TRANSITIONAL CARE
MANAGEMENT

Consent

Transitional care management (“TCM”) is a service designed to assist patients during their transition from an inpatient hospital stay or skilled nursing facility to their home or a community setting. TCM services may include, but are not limited to:

  • Coordination and facilitation of appointments with healthcare providers.

  • Review of the patient’s discharge summary.

  • Medication reconciliation and management.

  • Addressing any post-discharge complications or concerns.

  • Collaboration with healthcare providers involved in the patient’s care.


The benefits of TCM may include:

  • Improved coordination and continuity of care.

  • Enhanced communication between healthcare providers.

  • Reduction in medication errors and adverse events.

  • Increased patient and caregiver satisfaction.

  • Timely follow-up appointments and necessary referrals.


IF YOU DO NOT UNDERSTAND OR AGREE TO ANY OR ALL OF THE ITEMS BELOW, PLEASE DO NOT SIGN THIS CONSENT FORM.


By signing below, you acknowledge the following:

  • Your physician or other healthcare provider has explained to you what TCM means, the type of health data that will be collected, and how it will be used in your care;

  • You are aware that your health data will be collected and digitally transmitted to your healthcare provider in a safe and secure manner to maintain the confidentiality of your healthcare information;

  • You consent to the use of TCM services as part of your care and treatment;

  • You have the right to withdraw this consent at any time;

  • You are responsible for all applicable copay and deductible amounts (including, if you are a Medicare beneficiary, the copay for Part B services); and

  • TCM services are NOT emergency services and WILL NOT BE AVAILABLE 24/7. If you think you are experiencing a medical emergency, CALL 911 IMMEDIATELY.