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PATIENTCENTRED MEDICAL HOME ASSESSMENT (PCM HA) Organization name Site Name Date completed This document has been adapted for use in Australia by Went West with permission from the following source:

How to fill out patient-centred medical home assessment

How to fill out a patient-centred medical home assessment:

1. Start by carefully reviewing the assessment form provided. Familiarize yourself with the different sections and the information required for each.
2. Begin by filling out the basic demographic information, such as the patient's name, age, gender, and contact details. This will help identify the patient correctly and ensure accurate record-keeping.
3. Move on to the medical history section. Here, you will provide details about the patient's past and current medical conditions, surgeries, allergies, and medications. Be as thorough as possible to ensure comprehensive and accurate documentation.
4. In the next section, detail the patient's healthcare preferences and goals. This includes information about the patient's primary care provider, preferred language, and any cultural or religious considerations that may impact their healthcare choices.
5. The assessment may also include questions about the patient's social history, lifestyle choices, and psychosocial well-being. Take the time to gather this information, as it can provide valuable insights into the patient's overall health and well-being.
6. It is important to accurately report any relevant family medical history as well. This can help healthcare providers identify potential genetic predispositions or conditions that may impact the patient's health.
7. The assessment may include questions about the patient's access to healthcare services, including insurance coverage, personal financial constraints, and transportation options. Answer these questions to the best of your knowledge to help healthcare providers understand potential barriers to care.
8. Once you have completed all the sections of the patient-centred medical home assessment, take the time to review your answers. Double-check for any inaccuracies or missing information. Make sure all sections are properly filled out to ensure a comprehensive assessment.

Who needs a patient-centred medical home assessment:

1. Individuals seeking primary healthcare: The patient-centred medical home assessment is typically conducted for individuals who are seeking primary healthcare services. This assessment helps healthcare providers understand the patient's medical history, preferences, and goals, allowing them to deliver personalized and patient-centred care.
2. Patients with complex medical needs: The assessment is particularly beneficial for individuals with complex medical needs or chronic conditions. It helps healthcare providers gather detailed information about the patient's health status, social support, and access to healthcare services, enabling them to develop an effective care plan.
3. Healthcare organizations implementing the patient-centred medical home model: The patient-centred medical home assessment is an essential tool for healthcare organizations that have adopted the patient-centred medical home model. It allows them to collect standardized information from patients, enabling better care coordination, enhanced quality of care, and improved patient outcomes.

For pdfFiller’s FAQs

What is patient-centred medical home assessment?

Patient-centred medical home assessment is a tool used to evaluate and improve the quality of care provided by healthcare practices.

Who is required to file patient-centred medical home assessment?

Healthcare practices participating in patient-centred medical home programs are required to file the assessment.

How to fill out patient-centred medical home assessment?

The assessment can be filled out online or submitted through a designated platform provided by the program administrator.

What is the purpose of patient-centred medical home assessment?

The purpose is to assess the practice's ability to provide coordinated, comprehensive, patient-centered care.

What information must be reported on patient-centred medical home assessment?

Information on the practice's care coordination efforts, patient engagement strategies, and quality improvement initiatives.

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