Care Management Chart Review Tool Page 2
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2Care Management Chart Review Tool
SOCIAL SUPPORT
Communication Barriers (language, sensory deficits)?
YES
NO
Cognitive barriers?
YES
NO
Does not have stable housing?
YES
NO
Limited social support?
YES
NO
Is not currently employed?
YES
NO
Financial barriers (including underinsured, unable to afford meds)?
YES
NO
Transportation issues?
YES
NO
Literacy issues (difficulty with reading/writing)?
YES
NO
Issues with bereavement (losses/grieving)?
YES
NO
COMMENTS:
SELF MANAGEMENT/MENTAL HEALTH
Non-adherence to previous treatments?
YES
NO
Hospital admission(s) in the past year for mental health-related reason?
YES
NO
Current Behavioral Health diagnosis/substance abuse?
YES
NO
COMMENTS:
OTHER IMPORTANT INFORMATION
Other underlying issues not noted above?
YES
NO
If yes, please comment:
V. 11.20.2015
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Parent category: Medical