Transition to Adult Care — Outpatient Specialty Care and Primary Care

Recommendations for Content to Include in Final Clinic Note or Letter

The following table includes suggested content for specialty services to include in their last letter for patients transitioning from CHOP to adult care.

Current Medical Care
  • Current state (e.g. for patient with epilepsy—when was last seizure, how frequent are the seizures, typical duration for seizures, triggers/symptoms etc.)
  • Pertinent physical exam findings
  • Recent pertinent hospitalizations, labs, radiology
  • Current medications managed
  • Frequency of visits/monitoring
  • Presence of intellectual disability, if applicable
History
  • Previous treatments, medication trials, diagnostic imaging results
Ancillary Services
  • Durable medical equipment for any equipment or devices
  • Home nursing
  • PT/OT service
  • Case management, social worker, or care coordinator
  • Insurance information
  • Guardianship and name of legal guardian, if applicable
Contingency Instructions for conditions that have episodic flares and Emergency Plan
  • If there is a change in the patient’s condition, include steps for necessary action plan
  • If patient is taken to the Emergency Department or is seen by emergency personnel, include steps for necessary action plan
Contact Information
  • Current provider name, office number and email