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ecareplan.ahrq.gov/collaborate/download/temp/download366P1145438.zip?contentType=application/zip
September 01, 2021 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/download2H31L152657.zip?contentType=application/zip
September 01, 2021 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadL5sOk170851.zip?contentType=application/zip
September 01, 2021 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadlEZ4P215834.zip?contentType=application/zip
September 01, 2021 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadDm1At143957.zip?contentType=application/zip
September 01, 2021 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadg6CE5143330.zip?contentType=application/zip
May 01, 2022 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadM2Uu4142558.zip?contentType=application/zip
May 01, 2022 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadJhlcp223213.zip?contentType=application/zip
May 01, 2022 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadAZ2BG222954.zip?contentType=application/zip
May 01, 2022 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls
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ecareplan.ahrq.gov/collaborate/download/temp/downloadVatm6143310.zip?contentType=application/zip
May 01, 2022 - her home, falls and breaks her hip, admitted to hospital where clinical information is collected for … Data gathered in the home setting is shared. Individual is discharged from Hospital to SNF. … Data shared as care transitions from Hospital to SNF, then to home. … Scenes for Testing
Person receives home and community-based services (HCBS) at home
Person/Patient falls … Coordination Scene Demonstration
Conduct social risk screening
Generate/Update eCare Plan
Person/Patient falls