Post-Acute Placement Coordination Note

Note Type: [Initial evaluation / Interval update / Final confirmation & handoff]

Date/Time: [Date and time of note entry]

Author Name and Role: [Author full name, credentials, and role]

Patient Location: [Current unit/bed or care setting]

Medical Readiness Status: [Ready / Not ready / Pending] (If pending, briefly specify the item.)

Anticipated Discharge Date: [Anticipated discharge date or range] (If unknown, record "TBD" and add a task in Next Steps.)

Summary

[3–6 sentence situational summary including working discharge disposition goal, primary clinical driver, key current blockers, and current placement status] (For interval updates, lead with what changed since the last note. Cite sources inline, e.g., "per PT eval [date].")

Patient/Family Engagement and Choice

• Decision-maker and capacity: [Capacity status and decision-maker name/relationship providing consent] (If unclear, state explicitly and add a task to clarify.)
• Primary contact and communication needs: [Name, phone, preferred language, interpreter needs]
• Patient-centered goals/preferences: [Brief summary of goals and preferences] (Use brief quotes if directly stated.)
• Code status and directives: [Code status] — Advance directives on file: [Yes / No / Pending]
• Choice documentation: List of available post-acute providers presented: [Yes / No] — Network limitations communicated: [Yes / No / N/A]
• Preference factors: [Geographic preference, facility attributes, caregiver proximity, other relevant constraints]

Clinical Rationale for Level of Care

[Concise clinical justification for recommended post-acute setting] (Include: relevant diagnoses and recent events with sources; medical stability factors such as oxygen needs, IV meds, isolation status; functional status anchored to therapy documentation with dates; skilled needs such as wound care, IV antibiotics, enteral feeds; and relevant devices or lines. If therapy has not evaluated, state "Therapy eval pending." For the disposition being pursued, state why this level of care is appropriate. Use phrasing such as "appears clinically appropriate for [setting] pending receiving review" rather than declaring benefit eligibility.)

Placement Activity and Status

Current Barriers

• Clinical readiness: [Pending procedures, unstable symptoms, isolation constraints, therapy eval pending, or none identified]
• Disposition: [No accepting facility, special bed or isolation needs, transport requirements, or none identified]
• Administrative: [Authorization pending, PASRR status, coverage uncertainty, consent issues, or none identified]

Placement Outreach Log (Include only if outreach has begun; otherwise explain in Barriers why outreach has not started.)

Date/Time	Facility/Agency	Action	Status	Decline Reason	Next Action & Owner
[Date/Time]	[Facility/Agency name]	[Referral sent / Follow-up / Bed offer / Acceptance / Decline]	[Pending / Accepted / Declined / Waitlist / Need more info]	[Reason if declined] (Document objectively.)	[Next step, owner, and timeframe]

Authorization Status

• Authorization required: [Yes / No / Unknown] — Payer/plan: [Payer and plan name]
• Submission: [Date/time submitted and method] (If not yet submitted, note reason.)
• Determination: [Pending / Approved / Denied] — Reference #: [Number if available]
• Verbal approval: [If applicable, note "Verbal approval pending written confirmation" with payer rep name and time]
• PASRR status: [Not required / Submitted / Approved / Pending / Level II triggered] (Include dates as applicable.)

Handoff and Next Steps

Receiving Entity (Complete once a receiving entity is identified.)

• Facility/Agency: [Name] — Accepting provider: [Name if known] — Bed type: [Confirmed bed type]
• Information transmitted: [Items sent: medication list, clinical summary, therapy notes, infection control status, advance directives] — Method: [Portal / Fax / Phone] — Date/time: [When sent]
• Verbal handoff: [Completed / Not yet completed] (Note key questions clarified if applicable.)

Task List (Convert unknowns and pending items into tasks.)

• [Task description] — Owner: [Name/Role] — Due: [Date or trigger] — Escalate if: [Condition/timeframe]
• [Task description] — Owner: [Name/Role] — Due: [Date or trigger] — Escalate if: [Condition/timeframe]

Signature: [Typed name, credentials, role] — [Date/Time]