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Get Hospitalization Risk Assessment

__________ Prior pattern: Check all that apply ‰ > 1 Hospitalizations or ER visits in the past 12 months Chronic conditions: Check all that apply (M0230/M0240) ‰ History of falls * (Complete Falls Risk Assessment) ‰ CHF ‰ Chronic skin ulcers (Wound consult if indicated for any wounds) ‰ Diabetes ‰ COPD ‰ HIV/AIDS Risk Factors: Check all that apply ‰ Discharged from hospital or skilled nursing facility (M0175) ‰ Help with managing medications needed (M0780) ► ★ ‰ More than 2.

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