|
Medication Changes:
|
Med Change Comments
|
|
Continue Medication Rationale
• • •
|
New Medication Rationale
• • •
|
|
Taper Medication Rationale
• • •
|
|
|
Lithium Labs
|
|
|
Labs for anticonvulsants
|
Routine labs
|
|
Labs
• • •
|
Lab Comments
|
|
Radiology
• • •
|
Radiology Comments
|
|
Home Health
• • •
|
Home health comments
|
|
Referrals
• • •
|
Referral Comments
|
|
Referrals
|
Referral Comments
|
|
Education
|
Education Comments
|
|
Diet
• • •
|
Diet comments
|
|
General Instructions
• • •
|
General Instruction Comments
|
|
Follow-up
|
Release of information
|
|
Read
• • •
|
|
|
Education
• • •
|
Education Comments
|
|
Problems Addressed
• • •
|
Patient's BMI and Category
• • •
|
|
Data Reviewed
• • •
|
Time Activities
• • •
|
|
PLAN
|
REFERRALS
|
|
LPN/RN Notified To Place Referral
|
Staff Notified to Reschedule NP apt.
|
|
Staff Notified to reschedule/schedule apt. with therapist
|
Patient/CG verbalizes understanding to POC
|
|
PMP Reviewed
|
|
|
Prolonged Visit (if= >70minutes)
|
Prolonged Visit 70-84 min (PPO)
|
|
Prolonged Visit 70-84 min (medicare)
|
Prolonged Visit 85-99 min (PPO)
|
|
Prolonged Visit 85-99 min (medicare)
|
Prolonged Visit >100 min (PPO)
|
|
Low Risk (lifestyle intervention only)
|
Moderate Risk (medication, minor procedure, or socially complicated)
|
|
High Risk (major surgery or hospitalization)
|
|
|
99212 (Problems=2, Data=0, Risk=low)
|
99213 (Problems=3,Data =1. Risk=low)
|
|
99214(Problems =4, Data =2, Risk=Moderate)
|
99215 (Problems =5, Data = 4, Risk =High)
|
|
|
99203 (Problems=3,Data =1. Risk=low)
|
|
99204 (Problems =4, Data =2, Risk=Moderate)
|
99205 (Problems =5, Data = 4, Risk =High)
|
