Nurse-Vorlage
Generic Chronic Care Management (CCM) Plan Notes
Eine professionelle Nurse-Vorlage für medizinisches Fachpersonal.
Über diese Vorlage
The Generic Chronic Care Management (CCM) Plan Notes template is an essential tool for nurses and healthcare providers involved in managing patients with chronic conditions. This comprehensive template facilitates detailed documentation of patient information, chronic and other medical conditions, social and access to care needs, and time spent on care management activities. It supports accurate billing with specific codes for chronic care management services. When used with Heidi, this template ensures efficient and thorough record-keeping, enhancing patient care and streamlining communication among healthcare teams.
Vorlagenvorschau
Reporting Month/Year: November 2024
Patient Information:
Name: John Doe
Date of Birth (DOB): 15 March 1950
Medical Record (MR) #: 123456789
Type of Residence: Assisted Living
Chronic Conditions:
- Hypertension (ICD-10: I10), diagnosed 2010. Managed with Lisinopril 10mg daily, low-sodium diet, and regular blood pressure monitoring.
- Type 2 Diabetes Mellitus (ICD-10: E11.9), diagnosed 2015. Managed with Metformin 500mg twice daily, dietary adjustments, and regular blood glucose monitoring.
Other Medical Conditions:
- Hyperlipidemia (ICD-10: E78.5). Managed with Atorvastatin 20mg daily and dietary modifications.
Other Needs (Social & Access to Care):
- Transportation Issues: Relies on community transport services for medical appointments.
- Social Support: Daughter visits twice a week and assists with medication management.
- Nutritional Concerns: Difficulty adhering to diabetic diet; receives meal planning assistance from a dietitian.
- Cognitive Concerns: Mild cognitive impairment affecting medication adherence; uses a pill organizer and receives oversight from caregivers.
Physician/QHP Responsible for Care Management:
Primary Physician: Dr. Emily Carter, MD
Date Initial Plan of Care Developed: 1 November 2024
Date Plan of Care Provided to Patient/Caregiver: 1 November 2024
Time Documentation for Chronic Care Management Activities:
1. 5 November 2024 – Telehealth consultation
- Time (Start-Stop): 10:00 - 10:30
- Total Time: 30 minutes
- Documentation Reference: Telehealth note
- Signature: Jane Smith, RN
2. 12 November 2024 – Medication review
- Time (Start-Stop): 14:00 - 14:20
- Total Time: 20 minutes
- Documentation Reference: EHR entry
- Signature: Jane Smith, RN
3. 20 November 2024 – Care coordination with dietitian
- Time (Start-Stop): 09:00 - 09:15
- Total Time: 15 minutes
- Documentation Reference: Call notes
- Signature: Jane Smith, RN
Total Time: 65 minutes
Billing Codes:
- 99487 – Complex Chronic Care Management (CCCM), at least 60 minutes of clinical staff time with moderate or high complexity MDM, per calendar month
- 99489 – Each additional 30 minutes of clinical staff time per calendar month (1 unit)
- 99490 – Chronic Care Management (CCM), at least 20 minutes of clinical staff time per calendar month
Supervising Physician/QHP Signature:
Dr. Emily Carter, MD
Date: 1 November 2024
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