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CARE MANAGEMENT/CARE COORDINATION - DEPRESSION
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020
PATIENT PREFERENCES AND FUNCTIONAL LIFESTYLE GOALS:
increase life enjoyment, be more involved socially,be organized, feel better, have more energy, sleep less

SELF-MANAGEMENT PLAN:
consider attending counseling sessions, decrease alcohol intake, exercise daily, consider joining a support group, consider journaling, sleep 7-9 hours each night, take medication daily as
prescribed
CARE PLAN PROVIDED TO PATIENT/FAMILY/CAREGIVER

CARE MANAGEMENT/CARE COORDINATION - HIGH RISK / UTILIZATION OF MEDICATIONS
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020

SELF MANAGEMENT PLAN: adhere to medication treatment, get
timely refill, print out medication schedule, use medication pill box organizer


CARE MANAGEMENT/CARE COORDINATION - DIABETES
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020
PATIENT PREFERENCES AND FUNCTIONAL LIFESTYLE GOALS:
control eating habits, decrease pain/numbness in feet, increase exercise tolerance, increase life enjoyment, make better choices when eating out, feel better, increase energy levels

SELF-MANAGEMENT PLAN:
consider attending diabetes education classes, continue current management plan, eat frequent small meals, get 7-9 hours of sleep per night, increase exercise, limit carb intake, lose weight, monitor home glucose readings, reduce alcohol intake

CARE PLAN PROVIDED TO PATIENT/FAMILY/CAREGIVER

BARRIERS to care: assessed and addressed
potential barriers,Dosing frequency,Educational,Fear of
needles,Financial,Lack of confidence,Lack of family support,Lack of motivation, medication side effects
CARE MANAGEMENT/CARE COORDINATION - DEPRESSION
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020
PATIENT PREFERENCES AND FUNCTIONAL LIFESTYLE GOALS:
increase life enjoyment, be more involved socially,be organized, feel better, have more energy, sleep less

SELF-MANAGEMENT PLAN:
consider attending counseling sessions, decrease alcohol intake, exercise daily, consider joining a support group, consider journaling, sleep 7-9 hours each night, take medication daily as
prescribed
CARE PLAN PROVIDED TO PATIENT/FAMILY/CAREGIVER

CARE MANAGEMENT/CARE COORDINATION - HIGH RISK / UTILIZATION OF MEDICATIONS
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020

SELF MANAGEMENT PLAN: adhere to medication treatment, get
timely refill, print out medication schedule, use medication pill box organizer


CARE MANAGEMENT/CARE COORDINATION - DIABETES
DATE OF CARE PLAN CREATED/REVIEWED: 10/21/2020
PATIENT PREFERENCES AND FUNCTIONAL LIFESTYLE GOALS:
control eating habits, decrease pain/numbness in feet, increase exercise tolerance, increase life enjoyment, make better choices when eating out, feel better, increase energy levels

SELF-MANAGEMENT PLAN:
consider attending diabetes education classes, continue current management plan, eat frequent small meals, get 7-9 hours of sleep per night, increase exercise, limit carb intake, lose weight, monitor home glucose readings, reduce alcohol intake

CARE PLAN PROVIDED TO PATIENT/FAMILY/CAREGIVER

BARRIERS to care: assessed and addressed
potential barriers,Dosing frequency,Educational,Fear of
needles,Financial,Lack of confidence,Lack of family support,Lack of motivation, medication side effects

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