PCMH5C

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On its own or in conjunction with an external organization, the practice systematically:

5.C.1 Demonstrates its process for identifying patients with a hospital admission and patients with an emergency department visit

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.2 Demonstrates its process for sharing clinical information with admitting hospitals and emergency departments

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.3 Demonstrates its process for consistently obtaining patient discharge summaries from the hospital and other facilities

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.4 Demonstrates its process for contacting patients/families for appropriate follow-up care within an appropriate period following a hospital admission or emergency department visit

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.5 Demonstrates its process for exchanging patient information with the hospital during a patient’s hospitalization

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.6 Collaborates with the patient/family to develop a written care plan for patients transitioning from pediatric care to adult care (NA for adult-only practices)

Description	Example/Screenshot/Documentation	Source	Date Added
Using PCC EHR Care Plan functionality for organizing materials and information in preparation for transitioning a patient from pediatric care to adult care.	Using PCC EHR Care Plans for transitions of care	PCC	07/07/14
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.7 Demonstrates the ability for electronic exchange of key clinical information with facilities

Description	Example/Screenshot/Documentation	Source	Date Added
PCC EHR ability for electronic exchange of key clinical information with facilities	PCC EHR electronic exchange of key clinical info	PCC	07/07/14
External Organization Policies and Procedures Example	Examples	TPC	03/25/13

5.C.8 Provides an electronic summary-of-care record to another care facility for more than 50 percent of transitions of care

Description	Example/Screenshot/Documentation	Source	Date Added
External Organization Policies and Procedures Example	Examples	TPC	03/25/13