III. Coordination/Continuity of Care Criteria Note: A Coordination/Continuity section score < 80% requires a CAP for the entire MRR, regardless of the Total MRR score. RN/MD Review only Score Criteria met: Give one (1) point. Wt MR MR MR MR MR MR MR MR MR MR #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Criteria not met: 0 points Criteria not applicable: N/A Age/Gender History of present illness is documented. 1 Working diagnoses are consistent with findings. 1 Treatment plans are consistent with diagnoses. 1 Instruction for follow-up care is documented. 1 Unresolved/continuing problems are addressed in subsequent visit(s). 1 There is evidence of practitioner review of consult/referral reports and diagnostic test results. 1 There is evidence of follow-up of specialty referrals made, and results/reports of diagnostic tests, when appropriate 1 Missed primary care appointments and outreach efforts/follow-up contacts are documented. 1 Yes Comments: No N/A 8 Pts. Possible IV. Pediatric Preventive Criteria (continued on next page) Note: A Pediatric Preventive section score requires a CAP for the entire MRR, regardless of the Total MRR score. < 80%
III. Coordination/Continuity of Care Criteria Note: A Coordination/Continuity section score < 80% requires a CAP for the entire MRR, regardless of the Total MRR score. RN/MD Review only Criteria met: Give one (1) point. Criteria not met: 0 points Criteria not applicable: N/A Age/Gender Wt MR #1 MR #2 MR #3 MR #4 MR #5 MR #6 MR #7 MR #8 MR #9 MR #10 Score History of present illness is documented. 1 Working diagnoses are consistent with findings. 1 Treatment plans are consistent with diagnoses. 1 Instruction for follow-up care is documented. 1 Unresolved/continuing problems are addressed in subsequent visit(s). 1 There is evidence of practitioner review of consult/referral reports and diagnostic test results. 1 There is evidence of follow-up of specialty referrals made, and results/reports of diagnostic tests, when appropriate 1 Missed primary care appointments and outreach efforts/follow-up contacts are documented. 1 Comments: Yes No N/A 8 Pts. Possible IV. Pediatric Preventive Criteria (continued on next page) Note: A Pediatric Preventive section score < 80% requires a CAP for the entire MRR, regardless of the Total MRR score.