Chronic Disease Practice Register, Diagnosis and Registration Visit Sample Clauses

Chronic Disease Practice Register, Diagnosis and Registration Visit. At the commencement of the contract, GPs will identify all their existing patients who have been diagnosed with one of the listed diseases in the Treatment Programme. Informed consent for entry into the Programme should be sought and for sharing of data for a number of functions. This consent will need to be recorded and returned to the HSE. The patient will then be registered with the Programme on the chronic disease register which the GP has established. Subsequent to this when each new patient is first diagnosed they should be entered onto the register, informed consent for entry into the Programme and sharing of the data should be sought, recorded and returned. The HSE is required to establish data governance, analysis and feedback of information to facilitate this, in line with Data Protection requirements. The Registration/First Visit will encompass registration of the patient and the first scheduled review. Registration will include a history, behavioural risk factor assessment and brief intervention as appropriate undertake a comprehensive clinical examination, do the necessary diagnostic testing and commence the development of a Care Plan. The Registration/First Visit will contain all the elements of a scheduled review as set out in Table 2 below. This information then populates the database or clinical information system including test results, findings from a clinical examination, lifestyle behaviours and information on the provision of brief interventions, education and appropriate referral. At this Registration/First Visit the development of a Care Plan in partnership with the patient will be initiated. For patients with co-morbidities clinical information relevant to all co-morbidities will be recorded on the clinical information system. The management of patients with co-morbidities is more complex and therefore will require more resources including time than patients with single morbidities.
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