HIV/AIDS Medical Case Management Acuity Tool Form Massachusetts Department of Public Health Boston Public Health Commission Intensive Need Moderate Need Basic Need Self Management Area of Functioning (3) (2) (1) (0) Adherence to Medical Care and Treatment & HIV Health Status Has missed 1 or 2 (non- Has attended HIV medical Has attended all scheduled HIV Has missed 2 or more consecutive consecutive) HIV medical appointments in the last 6 months medical appointments in the last HIV medical appointments in the appointments in the last 6 months as indicated by HIV medical 12 months as indicated by HIV last 6 months but has been seen by member of provider medical provider HIV medical team HIV Care Adherence Requires on-going Needs referral to or help accessing accompaniment or assistance Needs assistance with making and Does not require any assistance or a culturally competent service with medical appointments due to keeping HIV medical appointments reminders to schedule or keep provider (e.g. LGBT, limited language or cognitive medical appointments linguistically appropriate, etc.) ability Requests accompaniments to Has not been seen by HIV Acuity Score: medical appointments from MCM medical team in the last 6 months or other member of the care team Comments (include referrals needed): Intensive Need Moderate Need Basic Need Self Management Area of Functioning (3) (2) (1) (0)
HIV/AIDS Medical Case Management Acuity Tool Form Massachusetts Department of Public Health Boston Public Health Commission Area of Functioning Intensive Need (3) Moderate Need (2) Basic Need (1) Self Management (0) Adherence to Medical Care and Treatment & HIV Health Status HIV Care Adherence Has missed 2 or more consecutive HIV medical appointments in the last 6 months Has missed 1 or 2 (non- consecutive) HIV medical appointments in the last 6 months but has been seen by member of HIV medical team Has attended HIV medical appointments in the last 6 months as indicated by HIV medical provider Has attended all scheduled HIV medical appointments in the last 12 months as indicated by HIV medical provider Requires on-going accompaniment or assistance with medical appointments due to limited language or cognitive ability Needs referral to or help accessing a culturally competent service provider (e.g. LGBT, linguistically appropriate, etc.) Needs assistance with making and keeping HIV medical appointments Does not require any assistance or reminders to schedule or keep medical appointments Acuity Score: Has not been seen by HIV medical team in the last 6 months Requests accompaniments to medical appointments from MCM or other member of the care team Comments (include referrals needed): Area of Functioning Intensive Need (3) Moderate Need (2) Basic Need (1) Self Management (0)