Patient Engagement

Physician	Specialty	Facility Location	Visit Date
Dr. Philip Anderson	Internal Medicine	Northwestern Medical, Chicago, IL	01 / 12 / 2015

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Primary Care Provider

PCP Name: Dr. Dave Eustis
Location Name: Accretive Clinic
Physician Specialty: Family Medicine
Physician Credential: MD
Most Recent Service Date: 03/15/2015
Most Recent Visit Reason: Wellness Visit
System: Ford
Physician Phone: (999) 999-9999

Specialist

PCP Name: Dr. Mikah Trent
Location Name: Accretive Clinic
Physician Specialty: Internal Medicine
Physician Credential: MD
Most Recent Service Date: 03/15/2014
Most Recent Visit Reason: Flu Shot
System: Ford
Physician Phone: (999) 999-9999

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Specialist

PCP Name: Dr. Jeffrey Anscomb
Location Name: McFadden Medical
Physician Specialty: Cardiology
Physician Credential: MD
Most Recent Service Date: 03/15/2015
Most Recent Visit Reason: Echocardiogram
System: Ford
Physician Phone: (999) 999-9999

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Specialist

PCP Name: Dr. Daniel Dooley
Location Name: Michigan Medical
Physician Specialty: Podiatry
Physician Credential: MD
Most Recent Service Date: 04/16/2015
Most Recent Visit Reason: Diabetic Screening
System: Ford
Physician Phone: (999) 999-9999

Set as PCP

Action	whiteNumberBox	Note	Activity	Call User
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson
Busy Signal	04/25/2015 - 10:23 AM	N/A	Documentation & Coding	Susan Peterson
Left Voicemail	04/21/2015 - 11:05 AM	No answer. Left message.	Patient Engagement	Jared Allen
Guarantor Requests Call Back	03/27/2015 - 3:02 PM	Spoke with Jonathan, however something came up and the call needed to be disconnected	Patient Engagement	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Documentation & Coding	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson
Busy Signal	04/25/2015 - 10:23 AM	N/A	Documentation & Coding	Susan Peterson
Left Voicemail	04/21/2015 - 11:05 AM	No answer. Left message.	Patient Engagement	Jared Allen
Guarantor Requests Call Back	03/27/2015 - 3:02 PM	Spoke with Jonathan, however something came up and the call needed to be disconnected	Patient Engagement	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Documentation & Coding	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson
No answer, left message with person	04/27/2015 - 9:02 AM	Jonathan was not home. A message was left with his sister.	Patient Engagement	Susan Peterson

Clinic / Department	Physician	Reason	Date	Time	Date Scheduled
Quest Diagnostics	—	Mammogram	04/15/2015	9:00 AM	03/10/2015
St. Michael's Medical	Dr. Smith	Wellness	02/10/2015	11:00 AM	01/15/2015

1Qualifying Guarantor

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2Attribution Confirmation

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3Service Eligiblity

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4Contact Verification / Preferences

5Engagement Outcome