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Southwest Transitional Care

About This Location

Transitional Care Management (TCM) services address the time from when the patient is discharged and returns home. After a hospitalization or other inpatient facility stay the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy. Some of the ways Transitional Care can assist include:

● Review discharge information (for example, discharge summary or continuity-of-care documents)

● Review the patient’s need for, or follow-up on, pending diagnostic tests and treatments

● Interact with other health care professionals who may assume or reassume care of the patient’s system-specific problems

● Educate the patient, family, guardian, or caregiver

● Establish or re-establish referrals and arrange needed community resources

● Help schedule required community providers and services follow-up
Providers at this location Jennifer Stringer FNP-C