General TCA Review Template - Item 732

TEAM CARE ARRANGEMENTS REVIEW (ITEM 732) Patient Name: [Enter the patient’s full legal name as recorded in medical records.] Date: [Enter the date of the review in DD/MM/YYYY format.] Doctor Coordinating Team Care Arrangement Review: [Enter the name of the doctor responsible for coordinating the review.] Informed consent has been obtained to prepare this review. (only include if explicitly mentioned in the transcript, contextual notes or clinical note, otherwise leave blank) Date of Original Team Care Arrangement: [Enter the date when the initial Team Care Arrangement was created.] Review of Team Care Arrangement goals in collaboration with the participating providers and with verbal informed consent from the patient: (Add more goals as required to ensure a complete review.) Goal 1: [Describe a specific goal from the original Team Care Arrangement that was set for the patient.] - Have goals been met? [Enter "Yes" if the goal has been achieved, "Partially" if only some progress has been made, or "No" if the goal has not been met.] - Further actions required: [Describe any additional steps needed to continue addressing this goal, including referrals, therapy, or medication adjustments.] Goal 2: [Describe another goal from the original Team Care Arrangement that was set for the patient.] - Have goals been met? [Enter "Yes," "Partially," or "No" based on the progress made.] - Further actions required: [List any additional steps necessary, such as modifying the treatment plan, adding new interventions, or changing patient actions.] Goal 3: [Describe a third goal from the original Team Care Arrangement that was set for the patient.] - Have goals been met? [Enter "Yes," "Partially," or "No."] - Further actions required: [Explain what needs to be done next to address this goal, if applicable.] Is a revised (new) Team Care Arrangement (Item 723) required?: [Enter "Yes" if a new TCA is needed based on the review findings; otherwise, enter "No." and state reason based on transcript, context, clinical notes] Review of Team Care Arrangement discussed with patient?: [Enter "Yes" if the review findings were discussed with the patient; otherwise, enter "No." and state reason based on transcript, context, clinical notes] Copies of Team Care Arrangement Review given to patient and relevant providers?: [Enter "Yes" if copies were provided; otherwise, enter "No." and state reason based on transcript, context, clinical notes] Next Review Date: [Enter the recommended date for the next review in DD/MM/YYYY format.] (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes, or clinical note as a reference for the information to include in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state that the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs, or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)