Transitions of Care Settings
Discharge Summary Review
Documenting TOCs
Miscellaneous
Miscellaneous (cont'd)
100

The client cannot wait to see their primary care doctor and they go here.

What is the The Emergency Room?

100

The clients should ________________ the discharge plan

What is understood? 

100

In GRHHN, you would use me as a drop-down to complete your notes.

What is the ED/IP Follow-Up Drop Down?


100

I am required when a member has an admission or stay for a reason not already identified through the assessment process and/or addressed on their plan of care.

What is the Adult Assessment Update?

100

We should be notified of the admission, discharge, and any changes in medications.

Who is the treatment team? 

200

The client goes for a visit and kept by a medical professional 

What is an Inpatient Admission?

200

The client should ___________________ with the plan.

What is agree?

200

In HHUNY, you would use me as a drop-down to enter your notes. 

What is the Transition of Care drop-down?

200

After the client has been admitted, when should they be pended? 

What is 30 days?

200

Upon discharge, you are required to attempt a face-to-face contact within what number of days?


What is contact the client within 2 business days of discharge or from the time you became aware of the event?

300

Sometimes the client needs a little more time to heal or recover and they go here

What is a Residential Rehabilitation Facility?

300

The after-visit summary should contain these things.

What are clear medical directions, follow-up appointments, and who to contact post-discharge?

300

I can be used for either GRHHN or HHUNY to ensure that pertinent information is included in the TOC note.

What are the GRHHN Templates?

300

The CC should do this if their client doesn’t attend a follow-up appointment.

What is the Care Coordinator should assist in rescheduling the missed appointment?

300

The CC needs to obtain me upon their client's discharge.

What is a copy of the discharge summary?

400

The client goes here to safely manage withdrawal symptoms. 

What is a detox facility?

400

This should be arranged so that the client can attend their scheduled appointment(s). 

What is transportation?

400

"The client went to the ED and I called them to follow up." I am an example of what?

A non-billable note. 

400

We should be reviewed and updated upon discharge as needed. 

What are the crisis plan and plan of care? 

500

If the admission was related to behavioral health, the CC must verify that this has occurred.  

What is behavioral health appointments are scheduled within 7 and 30 days of discharge?

500

I am required when a member has an admission or stay for a reason not already identified through the assessment process and/or addressed on their plan of care.

What is the  Adult Assessment Update? 

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