General Practice BILLING GUIDE - British Columbia Medical ...

APPENDIX i FORMS FOR THE GPSC INITIATIVES
Complex Care Plan Template
Initial Planning Date:
Patient Name:
Condition # : Condition #2: DX Code:
Other Co-Morbidities:
Medications:
Patient Values/Goals:
Plan for Management of Co-Morbid Conditions:
Linkage with other Heath Care Professionals:
Discussed with AHP:
Expected Outcomes:
Time frame for Re-Evaluation:
Discussed with: Patient Representative:
Re-Evaluation Date:
Change(s) to Plan, if any:
Discussed with: Patient Representative: AHP:
GENERAL PRACTICE BILLING GUIDE
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