Chronic Care Management Template

A chronic care management care plan is a comprehensive document that outlines the specific strategies and interventions needed to manage chronic conditions effectively. It includes individualized goals, medication management, and scheduled follow-ups to ensure continuous monitoring and support.

Chronic care management includes various components such as regular health assessments, medication management, coordination with multiple healthcare providers, and patient education. The goal is to create a holistic approach that empowers patients to manage their health and improve their quality of life.

The criteria for chronic care management (CCM) typically involve having two or more chronic conditions expected to last at least 12 months and requiring ongoing medical attention. Additionally, patients must agree to the care management services, allowing healthcare providers to deliver coordinated care tailored to their specific needs.