Identify timely and appropriate goals to strive for
Identify and implement the actions needed to reach those goals
A continuous and ongoing re-evaluation of your responses
Make adjustments as necessary
2. Direct you to the most competent and appropriate medical clinicians.
3. Maintain open and professional communication with you and your family, and all members of your care team to identify problems, goals, and best actions for optimum outcomes.
4.Support the stability and safety of you as a patient, and your family.
5.Empower you as a patient to self-directed care, self-advocacy, self-sufficiency and independent decision-making to the highest degree possible.
6. Coordinate and communicate the care activity of your medical professionals, community agents, funding sources, and family for the goal of reaching your most possible level of functional independence.
7. Provide information to you and your family to help facilitate timely and appropriate treatment.
8. Facilitate and coordinate your:
Inpatient and outpatient care and treatment
Medical evaluations
Transportation
Home care services
School services and Independent Education Program
Social Services
Medical equipment
Home and environmental modifications
Medicare Social Security Benefit application process
Medicaid Spend Down application process
9.Support your Guardian and Conservator
10.Provide support and advocacy at Court hearings and legal meetings
