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Plan - New Admission #1
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PLAN TRANSFER OF CARE MD
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PLAN: New admission #2
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Plan New admission SNF #3
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Plan: New admit lab monitoring
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PLAN ANNUAL H&P #1
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annual h&p #2
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Plan 30/60 #1
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annual h&p LTC
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PLAN 30/60 #2
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annual H&P dementia
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plan 30/60 #3
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ANNUAL H&P PLAN
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DR. R HCP ACTIVATION
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DR. JANCEK HCP ACTIVATION
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DR. DELGADO HCP ACTIVATION
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CCM activities
• • •
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CHF SubsVis Plan w Eval FTT WGC
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CHF SubsVis Plan EvalFTT (WCUnco
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CHF SubsPlan EvalFTT (WLUncon)
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Plan: initial weight for AFTT
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CHFSubs Plan EvalFTT (WLContr)
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Plan: annual H&P
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PLAN: Continue supportive care
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Plan: Discharge
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Plan: CHF initial visit
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Plan: malnutrition
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Plan: CHF initial visit
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Plan: REFILL anxiety
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Plan: hyperlipidemia
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Plan: Depression
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Plan: med refill
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Plan: pharmacy recommendations
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PAIN REFILL #1
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Plan: PT cert
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plan: psych recommendations
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generalized weakness
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Plan: anxiety
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Cerumen management
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DM II
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Cerumen management 2
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hypertension
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plan influenza
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s/p fall
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weight loss
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Skin tear
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CHF
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weight loss
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COPD
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DYSPHAGIA
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PLAN: covid elevated risk
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covid positive
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covid negative
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EDEMA
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DM SHOES
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MANUAL WHEEL CHAIR PLAN FACE TO FACE
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DEMENTIA
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PLAN no changes/psych patient
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MEDICARE CERTIFICATION AND RECERTIFICATION
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Peripheral IV hydratation 96360
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PLAN: anxiolytic refill
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PLAN-Therapy EVAL
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PLAN: power mobility device/F2F
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OT
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Labs
• • •
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Lab Comments
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Radiology
• • •
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Radiology Comments
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PT Recommendations
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PT Recommendation Comments
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Home Health
• • •
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Home health comments
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FOLLOW UP IN:
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Reason:
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Referrals
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Referral Comments
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Education
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Education Comments
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Diet
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Diet Comments
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General Instructions
• • •
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General Instruction Comments
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New Field
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Discontinued Meds:
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New Field
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Medications HOLD
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New Field
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New Field
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New Field
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New Field
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New Field
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New Field
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Arem
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Maria R.
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Jasmine
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Nancy (Dr. R)
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Nekera (Cindy)
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Nekera (Stephanie)
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Adriana (NP Pacheco)
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Nekera (Dr. Jancek)
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Adrianna (Dr. D)
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Star
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Adrianna (Dr. R)
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JOEMAYRI (Dr. R)
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Joemayri (Dr. Delgado)
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