This is where you will find all of the forms and handouts for the Connected Care program.
Looking for a referral resource? For referral or other resources to share with patients, check the Resource Library instead.
The New Patient Intake Form gathers demographic, clinical, utilization, and care-planning information before the first Connected Care visit. This information helps the team assess urgency, prioritize appropriate protocols, coordinate necessary supports, and tailor the visit to the patient’s needs, preferences, and circumstances.
“What Matters” is a foundation of age-friendly care. It means getting to know the whole person, including the beliefs, traditions, people, and relationships that matter most to them, before focusing on decisions or services. In this protocol, CHWs ask questions to better understand a patient’s concerns, wishes, and goals, and any Health Related Social Needs that may be impacting the patient’s health.
An Advance Directive is a written statement that describes what medical care a person would want if in the future they could not make decisions for themselves because of a medical crisis or an accident. Any adult (18+) can complete one. It also lets a person name someone they trust to make healthcare decisions for them. In this protocol, CHWs provide information and support to help patients to review, update, or complete an Advance Directive.
The Medication Protocol helps people manage their medications safely at home. It includes a review of a patient’s current medications compared to their medication list on file. CHWs share information about medication safety and aging, how to safely dispose of unwanted medication, and alert the primary care physician of any medication-related concerns.