Continuing Care Retirement Community to Personal Health Record

Personal Health Communication, Transfer of Care, Coordination of Care. see Use Case Categories

see Use Case Actors

Mrs. B is an 82 year woman who came to the CCRC three years ago. Each year she meets with the Nurse Practitioner to review her overall functioning and activities and adjust her PHR as needed. The assessment shows her cognitive status remains very good as is her communication. She has minimal hearing loss but that has not changed and she manages well. Her vision is fine with glasses but she prefers large print books. She is sad that her family persuaded her to stop driving and sell her car but she is able to use the CCRC bus to go shopping at local shopping malls and her family visits regularly and takes her out on trips or to visit friends. She has made many friends in the CCRC and plays bridge regularly. She had a fall a 3 weeks ago and continues to have mild low back pain. The pain is eased by a hot water bottle but she has stopped attending exercise classes. She continues to be independent in walking, managing stairs, showering and other ADL and IADL tasks including taking medications and managing her finances. She has the capacity to do light housework and make meals but has prefers others to do those tasks. She admits to occasional incontinence but manages well with pads. The NP takes this opportunity to encourage her to return to the exercise classes and consult the instructor for modifications if needed. She also notes that she has not had a mammogram in the last 3 years.