assessment
Paramedic Care: Principles & Practice Volume 2 Patient Assessment Chapter 1 The History Topics Establishing Patient Rapport The Comprehensive Patient History Special Challenges The Interview In the majority
School-Based Health Center William Penn High School 713 E. Basin Road New Castle, DE Phone: Fax:
School-Based Health Center William Penn High School 713 E. Basin Road New Castle, DE 19720 Phone: 324 5740 Fax: 324 5745 Dear Parents/Guardians: The William Penn School Based Health Center (SBHC) is a
National Institutes of Health, National Heart, Lung and Blood Institute (NHLBI)
October 27, 2016 To: Subject: National Institutes of Health, National Heart, Lung and Blood Institute (NHLBI) COPD National Action Plan As the national professional organization with a membership of over
HEART TRANSPLANT AND SOCIAL WORK SERVICES
UW MEDICINE REGIONAL HEART CENTER HEART TRANSPLANT AND SOCIAL WORK SERVICES Orientation Class at University of Washington Medical Center OVERVIEW This slideshow explains the: Role of Your Social Worker
Coordinating Access to Obtain ZOLINZA
ACT Now: 1-866-363-6379 Coordinating Access to Obtain ZOLINZA Reimbursement Support Services Patient Assistance BEFORE YOU LEAVE, please have your physician s office fax your prescription for ZOLINZA and
PEDIATRIC CENTER FOR WELLNESS, P.C. CRYSTAL B. HOOD, M.D KLONDIKE RD SW SUITE 205 CONYERS, GA TELEPHONE FAX
PEDIATRIC CENTER FOR WELLNESS, P.C. CRYSTAL B. HOOD, M.D. 1506 KLONDIKE RD SW SUITE 205 CONYERS, GA 30094 678-750-4000 TELEPHONE 678-750-4005 FAX www.pcfwellness.com Dear Family, We are excited to welcome
The University of Chicago Guide to Student Health and Counseling Services
The University of Chicago Guide to Student Health and Counseling Services 2017 2018 Welcome to the University of Chicago! We believe good health is essential for academic success. At the University of
Stage 2 GP longitudinal placement learning outcomes
Faculty of Life Sciences and Medicine Department of Primary Care & Public Health Sciences Stage 2 GP longitudinal placement learning outcomes Description This block focuses on how people and their health
Program Description PATIENT CARE ACADEMY
Program Description PATIENT CARE ACADEMY M-TEC at The Groves Campus 7107 Elm Valley Drive Kalamazoo, MI 49009 Phone: 269.353.1282 Fax: 269.353.1580 careeracademies@kvcc.edu www.kvcc.edu/training PATIENT
Going home after chemotherapy. An information guide
TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Going home after chemotherapy An information guide Going home after chemotherapy Information for haematology patients Going home between
Staying Healthy Guide Health Education Classes. Many classroom sites. Languages. How to sign up. Customer Service
Staying Healthy Guide Health Education Classes We care about the health of our members. That is why our health plan offers health education classes to help our members stay healthy and learn how to be
The process has been designed to be user friendly and involves a few simple steps.
HOW DO I ENROLL A PATIENT WITH HOUSECALL MD? The process has been designed to be user friendly and involves a few simple steps. It is the patient s/family s/dpoa s/guardian s decision, if they want to
PRIORITY 1 - OBESITY AND CHRONIC DISEASE
PRIORITY 1 - OBESITY AND CHRONIC DISEASE Goal: Promote health and reduce chronic disease risk through the consumption of healthy diets and achievement and maintenance of healthy body weights in Otsego,
Suicide Risk Screening, Assessment and Precautions (Non Psychiatric Care Units) Policy No.: NSI SFT_05
Suicide Risk Screening, Assessment and Precautions (Non Psychiatric Care Units) Policy No.: NSI SFT_05 ACKNOWLEDGEMENT: By opening and reviewing the following attachment: acknowledges that I have reviewed
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services
SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services Alcohol, drug, and substance abuse treatment services are provided by the Department of Alcohol and Other Drug Abuse Services
Supported Living Checklist-- How am I supported right now to meet my needs?
ed Living Checklist-- How am I supported right now to meet my needs? This checklist is a tool to assist in understanding the assistance each individual may need and is meant to be individualized. The checklist
ALFRED ALINGU, MD INTERNAL MEDICINE
Name Date of Birth Social Security Number Marital Status Address City State Zip Code Home Phone Cell Phone E-mail Address Pharmacy Name Pharmacy Phone Number Emergency Contact Phone Number Relationship
Covered Benefits Rhody Health Partners
Covered s Rhody Health Partners s Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current
Health & Medical Policy
[insert organisation name/logo] Health & Medical Policy Document Status: Date Issued: Lead Author: Approved by: Draft or Final [date] [name and position] [insert organisation name] Board of Directors on