Page 61 - Business Development Orientation Binder

4/9/2019

Coordination Note: BD Onsite Assessment Hospital Hold

REQUESTED START OF CARE:
HOMECARE REASON/HOMECARE SPECIAL INITIATIVES/CARE TYPES:
DIAGNOSIS: NOTES RELATED TO SPECIAL INITIATIVES:
TREATMENT ORDERS:
ANTICIPATED DISCHARGE DATE? HOMECARE REASON/HOMECARE
DIAGNOSIS:
ASSESSMENT NOTE FROM BD ONSITE TREATMENT ORDERS:
STAFF: CONFIRMED MD COORDINATING CARE IN
THE COMMUNITY (FULL NAME):
METHOD OF ASSESSMENT (TELEPHONIC OR NEXT APPOINTMENT DATE WITH
BEDSIDE): COMMUNITY MD:
IS THE PATIENT AGREEABLE TO HOMECARE?
UPDATED VISIT ADDRESS (IF ANY): FUNCTIONAL ISSUES:
IS THE PATIENT RECEIVING ANY OUTPATIENT SPECIFIC TEACHING INITIATED ONSITE:
THERAPY? CAREGIVER SUPPORT:
(IF YES, PLEASE REVIEW REFERRAL WITH ADVANCED CARE PLANNING PERFORMED?
BRANCH AS APPROPRIATE) PALLIATIVE PERFORMANCE SCALE SCORE:
OTHER NOTES:
ANTICIPATED DISCHARGE DATE?
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Coordination Note: BD Onsite Assessment Hospital Hold ctd.

SPECIAL INITIATIVES/CARE TYPES TELEHEALTH:
(PLEASE MARK “X” NEXT TO CARE TOTAL JOINT REPLACEMENT:
TYPE NEEDED FOR PATIENT): PEDIATRICS:
ADR:
POSTPARTUM:
AUR:
ADU: OTHER:
ANTEPARTUM:
NOTES RELATED TO SPECIAL
BEHAVIORAL HEALTH: INITIATIVES:
BP3:
BP2 (NYU):
INFUSION:
INTENSIVE REHAB:
MT. SINAI VISITING MD:

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