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  • Name

  • Address-- physical, facilities

  • Email

  • Cell phone

  • Phone 2

  • Emergency Contact

  • EC phone

  • DOB

  • MRN/ID

  • Link to family members?

SDOH:

Race

UDS Race Definition

Ethnicity

UDS Ethnicity Definition

Non-English

UDS Definition: Better served in language other than English

PopStatus

UDS Definition: Special Population Status

FPL

UDS Definition: Federal Poverty Level

HealthInsStatus

Health Insurance Status

HealthInsSource

Health Insurance Type

Education

Educational attainment

Transportation Access

Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

Zip Code

Food Insecurity

Housing Insecurity

Access to Care

Social Isolation

Domestic Violence

Pandemic Support Assessment
Bio Psycho -Social Assessment Measure
Bio - Medical
• Chronic
• Acute
• New
• COVID-19
Psycho -
• Existing MH
• Social Isolation & Coping
• New MH Needs
• Beyond Normal & Self harm (needing professional assistance)
Social -
• Groceries
• Transportation
• Access
• Financial
• Domestic Violence
○ Intimate Partner Safety
○ Child Abuse

Status:

No known risk, symptoms, testing or exposure-- have you ever tested positive, had illness consistent with COVID-19, been exposed to positive case or high risk person/location?

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  • Nurse/Case Managers

  • Physicians/APRNs/PAs

  • Other care team members?

  • Community Health Workers?

Requirements:

PopHealth:

  • Filter patients by status, demographics, case manager, follow up action

  • Open/link to individual patient from dashboard

  • Generate reports

  • Stratify patients by risk

Case Management:

  • Facilitate shared decision-making

  • Document goals and progress towards goals

  • Allow inclusion of relevant clinical data-- vital signs, conditions, medications

  • Allow import of data from an inpatient encounter

  • Facilitate information about SDOH and barriers to health and identify enabling services

  • Provide CDS on the next management step-- assign follow up to an individual and a date/time

  • Stratify patients by risk and clinical progress (change in condition)-- modify CDS to those factors

General Requirements:

Workflow:

Subcomponent 2: Risk Calculator for Existing Patients and Follow-Up Risk Reduction Tool (NACHC)

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