Coordinated Care Planning
|
|
- Curtis McDonald
- 5 years ago
- Views:
Transcription
1 Coordinated Care Planning What is a Coordinated Care Plan? A plan for your care that is created with you and your family (as per your direction) and involves all the members of your health care team. What s involved? Your care team will meet with you and your family to design a care plan that meets your specific needs and goals. Allied Health Professionals Primary Care Specialists Community Service Providers After the meeting you will have: Hospitals An individualized, coordinated plan focused on your goals Care providers who ensure the plan is being followed Support to make sure you are taking the right medication A care provider that you can call someone who knows you, is familiar with your situation and can help CCACs Long-Term Care
2 Why is your consent needed? To create a plan to improve your care, some information may need to be shared by your care team in order to: Determine eligibility for certain services Provide services Evaluate the services provided Plan Programs How will we protect your privacy? We will only collect, use, and disclose the minimum amount of your personal health information necessary to fulfill one of the purposes described above. Our goal is to provide the right care, at the right time, in the right place. Questions? Sandra Beausoleil, Project Manager (705) ext healthlink@muskoka.on.ca Secure Fax:
3 Muskoka Community Muskoka Health Link Frequently Asked Questions Q1. What is Muskoka Health Link? A1. Muskoka Health Link is a team of providers in Muskoka (primary care, hospital, home care, community care, long-term care providers, community support agencies, and other community partners) working together to provide coordinated health care to Clients with multiple complex conditions often seniors with the Client at the center. Providers design a care plan for each Client and work together with Clients and their families to ensure they receive the care they need. Q2. What are the Guiding Principles of Muskoka Health Link? A2. The Ministry of Health and Long Term Care (MOHLTC) provided the following for Health Link Guiding Principles: 1. Regular and timely access to primary care for complex Clients; 2. Effective provision of coordinated care for all of Ontario s complex Clients; 3. Consistent, quality care across the health care continuum and social services sectors; 4. Focus on vulnerable populations (frail and elderly, mental health and addictions, and palliative); 5. Evidence-based, measureable improvement of the Client experience through enhanced transitions in care; 6. Maximize coordinated care to generate system value, sustain the Health Link Model, and strengthen care coordination processes to realize greater efficiencies; 7. North Simcoe Muskoka Local Health Integration Network (NSM LHIN) has accountability for performance. NSM LHIN provides oversight of Muskoka Health Link and is accountable to the MOHLTC for Muskoka Health Link s performance; and 8. Shared MOHLTC, NSM LHIN, and Muskoka Health Link s accountability for overall success. 1
4 Muskoka Community Q3. What is Muskoka Health Link doing for Muskoka? A3. Our key goal is to strengthen linkages between primary care and the broader system of health and social services. Rural communities have easier access to primary care in Muskoka through the Muskoka Community Health Hubs in Dorset, Port Carling, Wahta, and the Mobile Unit which provides services to Vankoughnet, Port Sydney, and Severn Bridge. Developing coordinated care plans for clients with complex or chronic health and social needs. Q4. Who can receive coordinated care planning through Muskoka Health Link? A4. Any individual who is: 1. Living with complex conditions and is a high user of the health system, or is at risk of becoming a high user of the health system in one or more of the following ways: o Individual hospitalized in the last 3 months o 1 or more visits to the emergency department in the last month o Greater than 3 contacts with primary care provider in the last month o Greater than 3 organizations providing care to this individual AND 2. Currently dealing with 4 or more of the following criteria: o Lives Alone o Multiple Medications (5+) o Caregiver Burnout o Identified Disability (e.g. physical, visual, hearing, other) o Addiction Issue(s) (e.g. alcohol, smoking, drugs, gambling, other) o Chronic Disease(s) (e.g. diabetes, CHF, COPD, cancer, other) o Failure to Cope at Home o End of Life / Palliative o Poor Nutrition o Low Income / Ontario Works / ODSP o Cognitive Impairment / Dementia o o Frail o Risk of Falling o Other Mental Health Issues (e.g. depression, bipolar, PTSD, schizophrenia, other) 2
5 Muskoka Community Q5. How can you become a Muskoka Health Link Client? A5. Ask how you can be connected to Muskoka Health Link by speaking to your primary care provider or social services provider. More information can be found on our website at muskokahealthlink.ca. Q6. Who can refer clients to Muskoka Health Link? A6. Any health care provider or social services provider, including: Primary care providers (i.e. physicians, nurse practitioners, etc.) Family health teams Social service agencies North Simcoe Muskoka Community Care Access Centre Canadian Mental Health Association Muskoka Parry Sound Muskoka Algonquin Healthcare (Hospitals in Bracebridge and Huntsville) Muskoka Paramedic Services Ontario Provincial Police Fire Fighters Hospice Schools Other 3
6 Muskoka Community Q7. What is the Muskoka Health Link Referral Process? A7. Muskoka Health Link has attempted to make the referral process as efficient as possible. 1. Identify and refer clients who meet the criteria as outlined on the Muskoka Health Link Eligibility Form (as indicated in Question 4 above). a. Obtain Client consent and have the Client sign the Muskoka Health Link Participant Consent Form; b. Complete the Muskoka Health Link Eligibility Form; and c. Securely fax the completed Eligibility Form and signed Participant Consent Form to A Health Link Care Navigator will be assigned to work with the Care Team to assist and support the Client s needs: a. Muskoka Health Link Needs Assessment Tool may be used to identify Client goals; b. A Coordinated Care Plan will be completed for the Client; and c. Scheduling a Coordinated Care Conference, if required. Q8. What is a Coordinated Care Plan? A8. A Coordinated Care Plan is: A document that summarizes the Muskoka Health Link Client s needs, goals, barriers, identifies Care Team members, and shows a plan to meet the Client s goals, including advanced care plans; Shared with all Care Team members; and Anticipated to be updated based on the progress of the Client. 4
7 Muskoka Community Q9. Who are the Muskoka Health Link System Navigators and the Muskoka Health Link Care Navigators? A9. System Navigators are health care or social services providers who are the most appropriate primary contact to support the Muskoka Health Link Client. System Navigators may be primary care providers, social workers, case managers, patient experience flow navigators, or care coordinators. Care Navigators may act as System Navigators, or may act in a supportive capacity to the System Navigators. Care Navigators also work together to improve efficiencies to the Muskoka Health Link process so that Clients receive the best care possible. Q10. What do System Navigators and Care Navigators do? A10. System Navigators and/or Care Navigators: Are responsible for collaborating with Muskoka Health Link partners to identify and link Health Link Clients with health, social, and community services and programs; Aid in the facilitation and development of the coordinated care plans with care partners and providers, organizes and facilitates coordinated care conferences, monitors Clients needs, conducts surveys, and evaluates outcomes; Arranges, coordinates, and ensures the effectiveness of the services being provided to Clients with multiple medical and/or socially complex needs; Communicates with Clients to explain the Muskoka Health Link approach to care, schedule meetings and coordinated care conferences, completes assessments / reviews, and maintains regular contact with Clients and care partners; and Facilitates communication and collaboration with members of the Care Team, the Client, and their caregivers in order to optimize outcomes and to ensure the Client s goals are met. 5
8 Muskoka Community Q11. What is a Coordinated Care Conference? A11. The purpose of the Coordinated Care Conference is to bring together the Care Team to share information and to collaboratively create an action plan for meeting the Client s expressed goals and needs. The Coordinated Care Plan will be finalized at the Coordinated Care Conference and will be shared with the Care Team along with the signed consent. When possible, the Client should be present at the Coordinated Care Conference. If they are not able to attend or choose not to attend, efforts should be made to ensure that a caregiver is present and that the Client s goals are understood and clearly recorded in the Coordinated Care Plan as a result of the Client interview. Q12. What is the role of the Coordinated Care Conference? A12. The role of a Coordinated Care Conference is to: 1. Review, confirm, or revise a Client s Coordinated Care Plan (CCP), including goals; 2. Identify any gaps in programs, supports, and services required to implement the CCP; 3. Problem solve for better coordination of services to address any gaps in programs, supports, or services; 4. Clarify roles of each team member, including the client and family / caregiver; 5. Identify any other service providers who should be added to the Care Team going forward; and 6. Assign or re-assess the most appropriate provider to serve as System Navigator, or Care Navigator. 6
9 Muskoka Health Link facilitates bringing care providers together to coordinate and improve care delivery for individuals living with complex and chronic health needs. Patient/Client Eligibility Step 1: Checklist and Referral Information Page 1 of 2 INSTRUCTIONS: Please securely fax completed form and consent to A. PATIENT/CLIENT INFORMATION Eligibility Assessment Date: Patient / Client Name: Date of Birth: (Health Link is NOT age specific) Client Phone: ( ) Gender: Female Male Heath Card Number: Town/Community: (Please include HC version code, e.g. xxxx xxx xxx AA, where AA = version code) B. HEALTH LINK (HL) PATIENT/CLIENT IDENTIFICATION Using the criteria below, is the individual living with complex conditions a high user of the health system and/or at risk of becoming a high user? (Please check all that apply.) Individual Hospitalized in the last 3 months 1 or more visits to the emergency department in the last month Greater than 3 organizations providing care to this individual Greater than 3 contacts with Primary Care Provider in the last month Please list, if known. Note: if more than 5, please document in the Client s Coordinated Care Plan. Organization Contact Name Contact Contact Phone C. HEALTH LINK (HL) CRITERIA Does the patient also meet 4 or more of the identified criteria below? (Please check all that apply.) Lives Alone Caregiver Burnout Cognitive Impairment / Dementia Poor Nutrition Failure to Cope at Home Low Income/ Ontario Works / ODSP Frail Multiple Medications (5+) Risk of Falling End of Life / Palliative Chronic Disease(s) (e.g. diabetes, CHF, COPD, cancer, other): Please list. Addiction Issue(s) (e.g. alcohol, smoking, drugs, gambling, other): Please list. Mental Health Issues (e.g. depression, bipolar, PTSD, schizophrenia, other): Please list. Identified Disability (e.g. physical, visual, hearing, other): Please list. Other: Please list. When your health becomes more complicated, you often have more appointments, confusion with knowing the providers and what they do and maybe duplication or missed appointments. Health Link puts you in the centre with all of your providers working together to better coordinate care for you by developing a care plan to meet your needs. Health Link Eligibility Form Version Date: February 2017
10 Muskoka Health Link facilitates bringing care providers together to coordinate and improve care delivery for individuals living with complex and chronic health needs. Patient/Client Eligibility Step 1: Checklist and Referral Information Page 2 of 2 D. ACCESS TO PRIMARY CARE Does Patient/Client have a Primary Care Provider (PCP)? Yes No If Yes, provide name of PCP: PCP Phone: ( ) E. HEALTH LINK (HL) CARE TEAM Name of person who completed this form: Title: Organization: Phone: ( ) Has a Coordinated Care Plan (CCP) been developed? Yes No (CCP includes Name of System/Care Navigator, Names of Care Team Members, Summary of Patient/Client Needs and Goals, Linkage to Advanced Care Planning if appropriate, and has been developed with Patient/Client and/or Caregiver, System/Care Navigator, and Care Team.) If Yes, provide the date when the CCP was developed (mm/dd/yy): If Yes, please provide the name of the organization/agency where the CCP is stored: If No, the CCP has not yet been started, please identify reason: Provide Name of Primary Health Contact / System Navigator (e.g. Care Coordinators, Social Workers, Nurse Practitioners, Case Managers, others): Provide and Phone of Primary Health Contact / System Navigator: Phone: ( ) F. HEALTH LINK (HL) PATIENT/CLIENT CONSENT Patient and/or Health SDM/POA Accepts HL Service and has Completed HL Consent Form: Yes No If No, please identify reason: Please fax completed Health Link CLIENT ELIGIBILITY FORM and signed Health Link CONSENT FORM to: When your health becomes more complicated, you often have more appointments, confusion with knowing the providers and what they do and maybe duplication or missed appointments. Health Link puts you in the centre with all of your providers working together to better coordinate care for you by developing a care plan to meet your needs. Health Link Eligibility Form Version Date: February 2017
11 Muskoka Health Link Participant Consent Form Name Date of Birth / / (mm/dd/yyyy) I understand that in order to receive the best possible health outcomes, some information relevant to my care may need to be shared in order to: Determine eligibility for certain services; Provide services; Evaluate the services provided and plan programs. I understand and agree to the collection, use and disclosure of my personal health information with those care providers participating in the Health Link that have put information management practices and systems in place to make sure my information is shared only as necessary to fulfill the purposes described above. I understand that the Muskoka Community Health Link may ask for permission to disclose some of my information to additional service providers, on my behalf, with my specific agreement. I understand and agree that the Muskoka Community Health Link will only collect, use and disclose the minimum amount of my personal health information as necessary to fulfill the purposes described above. I also understand that I may: Withdraw consent for the sharing of personal health information by notifying my care provider; Have access to my information being held by my care provider by making a request to the care provider; Find out more about the Health Link and the way it manages my personal health information at Forward any questions I may have about my information or make a complaint if I believe that my personal health information has not been managed properly by contacting: Sandra Beausoleil, Project Manager Phone: x219 Yes, I have received the Health Link Post Card and have discussed this information with my care team. Printed Name of Health Link Client or Substitute Decision Maker Signature of Health Link Client or Substitute Decision Maker Date (mm/dd/yyyy) Printed Name of Witness Signature of Witness Date (mm/dd/yyyy) Version Date-February 2017
12 Coordinated Care Plan (CCP) Template Step 2: Health Link Coordinated Care Planning INSTRUCTIONS: Complete this form in collaboration with the Client and/or Health SDM, the Care Team, and HL Navigator. A. Coordinated Care Plan (CCP) Details Date Developed: Developed By: Next Review Date: Reviewed By: B. Health Link (HL) Client Information Given name: Preferred name: Surname: Date of birth: Telephone number: Marital status: Health card number: Official language: Ethnicity / Culture: People who live with Client: Where Client currently lives: People Client relies on most at home: People who depend on Client: Main Client contact: Relationship to Client: Telephone number: Emergency contact: Relationship to Client: Telephone number: Name(s) of Power of Attorney (POA), or Substitute Decision Maker (SDM) for Health: Telephone number of Power of Attorney (POA) or Substitute Decision (SDM) for Health: C. Health Link Client Care Team Name Role or Relationship Telephone # Primary Health Contact / System Nav. Participated in CCP?Y/N Health Link Care Navigator Has the Client and/or Health SDM been involved in the development of coordinated care plan? Revised: February 2017 Page 1
13 Coordinated Care Plan (CCP) Template Step 2: Health Link Coordinated Care Planning D. Client Medical Information Medical Diagnosis: Medications: See Attached (copies of medications from Pharmacies) Medication Review / Reconciliation Needed Past Medical History (May include allergies, significant surgeries and/or implanted devices such as pacemakers, transplants, stents.): Pharmacies Used in the Past 12 Months Name Tel E. Client Goals For Health and Well-Being Date Developed: What is most important to the Client right now: What does wellness mean to the Client: What are the Clients strengths and weaknesses: Expected Outcome (What Client Hopes to Achieve) Steps to Achieve Goal (What Client Can Do to Achieve it) Who Will be Responsible Barriers and Challenges Results So Far Review Date Revised: February 2017 Page 2
14 Coordinated Care Plan (CCP) Template Step 2: Health Link Coordinated Care Planning Expected Outcome (What Client Hopes to Achieve) Steps to Achieve Goal (What Client Can Do to Achieve it) Who Will be Responsible Barriers and Challenges Results So Far Review Date Expected Outcome (What Client Hopes to Achieve) Steps to Achieve Goal (What Client Can Do to Achieve it) Who Will be Responsible Barriers and Challenges Results So Far Review Date Revised: February 2017 Page 3
15 Coordinated Care Plan (CCP) Template Step 2: Health Link Coordinated Care Planning Expected Outcome (What Client Hopes to Achieve) Steps to Achieve Goal (What Client Can Do to Achieve it) Who Will be Responsible Barriers and Challenges Results So Far Review Date F. Client s Plan for Future Situations / Advanced Care Planning Do you have a plan for your future care? YES NO Would you like more information to help make plans for your future care? YES NO FOR HL NAVIGATORS ONLY: Copy of CCP provided to Primary Care Practitioner? YES NO Comments: Revised: February 2017 Page 4
TOOLKIT COORDINATED CARE PLANNING. London Middlesex Health Link
TOOLKIT COORDINATED CARE PLANNING The toolkit is for any individual/organization who will be participating in the Health Link approach to coordinated care planning September 2016 London Middlesex Health
More informationFrequently Asked Questions
Frequently Asked Questions What is Health Links? The Health Links approach intends to improve communication and collaboration among providers who share in the care of people with high care needs, the 5%
More informationOVERVIEW SCOPE & DEMONSTRATION OF IMPACT
210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: 705 326-7750 Toll Free: 1 866 903-5446 Fax: 705 326-1392 www.nsmlhin.on.ca 210, avenue Mémorial, Bureaux 128 Orillia, ON L3V 7V1 Téléphone : 705
More informationOVERVIEW. 210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: Toll Free: Fax:
210 Memorial Avenue, Suite 128 Orillia, ON L3V 7V1 Tel: 705 326-7750 Toll Free: 1 866 903-5446 Fax: 705 326-1392 www.nsmlhin.on.ca 210, avenue Mémorial, Bureaux 128 Orillia, ON L3V 7V1 Téléphone : 705
More informationMUSKOKA AND AREA HEALTH SYSTEM TRANSFORMATION COUNCIL TERMS OF REFERENCE
MUSKOKA AND AREA HEALTH SYSTEM TRANSFORMATION COUNCIL TERMS OF REFERENCE Table of Contents Background... 1 Vision for our Future... 1 Purpose of Health System Transformation Council... 2 Accountability...
More informationImproving the Last Stages of Life. UHN Alzheimer Symposium Ryan Fritsch, Project Lead May 2018
Improving the Last Stages of Life UHN Alzheimer Symposium Ryan Fritsch, Project Lead May 2018 The Law Commission of Ontario The Law Commission of Ontario (LCO) is Ontario s leading independent law reform
More informationPatient Reference Guide. Palliative Care. Care for Adults
Patient Reference Guide Palliative Care Care for Adults Quality standards outline what high-quality care looks like. They focus on topics where there are large variations in how care is delivered, or where
More informationHome and Community Care at the Champlain LHIN Towards a person-centred health care system
Home and Community Care at the Champlain LHIN Towards a person-centred health care system Presenter: Kevin Babulic Director, Champlain LHIN - Home and Community Care Outline Who is the Champlain LHIN-Home
More informationNorth Simcoe Muskoka Integrated Health Service Plan 1
North Simcoe Muskoka Integrated Health Service Plan 1 2 Imagine...a better health care system North Simcoe Muskoka Integrated Health Service Plan 1. Imagine...a better health care system 2 2. A vision
More informationCommunity Health and Hospital Services Integration Planning Process DRAFT Integrated Service Delivery Model for Northumberland County December 2013
Overview The Central East Local Health Integration Network is one of 14 Local Health Integration Networks (LHINs) established by the Government of Ontario in 2006. LHINs are community-based organizations
More informationA Guide to Consent and Capacity in Ontario
A Guide to Consent and Capacity in Ontario Table of Contents Introduction... 1 What Is Informed Consent and Capacity?... 2 Exceptions to Informed Consent and Capacity... 2 Who Determines Capacity?... 4
More informationCommon ACTT Referral Form
Common ACTT Referral Form WELCOME! Please ensure that you have completed the accompanying screening tool to ensure that the applicant qualifies for this service. We want to process this application as
More information2014/15 Quality Improvement Plan (QIP) Narrative
2014/15 Quality Improvement Plan (QIP) Narrative 4/1/2014 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a quality improvement plan.
More informationCPAN / CAPA Examination Study Plan
CPAN / CAPA Examination Study Plan Candidates should prepare thoroughly prior to taking the CPAN and/or CAPA examinations. This Study Plan is based on the CPAN and CAPA Test Blueprints and a weekly learning
More informationPatient: Gender: Male Female. Mailing Address: Ethnicity: Not Hispanic or Latin Hispanic/Latin Home Phone #:
5002 Highway 39 N Bldg. A Meridian, MS 39301 Phone: 601-512-0500 Fax: 601-512-0505 Patient Information Patient: Gender: Male Female First Middle Last Primary Language: English Spanish Other Mailing Address:
More informationThe Patient s Voice. Key findings from LHIN engagements with patients, families and caregivers. September 2015
The Patient s Voice Key findings from LHIN engagements with patients, families and caregivers September 2015 Background The Integrated Health Service Plan is a strategic roadmap that enables LHINs to move
More informationAdvancing Health Links: Using Year 1 Results to Move Forward
Advancing Health Links: Using Year 1 Results to Move Forward Progress to Date Province: 3,264 WW: 1,014 CARE PLANS PRODUCED Health Links are improving their care plan processes and laying the groundwork
More informationHealth Links: Meeting the needs of Ontario s high needs users. Presentation to the Canadian Institute for Health Information January 27, 2016
Health Links: Meeting the needs of Ontario s high needs users Presentation to the Canadian Institute for Health Information January 27, 2016 Agenda Items Health Links: Overview and successes to date Critical
More informationPatient-Centred Care. Health System Planning and Physician Practice. Aura Hanna, Ph.D.
Patient-Centred Care Health System Planning and Physician Practice Aura Hanna, Ph.D. Topics 2 Health Care System Integration Access Funding Chronic Disease Focus Physician Practice Communicating with patients
More informationExploring Your Options for Palliative Care
Exploring Your Options for Palliative Care A guide for patients and families Inside this booklet Question Page What is palliative care? 1 When should I receive palliative care? 2 Where can I receive palliative
More informationExpected Death in the Home Protocol EDITH. Guidelines for Implementation
EDITH Guidelines for Implementation Hospice Palliative Care Teams for Champlain Champlain Community Care Access Centre Centre d accès aux soins communautaires de Champlain Table of Contents 1. Overview...
More informationAdvance Care Planning Workbook Ontario Edition
Advance Care Planning Workbook Ontario Edition Speak Up Ontario c/o Hospice Palliative Care Ontario, 2 Carlton Street, Suite 808, Toronto, Ontario M5B 1J3 Who will speak for you? Start the conversation.
More informationQuality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario
Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/24/2017 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop
More informationIf you require films or CD, kindly give us 48 hour notice or make technologist aware at the time of your study.
A Note to Our Patient: Your physician will be receiving a copy of your results via fax within two business days. Please contact your physician to go over your results and to obtain a copy of your report.
More informationHEALTH HISTORY QUESTIONNAIRE
Patient Name: of Birth: HEALTH HISTORY QUESTIONNAIRE Primary Care Physician: Other physicians you currently see: Emergency Phone #: Contact Person/Relationship: Reason for the Visit: Please list your medications
More informationCentralized Intake and Referral Application to Specialty Hospitals
Centralized Intake and Referral Application to Specialty Hospitals CLIENT INFORMATION **** upon completion of referral please fax to 416-506-0439 **** Client Name: Gender: Male Female Other Client Preferred
More informationAssisted Living Services for High Risk Seniors Policy, 2011 An updated supportive housing program for frail or cognitively impaired seniors
Assisted Living Services for High Risk Seniors Policy, 2011 An updated supportive housing program for frail or cognitively impaired seniors January 2011 (as updated September 2012) Ministry of Health and
More informationSeniors Programs Activity Guide
Seniors Programs Activity Guide Monthly Spotlight Red Cross Transportation has agreed to partner with Seniors Programs and Services to provide transportation for W.I.S.E. Clubhouse participants who live
More informationCURE CARDIOVASCULAR CONSULTANTS
NEW PATIENT PACKET There are six pages in this packet that will help us get a clearer picture of your medical history and physical health. Please note: SIGNATURES are required on pages 2, 4, and 6. Please
More informationEnabling Health Links with a Care Coordination Tool. February 2014
Enabling Health Links with a Care Coordination Tool February 2014 Health Links highlighted the need for a care coordination tool Health Link business plans consistently highlight how technology could enable
More informationApplication Guide. Call for Applications Caregiver Education and Training. February 2017
Application Guide Call for Applications Caregiver Education and Training February 2017 Ministry of Health and Long-term Care Home and Community Care Branch 1075 Bay St, 10 th Floor Toronto, ON M5S 2B1
More informationThe Re-ACT Program. Remote Access to Care Technology
w w w.w E C A R E. C A The Re-ACT Program Remote Access to Care Technology January 2011 Introduction Almost 80% of Canadian adults over the age of 65 have some form of chronic disease. Treating and caring
More informationPatient Information & Medical History Nurse/Doctor appointment
18 William Street Bellingen NSW 2454 Phone: 6655 0000 Fax: 6655 0266 ABN 35 616 896 074 bhc@bellingenhealingcentre.com.au www.bellingenhealingcentre.com.au Patient Information & Medical History Nurse/Doctor
More informationPresenter Disclosure
CFPC Conflict of Interest Presenter Disclosure Presenters: Jenny Stranges, Programs Director Despina Tzemis, Programs Manager Ashley Edwardson, Outreach Social Worker Relationships to commercial interests:
More informationNorth Simcoe Muskoka LHIN
Further NSM LHIN HEALTH SYSTEM IMPROVEMENT PROPOSAL FORM Instructions for Use: Download (save) the file to your hard-drive or network. Rename the file in the following manner: name of your organization_cfp_code.
More informationParticipant Consent to Release Information
Participant Consent to Release Information I,, (print full name of participant or substitute decision maker) of (address) hereby authorize (name of agency serving in the role of Greater Sudbury Health
More informationCommunity and. Patti-Ann Allen Manager of Community & Population Health Services
Community and Population Health Services Patti-Ann Allen Manager of Community & Population Health Services October 2017 Community and Population Health Services-HHS ALC Corporate Planning Site Admin Managers
More informationPalliative Care Competencies for Occupational Therapists
Principles of Palliative Care Demonstrates an understanding of the philosophy of palliative care Demonstrates an understanding that a palliative approach to care starts early in the trajectory of a progressive
More informationPATIENT INTAKE PACKET
PATIENT INTAKE PACKET Welcome to the CannaMD family - you're in great hands! To reduce your visit and wait time, we ask that you please complete and submit this intake packet at least 24 hours prior to
More informationSpecial Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training
Special Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training 2018 Learning Objectives Program participants will be able to: List the three overall goals of the SNP Model of Care Describe the
More informationPalliative Care. Care for Adults With a Progressive, Life-Limiting Illness
Palliative Care Care for Adults With a Progressive, Life-Limiting Illness Summary This quality standard addresses palliative care for people who are living with a serious, life-limiting illness, and for
More informationKey Highlights
Working as a team with our many partners across Ontario s health care system, the Ontario Association of Community Care Access Centres (OACCAC) and Community Care Access Centres (CCACs) are helping transform
More informationLast Name First Middle. Mailing Address. City State Zip Phone. Date of Birth Age Soc. Sec# Cell. Employer Work Phone
Last Name First Middle Mailing Address City State Zip Phone Date of Birth Age Soc. Sec# Cell Employer Work Phone Email Address Emergency contact Phone # Relation: Name of Primary Insurance Policy # -----
More informationTrenton Memorial Hospital. Presentation to
Our TMH Resource Committee Trenton Memorial Hospital Facts and Figures Presentation to Quinte West Council 12 August 2015 1 Overview OurTMH Resource Committee projects: Provincial Organization of Health
More informationExpected Death in the Home Protocol EDITH. Guidelines
EDITH Hospice Palliative Care Teams for Central LHIN Sep 2015 Table of Contents 1. Overview... 3 2. Legislation... 3 3. Process... 4 Appendix 1 Do Not Resuscitate Confirmation Form... 6 Appendix 2 Do Not
More informationPatient Request Section:
Patient Request Form: Instructions Medical Assistance in Dying Manitoba Patient Request Section: In this section, you are making a request for medical assistance in dying. You are required to initial the
More informationEducation Facilitator Job Posting
North Simcoe Muskoka Hospice Palliative Care Network 169 Front Street South Orillia, ON, L3V 4S8 Education Facilitator Job Posting Title: Education Facilitator Reports to: Clinical Nurse Lead Classification:
More informationCrescent Community Clinic Application for Healthcare Services
Crescent Community Clinic Application for Healthcare Services If you have been diagnosed with a dental concern, a chronic health or mental health condition, you may be eligible for free healthcare at the
More informationOPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES
OPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES SECTION: PATIENT REFERRAL and INTAKE PROCEDURES 1 P age 1 CCP Referral Procedure Referrals for the Care Connections
More informationQuality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario
Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 2/22/2017 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop
More informationFaculty of Health and Environmental Sciences FHES Undergraduate Addendum
Faculty of Health and Environmental Sciences FHES Undergraduate Addendum Submission instruction: Health, science and sport students must complete the Health Addendum. Please upload the completed forms
More informationQuality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario
Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/30/2017 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop
More informationHOME IN THEHEROES INTHISISSUE FLOYD AND OLIVE DID YOU KNOW SOUTH WEST CCAC BY THE NUMBERS
HOME IN THEHEROES VOLUME 6 ISSUE 1 SUMMER 2 0 1 5 COMMUNITY NEWSLETTER INTHISISSUE MESSAGE FROM SANDRA COLEMAN, CEO SERVICES AVAILABLE THROUGH THE CCAC ALICIA S EXPERIENCE SHOW YOUR HERO YOU CARE WHAT
More informationTowards Aging at Home
Balance of Care: Towards Aging at Home Paul Williams, Janet Lum, Kerry Kuluski, Frances Morton, Allie Peckham, Jillian Watkins Presented to CIHR Team in Community Care & Health Human Resources 2009 Symposium,
More informationPATIENT INFORMATION Please Print
PATIENT INFORMATION Please Print DATE Patient s Last Name First Name Middle Name Suffix Gender: q Male q Female Social Security Number of Birth Race Ethnic Group: q Hispanic q Non-Hispanic q Unknown Preferred
More informationRule definitions OAR (d) OAR (a)
Rule definitions OAR 411-020-002 (d) OAR 411-020-002 (a) Statute Definitions ORS 124.050 (b) ORS 124.050 (c) ORS 163.200-205 Application Neglect and Abandonment Neglect means the failure (whether intentional,
More informationFamily doctor services registration
Family doctor services registration GMS1 Patient s details Mr Mrs Miss Ms of birth Surname First names Please complete in BLOCK CAPITALS and tick as appropriate NHS No. Male Female Home address Previous
More informationPatient s Full Name DOB Age. Patient s SSN Sex: Male Female Preferred Language. Place of Birth: City State Country
Hoover Hearing Clinic A division of Hoover ENT Hoover, Alabama 35244 205-733-9694 Tel PATIENT INFORMATION ACCOUNT # DATE MD NEW UPDATE Patient s Full Name DOB Age Patient s SSN Sex: Male Female Preferred
More informationThe South West Regional Wound Care Program (SWRWCP): A Collaborative Approach to Wound Care
The South West Regional Wound Care Program (SWRWCP): A Collaborative Approach to Wound Care 2017 OACCAC Conference June 15, 2017 #OACON17 I @OACCAC I @SWRWCP Disclosures None Objectives By the conclusion
More informationPatient Registration Form
Date: Padma Sripada MD, Columbia Internal Medicine 2500 Pond View, Suite 202 Castleton on Hudson, NY 12033 Phone: 518-391-2889 Patient Registration Form First Name Middle Last Name... Sex: M F Date of
More informationNHS Continuing Health Care Consent Form
NHS Continuing Health Care Consent Form Surname/family name (of individual being assessed) First names Date of birth: NHS number (or other identifier)... Responsible professional 1 Name:...... Job title...
More informationComplex Needs Working Group Report. Improving Home Care and Community Services for Individuals with Intellectual Disabilities and Complex Care Needs
Complex Needs Working Group Report Improving Home Care and Community Services for Individuals with Intellectual Disabilities and Complex Care Needs June 8, 2017 Contents Executive Summary... 3 1 Introduction
More informationPATIENT INFORMATION Name: Date of Birth Address: City: State: Zip
PATIENT INFORMATION Name: Date of Birth Address: City: State: Zip Primary Phone ( ) Secondary Phone ( ) Other Phone ( ) SS# - - Race Ethnicity Email address Preferred language Marital Status Minor Single
More informationResponsible Party Information (Information used for patient balance statements) Responsible Party Another Patient Guarantor Self
Patient Information (Please Print) Dr. Miss Mr. Mrs. Sir Patient s Name (Last) (First) (MI) Previous Name Address Line 1 City, State ZIP Home Phone Cell No. Work Phone Ext. Primary Care Provider (PCP)
More informationDr. Kristin Heins, ND Thrive Natural Family Health 110 Eglinton Avenue East, Suite 502 Toronto, Ontario M4P 2Y1 Telephone: (647)
Psychotherapy Client Information Today's date: A. Identification Your name: Date of birth: Age: Your nicknames/previous/maiden/aliases: Sex: [ ]Male [ ]Female Gender: Title: [ ]Mr. [ ]Mrs. [ ]Miss [ ]Ms
More informationFullerton Physical Therapy and Sports Care, Inc.
Fullerton Physical Therapy and Sports Care, Inc. Patient Information: Title Address Patient Name (Last, First, Middle initial) City/State/Zip Home Phone Work Phone Cell Phone Social Security DOB Gender
More informationAssessments of Decisional Capacity Who Does an Assessment and How is it to be done. Judith A. Wahl Advocacy Centre for the Elderly
Assessments of Decisional Capacity Who Does an Assessment and How is it to be done Judith A. Wahl Advocacy Centre for the Elderly Advocacy Centre for The Elderly 2 Carlton Street, Suite 701 Toronto, Ontario
More informationSupporting Best Practice for COPD Care Across the System
Supporting Best Practice for COPD Care Across the System May 3, 2017 Health Quality Ontario The provincial advisor on the quality of health care in Ontario Overview Health Quality Ontario background QBP
More informationBehavioural Supports Ontario (BSO)
Behavioural Supports Ontario (BSO) What does it mean for you? Laurie Fox HNHB BSO Project Implementation Lead Hamilton Health Sciences With I am who I am, so help me continue to be me Dana Vladescu, Manager,
More informationTelemedicine Services Telemedicine and Bringing Health Care Closer To Home Highlighting a Community-Based Approach
Telemedicine and Bringing Health Care Closer To Home Highlighting a Community-Based Approach Telemedicine Services, a part of Rideau Community Health Services Faculty/Presenter Disclosure Faculty: Andrea
More informationGP SERVICES COMMITTEE Palliative Care INCENTIVES. Revised January 2018
GP SERVICES COMMITTEE Palliative Care INCENTIVES Revised January 2018 GPSC Palliative Care Planning and Management Fees The following incentive payments are available to B.C. s eligible family physicians.
More informationW e l c o m e t o B i l l e r i c a C h i r o p r a c t i c
W e l c o m e t o B i l l e r i c a C h i r o p r a c t i c N E W P A T I E N T I N T A K E F O R M Print Name Today s Date Address City State Zip Email Address Date of Birth Male Female Social Security
More informationSeniors Programs Activity Guide
Seniors Programs Activity Guide Monthly Spotlight On May 4, 2018, Seniors Programs and Services announced our successful application to the Seniors Active Living Centre Program Expansion Grant. Now designated
More informationProject Description: Page Memorial Hospital (PMH) identified a need for patient care coordination and continuity for post discharge care.
Title: Improving Care Transitions by Utilizing a Multidisciplinary Approach Including a Transition Coach and Primary Care Model Hospital: Valley Health Page Memorial Contacts: Portia Brown Vice President
More informationToolkit to Support Effective Collaboration within an Integrated Care Team
Toolkit to Support Effective Collaboration within an Integrated Care Team January 2015 1 P a g e PCMCH Toolkit to Support Integrated Care Team Members The Provincial Council for Maternal and Child Health
More informationCMS Proposed Rule. The IMPACT Act. 3 Overhaul Discharge Planning Processes to Comply With New CoPs. Arlene Maxim VP of Program Development, QIRT
Overhaul Discharge Planning Processes to Comply With New CoPs Arlene Maxim VP of Program Development, QIRT 1 CMS Proposed Rule Included discharge planning specifics However, when the CoPs were finalized,
More informationApplication Form Travel Treatment Fund/Financial Support Drug Program
Application Form Travel Treatment Fund/Financial Support Drug Program Completing the Application Please fill out the form as completely as possible and attach the required document(s). If you need help
More informationRecommendations for Adoption: Diabetic Foot Ulcer. Recommendations to enable widespread adoption of this quality standard
Recommendations for Adoption: Diabetic Foot Ulcer Recommendations to enable widespread adoption of this quality standard About this Document This document summarizes recommendations at local practice and
More informationCooley Chiropractic. Date of Birth. Married Single Spouse Name. Street City State Zip. . Name. Occupation. Current Symptoms. When Symptoms began
Please Print Clearly Date NAME: Date of Birth Male Female Married Single Spouse Name Address: Street City State Zip Home Phone Cell Phone E-mail In Case of Emergency please contact: Name Phone Relationship
More information3/14/2014. Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking. Objectives. Background Information
Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking Jennifer Moore, RN Content Developer Objectives Describe two reasons why returns to the hospital are not desirable
More information2014/2015 Mississauga Halton CCAC Quality Improvement Plan
2014/2015 CCAC Quality Improvement Plan February, 2014 Approved by the MISSISSAUGA HALTON CCAC Board of Directors March 5, 2014 Community Care Access Centre 1 Overview of Our Organization s Quality Improvement
More informationSignature (Patient or Legal Guardian): Date:
X-Ray Patient Information: [ ] Male [ ] Female Patient Name: Date of Birth: / / SS#: Mailing Address: City: State: Zip: Phone # s: (Home) (Work) (Cell) Referring Physician: Phone #: /Fax#: Additional Physician:
More informationPalliative Care Community Teams: Supporting a Central East LHIN Model of Care June 2016
Palliative Care Community Teams: Supporting a Central East LHIN Model of Care June 2016 Introduction The Ministry of Health and Long Term Care s (MOHLTC) Patients First: Action Plan for Health Care exemplifies
More informationSage 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
More informationCare Management in the Patient Centered Medical Home. Self Study Module
Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management
More informationPERSONAL HEALTH INFORMATION PROTECTION ACT (PHIPA) Frequently Asked Questions (FAQ s) Office of Access and Privacy
PERSONAL HEALTH INFORMATION PROTECTION ACT (PHIPA) Frequently Asked Questions (FAQ s) Office of Access and Privacy The purpose of PHIPA is to protect and govern the individual s right to retain control
More informationCommunity Engagement Plan
Community Engagement Plan 2015/2016 1 Community Engagement C e n t r a l L H I N A n n u a l R e p o r t 2 0 1 5 / 2 0 1 6 Listening to the voices of our patients and caregivers, and continued engagement
More informationThe LHIN s role in creating integrated health service delivery systems
PATIENTS FIRST UPDATE The LHIN s role in creating integrated health service delivery systems February 7, 2018 Overview 1. Review of five goals of Patients First 2. South West LHIN committees, alliances
More informationPatient Registration Form
Padma Sripada MD, Columbia Internal Medicine 2500 Pond View, Suite 202 Castleton on Hudson, NY 12033 Phone: 518-391-2889 Date: Patient Registration Form First Name Middle Last Name... Sex: M F Preferred
More informationRegional Hospice Palliative Care Model Action Plan
ITEM 11.1 Regional Hospice Palliative Care Model Action Plan Central LHIN Board of Directors October 28, 2014 1 Agenda Background Declaration A Vision for Palliative Care in Ontario Central LHIN Approach
More informationSpecial Needs Plan Model of Care Chinese Community Health Plan
Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries
More informationChapter 2: Admitting, Transfer, and Discharge
Chapter 2: Admitting, Transfer, and Discharge MULTIPLE CHOICE 1. The patient is scheduled to go home after having coronary angioplasty. What would be the most effective way to provide discharge teaching
More informationSchedule 3. Services Schedule. Occupational Therapy
Occupational Therapy Services Schedule 2014 Consolidated Services Version Template Final Version September, 2014 Schedule 3 Services Schedule Occupational Therapy Occupational Therapy Services Schedule
More informationChamplain Community Care Access Centre
Champlain Community Care Access Centre What s inside: Welcome to the Champlain CCAC What Can I Expect From the CCAC? Nursing Clinics and Community Services Alternatives to Care at Home Your Rights and
More informationGuide to Accessing Quality Health Care Spring 2017
Guide to Accessing Quality Health Care Spring 2017 MolinaHealthcare.com 5771749DM0217 MyMolina MyMolina is a secure web portal that lets you manage your own health from your computer. MyMolina.com is easy
More informationDear New Patient, Once again, we would like to thank you for choosing us as your primary health care provider. We look forward to working with you.
307 West Central Street Wendy J. Parker, M.D. Natick, MA 01760 Deborah J. Riester, M.D. Telephone: 508-820-8383 Jo-Ann Suna,M.D. Fax: 508-820-0250 Hadia F. Tirmizi, M.D. Natalia Sedo, N.P. Christine Chang,
More informationCentral LHIN Community Governance Council Meeting. May 23 & 30, 2012
Central LHIN Community Governance Council Meeting May 23 & 30, 2012 Agenda Wl Welcome and dit Introductions ti Central LHIN Overview Draft ftstrategic t Vision i and dprinciples i Community Sector Optimization
More informationLEVELS OF CARE FRAMEWORK
LEVELS OF CARE FRAMEWORK DISCUSSION PAPER July 2016 INTRODUCTION In Patients First: A Roadmap to Strengthen Home and Community Care, May 2015, the Ontario Ministry of Health and Long-Term Care stated its
More informationCo-Creating the Future of Integrated Health Care
Co-Creating the Future of Integrated Health Care The text below accompanies a Prezi presentation entitled Co-Creating the Future of Integrated Health Care. The topic column will guide you through the presentation.
More informationAPPROACHES TO ENHANCING THE QUALITY OF DRUG THERAPY A JOINT STATEMENT BY THE CMA ANDTHE CANADIAN PHARMACEUTICAL ASSOCIATION
APPROACHES TO ENHANCING THE QUALITY OF DRUG THERAPY A JOINT STATEMENT BY THE CMA ANDTHE CANADIAN PHARMACEUTICAL ASSOCIATION This joint statement was developed by the CMA and the Canadian Pharmaceutical
More information