Nursing Home: Interdisciplinary Care Team
Interdisciplinary Care Team
- Provide written communication of significant health events, name, and contact information of the member’s case manager/care coordinator and information from the member’s service plan for the PCP at least annually and as needed for emergency department visits, care transitions, and other events or services.
- Use the template document
ICT Communications Form (doc)
in CCM under “Document Templates.”
- Document in contact notes when the ICT Communication Form was sent to the member’s PCP.
- Copy of the ICT Communication Form can be placed into the member’s nursing home chart where the PCP would review it when visiting the member in the nursing home.