NextGen Knowledge Center

Document General Transition of Care Information for a Patient

Before you begin

Ensure that you have selected the Specialty and Visit Type as Care Management.
  1. Click the Care Transitions tab.
    The Cm Care Transitions template opens.
    Cm Care Transitions

  2. Click the PCP field.
    The field populates with the Primary Care Practitioner established in the patient's demographics.

    If there is no PCP selected in the patient chart, the Modify Patient Information template opens, enabling you to select a PCP.

  3. Do one of the following:
    • Click the Encounter Type field to launch a list of transitional care encounter types and then select an encounter type from that list.
    • Click the blue arrow to the right of the Encounter type field to launch the interim history data list and then select a past encounter from the interim history data.
  4. Click the first Historian field and select the relationship of the historian to the patient from the resulting list.
  5. If needed, click the second Historian field and select the relationship of the second historian to the patient from the resulting list.
  6. If the patient had a recent hospitalization:
    1. Click the Admitted to field and select the hospital that the patient was admitted to from the resulting list.
    2. Click the Date field and use the resulting calendar to select the date that the patient was admitted.
    3. Click the From field and select the type of facility that the patient was admitted from.
  7. If the patient had been discharged:
    1. Click the Discharged to field and select the type of facility that the patient was discharged to from the resulting list.
    2. Click the Date field and use the resulting calendar to select the date that the patient was discharged.
  8. If the patient has been referred to care management:
    1. Click the Care Manager field and select the care manager that the patient was referred to.
    2. Click the Reason for Referral field and select the reason for referral.
  9. Click the first Discharge diagnosis field and then select a discharge diagnosis from the diagnosis search screen.
  10. Select either Yes or No to answer the following questions:
    • Previous hospital admission in last 30 days?
    • Follow up on pending tests or treatment performed?
    • Education provided to patient/family/caregiver?
    • Community resources needs accessed, such as home health, assisted living, hospice and/or support groups?
    • Discharge summary or continuity of care document obtained and reviewed?
    • DME needs assessed and orders completed if needed?
    • Referral needs assessed and completed if needed?

    Once you have completed all the entries, a row is added to the Care Management Summary grid.