INSERT PATIENT’S NAME, AGE, GENDER, SOCIAL SECURITY ...



Re: TRANSFER INITIATION Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Dear Dr. Click here to enter text.“The number of young patients graduating from pediatric to adult renal care has progressively increased due to improved management resulting in patient survival rates of 85–90%. Adult renal services are being exposed to an increasing number of adolescent and young adult patients who have either transitioned from pediatric care or presented directly to adult services. It is recognized that there are substantial risks of non-adherence at the time of transfer from pediatric to adult care and among the cohort of patients aged 25 years who are managed in adult care.” “The phrase ‘transition’ [is] a process that involves purposeful, planned efforts to prepare the pediatric patient to move from caregiver-directed care to disease self-management in the adult unit.11 In the most desirable format, therefore, transfer is an event that takes place at the end of a transition process and that is designed to be a more purposeful and concerted effort to prepare the young person with a chronic condition to accept responsibility for his/her disease management.”Thank you for accepting this patient in TRANSFER. This letter is intended to coordinate the actual transfer of the patient’s care to you and your associates. We estimate transfer of care to you can occur by Click here to enter a date. . We will call your program or have the patient or family call for a specific scheduled date for their first appointment under your care. We respectfully suggest that family remain involved initially. As you know, the family and patient are accustomed to the family participating in medical decision making during the pediatric nephrology phase of care. A useful indicator that direct family involvement can be tapered is when the patient moves into independent living arrangements, but as always this decision should be individualized to the needs of the patient and family. Patient Demographics: Click here to enter text.is a Click here to enter text. year old with Chronic Kidney Disease Stage Choose an item. The patient’s CKD is secondary to fill in the blank (if not below)People chronically involved in the patient’s medical decision-making include: (check below)? mother, Click here to enter text.? father, Click here to enter text.? step parents Click here to enter text.? sibling(s) Click here to enter text.? friend(s) Click here to enter text.? other(s) Click here to enter text.MEDICAL PROBLEM LIST (insert, cut and paste, or enter): MOST CURRENT MEDICATION LIST (insert, cut and paste, or enter) LAST RECONCILED ON Click here to enter a date.:In addition to an accompanying medical problem list, we believe ACTIVE PROBLEMS that will likely need to be addressed include: ? Vascular Access problems Click here to enter text.? Hemodialysis problems Click here to enter text.? Peritoneal catheter problems Click here to enter text.? Peritoneal dialysis problems Click here to enter text.? Hypertension Click here to enter text.? Urinary tract infections Click here to enter text.? Secondary hyperparathyroidism Click here to enter text.? Anemia Click here to enter text.? High risk behaviors (smoking, drinking, illegal drug use) Click here to enter text.? Acid-base disorders Click here to enter text.? Nephrotic syndrome Click here to enter text.? Nutrition Click here to enter text.? Growth and developmental problems Click here to enter text.? Psychosocial issues Click here to enter text.? Other congenital anomalies or disabilities Click here to enter text.(see attached “Recommended Resources” Table)Check list for medical records accompanying this letter (check all that apply):? Most current assessment of “transitioning and transfer readiness.”? Medical Problem List if not listed above? Current Medication List if not listed above? Most current Patient Care Plan/Clinic Visit ? Current nursing, dietary and,or social worker plans when relevant.? Current Dialysis Visit(s); Dialysis Perscription.? Current labs and imaging studies ? Any relevant Hospital Discharge Summaries.? Table of other specialists and subspecialists (Resources Table) that you may want to co-manage some of the congenital, developmental, and psychosocial comorbid conditions.? Current primary and secondary insurance coverageIf all the relevant transfer records do not accompany this letter, we will make every effort to provide all relevant medical records at least one month in advance of imminent transfer. Please contact Click here to enter text. for any additional records or information.If there are any additional questions or medical information you require, please do not hesitate to contact me at my office ___-___-____, by cell phone ___-___-____, or by e-mail ____@___.___.We will make every effort to provide all relevant medical details and records at least one month in advance of imminent transfer. Sincerely, ................
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