Patient Log Template

This is a Patient Log Template document associated with a Community Paramedic contract opportunity issued by the Georgia Department of Public Health (DPH) Epidemiology Section in collaboration with Augusta University Hospital. The template is designed to track patient data for the Community Paramedic District 6 East Central Georgia Health District program, which serves Columbia, Jefferson, and Richmond Counties in the Augusta area. The program aims to provide follow-up care services to high-risk stroke patients with hypertension who have been discharged from Augusta University Medical Center. The template captures essential patient information including demographics (age, race, ethnicity, sex), visit frequency metrics (first visit, last visit, 90-day and 365-day intervals), relevant health conditions (stroke, hypertension, diabetes, hypercholesterolemia, tobacco use), telehealth utilization, mental health screening (PHQ-9 assessment dates), and COVID-19 vaccination status. The template accommodates up to 100 patient records with numbered rows for systematic data collection and monitoring.

The Patient Log Template serves as an evaluation and documentation tool for the Community Paramedicine Program, which represents an innovative approach to healthcare delivery by utilizing community paramedics for preventive and follow-up care services. This template enables the contractor's community paramedic to systematically track patient outcomes and service delivery metrics, supporting the program's goals of improving health outcomes for high-risk stroke patients through coordinated care coordination and monitoring. The structured format allows for comprehensive data analysis regarding patient engagement, comorbidity management, preventive health measures, and mental health screening compliance across the service area.

#	LONGID	Age	Race	Ethnicity	Sex	First Visit	Last Visit	≥90 Days	≥365 Days	Stroke	Hypertension	Diabetes	Hypercholesterolemia	Tobacco Use	Tele-	Initial PHQ-9	Date	Final PHQ-9	Date2	COVID-19 VAX
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File	Type	Posted
Supplier Q and A Responses	—	Jan 18, 2023
Notice of Cancellation	—	Jan 18, 2023

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