For each incident, include: date, type, circumstances leading up to it, and post-incident follow-up (how staff are supporting/preventing future incidents). One incident per paragraph.
Include date of visit, whether seen by a provider, if admission was recommended, if they left AMA, and follow-up engagement upon return. One visit per paragraph.
Include date admitted, unit, reason, and follow-up (still hospitalized / discharge date / current follow-up steps). One hospitalization per paragraph.
If tenant is connected to ACS, APS, AOT, ACT, or IMT this must be included and indicated. One provider/service per paragraph, with notes on status, progress, and ways to support increased or continued engagement.
Review appointments tenant had scheduled in the past month and provide updates. For each: appt date, appt type/provider (if it was to receive a medication, e.g. an injection, note that clearly), whether they did or did not attend and what facilitated or got in the way, and follow-up notes. Include all appointment types (medical, legal, social, etc.). One appointment per paragraph.
For each: appt date, appt type/provider, and notes on how to support attendance (e.g. plans for escort). One appointment per paragraph.
Write down the goals the tenant is working on (per their A-ICM Assessment-informed Service Plan) and their progress since last case conference. For each goal: state the goal, progress (Making progress/Improving, Stable/No significant change, or Declining), and notes on progress (barriers, facilitators, ideas to support). One goal per paragraph.
Based on today's case conference discussion, what tasks should each A-ICM team member be working on? Include all pertinent supports (CM, APD, PD, HRS, ADS, HSS, Tenant Peer Support, etc.). For each staff member: name, role/function, present for today's meeting (yes/no), and tasks assigned plus target completion date. One staff member per paragraph.
Anything else important to document about the tenant (engagement, needs, strengths, challenges, etc.).
