Medical Care Plan Admission Date Client's First Name Client's MI Client's Last Name Suffix (If Applicable) DOB: Race Gender Please select an option Male Female Mobile Number Referring Hospital Referring Provider Insurance Provider Provider Please select an option BCBS HealthPartners Hennepin Health MA Medica UCare Diagnosis Code #1 Diagnosis Description #1 Diagnosis Code #2 (If Applicable) Diagnosis Description #2 (If Applicable) Diagnosis Code #3 (If Applicable) Diagnosis Description #3 (If Applicable) Knowledge Deficit of Current Diagnosis (Hold Control Button For Multiple Selections) · Client will verbalize understanding of current medical conditions · Medications and treatment regimens to improved conditions · Educate on lifestyle modifications to reduce occurrences (diet and exercise) · Educate on prevention (annual physical exams and vaccinations) · Facilitate follow-up appointments Knowledge Diagnosis Goal DM HTN Heart Disease Vascular Disease Heart Failure Respiratory Disease GI Disorder Wound Care Musculoskeletal Injury Reduced Hospital Readmission Goal · Client will verbalize understanding of chronic medical conditions · Educate on importance of medications and treatment regimens to improved conditions · Educate on lifestyle modifications to reduce occurrences (diet and exercises) · Educate on prevention (routine -follow-up, annual exams, and vaccinations) · Facilitate communication between specialist and primary care providers to avoid gaps in treatment. Improve Quality of Life Goal · Adopt a balanced diet and daily exercise · Address physical, emotional and social needs · Management of pain · Mental health screenings Improved Daily Living & Security Goal · Safe and secure shelter for recovery · Connections to social services and resources · Connection to long-term housing and safe environment · Fall prevention Other Known Medical Conditions Impacting Recovery (If Applicable.) Medication List Plan of Care Orders Medication Reminder Assistance Supervised Self-Administration of Medications Wound Care Observation & Dressing Change Infection Monitoring Daily Vitals Blood Pressure Monitoring Blood Glucose Monitoring Oxygen Use Monitoring Periodic Weight Monitoring Medical Appointment Coordination Mental Health Coordination Substance Use Coordination Additional Orders & Goals Client Responsibility • Follow provider medical instructions • Take medications as prescribed • Attend all scheduled appointments • Notify staff of worsening symptoms • Participate in discharge planning Staff Completing Case Plan Staff Title Staff Phone Number Staff Email Date Created Submit Medical Plan Your Preferred Recuperative Care Provider
