Aggregated Report on All Variances for Each Patient Patient Name: _______________________________ Pt ID: ___________ Date Start CCC: _________ Date D/C: _________ Var # Description Report Event Intervention Date Date Resolved / Outcome by Date Date to F/U Y/N Aggregated Report on All Variances for All Patients Var # Description Pt ID Report Report Event Intervention Date to Escalate? Date Resolved / Outcome by Date Date F/U Y/N A12 Will not take Yes CC 2/4 2/4 Ask PCP for 2/6 No 2/7 new Rx Rx as claims alternative drowsiness medication Call Pt to check on 2/11 No No more drowsiness response
Aggregated Report on All Variances for Each Patient Patient Name: _______________________________ Pt ID: ___________ Date Start CCC: _________ Date D/C: _________ Var # Description by Report Date Event Date Intervention Date to F/U Y/N Date Resolved / Outcome Aggregated Report on All Variances for All Patients Var # Description Pt ID Report by Report Date Event Date Intervention Date to F/U Escalate? Y/N Date Resolved / Outcome A12 Will not take Rx as claims drowsiness Yes CC 2/4 2/4 Ask PCP for alternative medication 2/6 No 2/7 new Rx Call Pt to check on response 2/11 No No more drowsiness
4-Patient-Care-Coordination-Variance-Reports-Template.docx