Care Team
Physician and APP
- Initial assessment
- Plan of care
- Complex symptom management
- Ongoing medication management
RN
- Routine visits
- Medication education
- Manage triage calls
LCSW/LMSW
- Psycho-social needs
- Resources
- Advance directives
Components
Symptom management for advanced illnesses
Care collaboration/ transition of care
Patient and Caregiver Education
Goals of Care and Advance Plan Directives
Social and spiritual services
Services
24/7 on call triage service with access to physician as needed
Care collaboration; may include sharing plan of care with other providers
Proactive medication refills
Inter-disciplinary team visits; frequency based on patient need
Patient contacted within two business days from referral
Full office hours Monday-Friday (8am-5pm)
Why Integrity Care Partners?
Clinical Teams Trained In Palliative Care
Providing The Appropriate Services
A Comprehensive Care Model
