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Client's Monthly Intake Form

Gender
Preferred Contact
Tier Service
Service Type
Meeting Conducted Via

This document serves as the Health Home Monthly Progression Report for the service date and time listed above. The Care Coordinator (CC) provided Health Home services to the client during this visit. Throughout the visit, the CC engaged in discussions with the client regarding the risks and benefits outlined in the Health Action Plan (HAP), making sure the client had space to ask questions and express concerns. The CC also took time to go over the client’s rights and responsibilities, helping them understand their role in the care process. To support quality home health services, the CC reviewed privacy practices in line with Washington State HIPAA laws and EiJas Holistic Care’s Health Home Notice of Privacy Practices.”

Physical & Medical Update
Health & Wellness:   
For capturing behavioral, emotional, and social factors affecting care

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Services & Interventions
End-of-Visit Summary
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