Form Helps Coordinate Care for Seniors

A team of Pennsylvania health care organizations has developed a form that will help long-term care facilities and physicians coordinate patient care. 

Download the form to use in your practice or facility 
 

“We’re hoping that it will be a win-win for everyone. Hopefully, it will facilitate providing the highest quality care,” said Joseph Sassani, MD.  

The Hershey ophthalmologist represents the Pennsylvania Academy of Ophthalmology on the Pennsylvania Medical Society’s Specialty Leadership Cabinet and brought the issue to the cabinet. 

The form was developed by the Pennsylvania Medical Society, the Pennsylvania Medical Directors Association, and Pennsylvania’s medical and surgical specialty societies. 

Consultation forms that accompany patients to the physician’s office are often missing a key piece of information—the name and address of the long-term care facility that sent the patient. 

“Unfortunately, there’s no standardization of forms. Many of them assume that we know the name and address of the institution from which the patient is coming, and that is often not the case,” Dr. Sassani said.  

“The new form more clearly states the information that we need to do our consults,” he added. 

Dr. Sassani said the form can replace a facility’s current consultation form. Staff just completes the first half of the form—which asks for information like patient name, reason for consultation, and current medications—and sends it with the patient to the specialist’s office.  

The specialist completes the rest of the form with diagnosis information, recommendations for further testing or medication changes, and whether a follow-up appointment is needed. 

Download the form below.

Some links require Adobe Acrobat Reader. Download it for free.

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Last Updated: 7/23/2009
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