Our clinical staff is then scheduled to contact patients by phone a few days ahead of their scheduled E/M visit. During the call, our staff completes a Health Risk Assessment, discusses care needs, establishes goals, and provides education related to the management of the patient’s chronic condition(s).

The Health Risk Assessment identifies and documents gaps in care, any needed adjustments to the risk profile to support the patient in closing any gaps and assistance with managing the risk to improve patient outcomes. Our Wellness Nurse documents all findings and uploads them to the patient’s chart in the provider’s EMR and sends an Annual Wellness Guide and Checklist to the appropriate provider or designated staff in support of completing the Annual Wellness Visit at the patient’s next office visit.