The Complex Care Program is a multidisciplinary approach to managing a patient with complex medical needs. The Complex Care team consists of:
- Primary Care Providers
- Registered Nurses
- Registered Dietitian
- Social Worker
- Partnership with North of Superior Counseling Services for an adult counselor (when available)
Patients are scheduled to meet with the entire team on a quarterly basis and with individual care providers as determined by their patient centered care plan. Together with the patient and the team, goals are set to optimize the patient’s overall quality of life within their limitations.
Appointments are approximately 60 minutes in duration when meeting with the care team. Individual appointment times will vary depending on the service(s) being utilized.
At a Complex Care appointment you can expect to have the following (includes but not limited to):
- Height Assessment
- Weight Assessment
- Base-line vitals assessment
- Dietary Assessment
- Exercise/Mobility Assessment
- Health History Review
- Medication Review
- Review of current medical conditions
- Ordering of any necessary laboratory and diagnostic tests
- Referrals to appropriate specialists or tertiary care centers
- Developing a plan of care for the duration in the program
- Establishing therapeutic relationships with the care team
- Establishing a schedule for ongoing care and management
Patients are selected by the care team based on their diagnoses, number of visits with care providers, number of medications they are taking, falls risk or history of falls, number of emergency room visits and number of admissions.
Patients can contact the Manitouwadge Family Health Team at (807) 826-3251 Ext. 301 if they wish to be considered for this comprehensive program.
Hours of Operation
Monday – 8:00am – 4:30pm
Tuesday – 8:00am – 4:30pm
Wednesday – 8:00am – 4:30pm
Thursday 10:00am – 4:30pm
Friday 8:00am – 4:30pm