Complex Care Plan Lite

Start time: End time:

Date:

Patient: Provider:

Family/Medical Representative:
Representation Agreement (Section 9) completed
Previous MOST: ()
Diagnosis:
Diabetes Chronic renal failure (eGFR < 60) CHF Asthma, COPD, Chronic Respiratory Disease Cerebrovascular Disease (stroke) Ischemic Heart Disease (heart attack) Chronic Liver Disease (hepatitis, cirrhosis) Chronic Neurological Disease (MS, ALS, Parkinsonism, Dementia, etc)
Preventions:
Flu vaccine done Pneumovax done Prevnar done Shingles vaccine done COVID vaccine done

















Other Current Problems:
Other Healthcare Professionals:
Medication Review:
Other Medications:
Allergies:

Care Plans:
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Other.

Goals / Fears/ Strengths / Abilities / Trade-Offs / Values / Expected Outcomes:
Serious Illness Conversation Guide
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Other.
Comments:

Subject:

If you wish to complete this form later, click on and DO NOT COPY to encounter.   You may proceed to finish your encounter note as usual.

The COMPLETED FORM can be copied to the eCHART as a standard progress note, with .
  • This feature only works when the CCP Lite eFORM is opened from the eCHART and the chart REMAINS OPEN.
  • If the eCHART is closed, do a Partial Submit, reopen the chart, and reopen the CCP Lite eFORM then do the Copy to Encounter.
  • This feature does not work in CHROME.
  • You will encounter a warning box STATING: Click OK to save it or Cancel to continue editing the current note.
  • DO NOT CLICK OK
  • Please click CANCEL repeatedly to complete the copy process.
  • Copy to Encounter does not Submit (save) the eForm.
  • Copy to Encounter should be done before Complete Submit.

    • the completed eForm to share with patient and family.
    Use for the final save.