TCM Note_No contact made

Transitional Care Management Initial Contact Note

Date of admission: [date name="date_of_admission"]

Date of discharge: [date name="date_of_discharge"]

Hospital: [text name="hospital" default="Name of hospital"]

Attending Physician: [text name="attending" default="Attending provider name, if known"]

Reason for Hospitalization: [textarea name="reason" default=""]

Discharge Diagnoses: [textarea name="discharge_diagnoses" default=""]

[checkbox name="Records" value="Records available and uploaded into GehriMed.|Records request sent today."]

Contact attempt #1:[date name="contact_date" default="08/27/2021"]
Number called: [text name="number_called" default="615-999-9999"]
Result: [radio name="Results" value="Voicemail left|Voicemail box was full or not set up|Phone number was disconnected|Phone number is no longer valid"]

Contact attempt #2:[date name="contact_date2" default="08/27/2021"]
Number called: [text name="number_called2" default="615-999-9999"]
Result: [radio name="Results" value="Voicemail left|Voicemail box was full or not set up|Phone number was disconnected|Phone number is no longer valid"]

The patient has the following NEW medications: [textarea name="New_meds" default="Unable to determine, patient and records not available."]
The following medications were stopped: [textarea name="Stopped_meds" default="Unable to determine, patient and records not available."]

Pending Labs and Imaging Studies: [textarea name="pending_findings" default="Unable to determine, patient and records not available."]

Recommended Outpatient Evaluations/Appointments: [textarea name="outpatient_evaluations" default="Unable to determine, patient and records not available."]

Home health agency: [textarea name="Home_Health" default="Unable to determine, patient and records not available."]

Scheduled TCM Provider Visit: [date name="date_of_visit"]