Medical Director Rounds Template

Case Rounds Date:
Care Coordinator:
Member Name:
Member ID:	Member DOB:
Specialty Providers:
EMR/Health System:
Current Status: (relevant illness, co-morbids, labs, barriers)
Relevant Past Medical History: (including utilization)
Reason for Presenting/ Barriers/Concerns:
Medications Concerns:
Psychosocial/ Social Determinants of Health Concerns:
Caregiver Supports: