PCP letter
Hi, I am {formtext: name=Clinician Name} a clinician at Accompany Health. I saw your patient on {formdate: YYYY-MM-DD; name=Visit Date}.
Patient clinical stability is {formmenu: stable; worsening; unstable; high risk; name=Clinical Stability}.
{if: `Clinical Stability` <> "stable"}
{formtoggle: name=Show Clinical Recommendations}Clinical recommendations below:{endformtoggle}
{endif}
Med rec was completed — {formmenu: patient is taking all meds as prescribed; is not taking all meds as prescribed; patient has questions/concerns about their meds that we were unable to answer; name=Medication Reconciliation}.
{if: `Medication Reconciliation` = "patient has questions/concerns about their meds that we were unable to answer"}
{formmenu: all questions were answered and patient understands medications; additional questions/concerns are:; name=Medication Questions Status}
{if: `Medication Questions Status` = "additional questions/concerns are:"}
{formparagraph: name=Additional Medication Questions}
{endif}
{endif}
{if: `Medication Reconciliation` = "is not taking all meds as prescribed"}
{formtoggle: name=Reviewed Appropriate Use}Reviewed appropriate use of all meds{endformtoggle}
{formtoggle: name=Suggest Discontinuing}Suggest discontinuing or deprescribing as below{endformtoggle}
{formtoggle: name=Outreach Specialist}Outreach to specialist to clarify or confirm{endformtoggle}
{formtoggle: name=Patient Ran Out}Patient has run out of {formtext: name=Medication Name} and action plan is {formtext: name=Action Plan}{endformtoggle}
{formtoggle: name=Additional Supports}Patient may need additional supports to promote med adherence{endformtoggle}
{endif}
Medication change recommendations based on today’s visit? {formmenu: yes; no; name=Medication Change Recommendations?}
{if: `Medication Change Recommendations?` = "yes"}
Medication change recommendations: {formparagraph: name=Medication Recommendations}
{endif}
Vital signs {formmenu: at goal; not at goal; name=Vital Signs Status} today.
{if: `Vital Signs Status` = "not at goal"}
Recommendations: {formparagraph: name=Vital Sign Recommendations}
{endif}
Based on {formtext: name=Reason for Referral}, we made referrals to the following specialists:
{formparagraph: name=Specialist Referrals}
Orders placed? {formmenu: yes; no; name=Orders Placed}
{if: `Orders Placed` = "yes"}
{formmenu: yes; no; name=Quality Orders Placed}
{if: `Quality Orders Placed` = "yes"}
Quality orders: {formmenu: multiple=yes; mammogram; colonoscopy; FIT test or Cologuard; DEXA scan; name=Quality Orders}
{endif}
Work up based on risk factors: {formmenu: multiple=yes; Sleep Study; Labs (A1C, CMP, Hepatitis Screenings, HIV screening, CBC, Other {formtext: name=Other Labs}); PFTs; Imaging: {formtext: name=Imaging Type}; name=Risk Factor Workup}
{endif}
Follow-up plan: {formmenu: annually and as needed; next visit scheduled on; name=Follow Up Plan}
{if: `Follow Up Plan` = "next visit scheduled on"}
{formdate: YYYY-MM-DD; name=Next Visit Date}
{endif}