Care Navigation Visit
- Collaborate with healthcare team
- Liaison
- Accompany patient to medical appointments, if applicable
Immediate Needs Assessment
Immediate Needs Assessment
Immediate Needs Assessment
- Evaluate level of care needed
- In-home nurse practitioner monitoring, if applicable
- Facilitate expediting care
Post Hospital Discharge
Immediate Needs Assessment
Immediate Needs Assessment
- Facilitate appointment scheduling
- Medication review, assistance, education
- Symptom co-management and wound care guidance
Palliative Prognosis
Palliative Prognosis
Palliative Prognosis
- Review medical records
- Assess understanding of health status, provide guidance and clarification
- Symptom co-management and wound care guidance
- Re-assess baseline functional status
Family Support
Palliative Prognosis
Palliative Prognosis
- What to expect and how to prepare for changes in condition or care setting
- Questions, concerns, validation and emotional support