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Multidisciplinary Care Clinic (MCC) Referral/Consult Form Sherwood Park Primary Care Network, 150 Broadway Crescent, Sherwood Park, AB T8H 0V3 Fax: (780) 4160139
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How to fill out multidisciplinary care clinic MCC:

01
Gather all relevant medical records and documentation before starting the process.
02
Complete the patient information section accurately, including personal details such as name, address, contact information, and insurance details.
03
Fill in the primary reason for seeking multidisciplinary care and provide a detailed description of the patient's medical history, diagnoses, and symptoms.
04
Specify any previous treatments or interventions the patient has undergone and their outcomes.
05
Provide contact information for other healthcare providers involved in the patient's care, such as primary care physicians, specialists, therapists, or counselors.
06
Indicate any specific goals or expectations for the multidisciplinary care clinic and how it aligns with the patient's overall treatment plan.
07
Outline any known allergies or adverse reactions to medications or treatments.
08
If applicable, provide a list of current medications, dosage instructions, and any ongoing treatments or therapies.
09
Include relevant diagnostic test results, such as laboratory reports, imaging studies, or biopsies, along with their respective dates.
10
Sign and date the form, acknowledging that the information provided is accurate and complete.

Who needs multidisciplinary care clinic MCC:

01
Patients with complex medical conditions requiring the expertise of multiple healthcare professionals.
02
Individuals with chronic diseases or disabilities that require coordinated care from a multidisciplinary team.
03
Those who would benefit from an integrated approach to treatment, combining medical, psychological, rehabilitative, and supportive services.
04
Patients with complex mental health needs, such as comorbid psychiatric disorders, substance abuse issues, or personality disorders.
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Individuals requiring palliative or end-of-life care, where comprehensive team-based support is vital.
06
Patients with a history of frequent hospitalizations or emergency room visits, indicating a need for more coordinated and proactive care.
07
Individuals transitioning from one care setting to another, such as from hospital to home or long-term care, where multidisciplinary coordination is essential for smooth transitions.
08
Those with multiple chronic conditions that interact with one another or have overlapping symptoms, requiring a holistic approach to management.
09
Patients seeking a second opinion or alternative treatment options for complex medical conditions.
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Individuals with complex social or environmental factors influencing their health, such as homelessness, poverty, or lack of access to healthcare services.
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Multidisciplinary Care Clinic (MCC) is a collaborative approach to patient care involving professionals from different medical specialties.
Healthcare facilities that provide multidisciplinary care services are required to file MCC.
MCC forms are typically filled out by healthcare professionals involved in the patient's care, documenting the different specialties involved.
The purpose of MCC is to ensure coordinated and comprehensive care for patients by involving specialists from different disciplines.
MCC forms usually include patient information, details of specialists involved, treatment plans, and progress notes.
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