The Coordinated Care Record was designed by a committee of parents of children with special health care needs, and DSCC staff, to help families record and organize information about their child's needs and services. The pages can be easily maintained in a 3-ring binder with divider tabs to separate the sections.

Below is an outline of the contents of the Coordinated Care Record with hyperlinks to individual pages or sections of the workbook. This is provided to make it easier and faster to view or print the information. The entire workbook is also available as a single file. Click the Families button on the navigation bar at the right to find out more information about this option.

The workbook contents are available in both Microsoft Word and PDF. You will need the free Adobe Reader to view and print the PDF documents. The Reader is available free from the Adobe web site.

Coordinated Care Record (PDF) (Word)

Table of Contents (PDF) (Word)

Acknowledgments (PDF) (Word)

Parent to Parent Letter (PDF) (Word)

Joys (PDF) (Word)

Introduction (PDF) (Word)

I. Home Medical Record (PDF) (Word)

A. Introduction & Tips (PDF) (Word)

B. Home Medical Record Forms

• Identification Numbers (PDF) (Word)
  (Form CCR.38)
  
• Blank Calendar (PDF) (Word)
  (Form CCR.2A)
  
• Appointment Calendar (PDF) (Word)
  (Form CCR.2B)
  
• Physicians/Therapists/Dentists (PDF) (Word)
  (Form CCR.4)
  Can be used for other professionals involved in child's care

C. Diagnosis/Medications/Hospitalizations (PDF) (Word)

• Diagnosis (PDF) (Word)
  (Form CCR.6)
  
• Medications (PDF) (Word)
  (Form CCR.28)
  
• Hospitalizations (PDF) (Word)
  (Form CCR.30)

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D. Medical History (PDF) (Word)

• Birth History (PDF) (Word)
  (Form CCR.10)
  
• Family History (PDF) (Word)
  (Form CCR.12)
  
• Feeding History (PDF) (Word)
  (Form CCR.24)
  
• Growth and Development Record (PDF) (Word)
  (Form CCR.26)

E. Routine Health Care (PDF) (Word)

• Routine Health Care (PDF) (Word)
  (Form CCR.13)
  
• Child's Illness/Infection/Injury Record (PDF) (Word)
  (Form CCR.14)
  
• Immunization and Allergy Record (PDF) (Word)
  (Form CCR.20)
  
• Dental Record (PDF) (Word)
  (Form CCR.22)

F. Specialized Health Care (PDF) (Word)

• Equipment/Supplies Sheet (PDF) (Word)
  (Form CCR.32)
  
• Tests and X-Rays (PDF) (Word)
  (Form CCR.36)
  
• Notes (PDF) (Word)
  (Form CCR.40)
  
• Words and Their Meanings (PDF) (Word)
  (Form CCR.8)
  
• Medical Specialties and Specialists (PDF) (Word)

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II. Funding (PDF) (Word)

A. Introduction, Tips, Private Insurance & Public Insurance (PDF) (Word)

• Medicaid (PDF) (Word)
  
• Medicare (PDF) (Word)
  
• Division of Specialized Care for Children (DSCC) (PDF) (Word)
  
• Comprehensive Health Insurance Plan (CHIP) (PDF) (Word)
  
• Supplemental Security Income (SSI) (PDF) (Word)
  
• Department of Rehabilitation Services (DRS) (PDF) (Word)
  

B. Other Possible Funding Resources (PDF) (Word)

C. Insurance Terms Glossary (PDF) (Word)

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D. Worksheets (PDF) (Word)

• General Insurance Information (PDF) (Word)
  
  
• Your Child's Insurance Information (PDF) (Word)
  (Form CCR.44)
  
• Private Insurance Worksheet (PDF) (Word)
  (Form CCR.46)
  
• Public Insurance Worksheet (PDF) (Word)
  (Form CCR.48)
  
• Income Tax Expense Record (PDF) (Word)
  (Form CCR.50)
  
• Medical Travel Expense (PDF) (Word)
  (Form CCR.52)
  
• Notes (PDF) (Word)
  (Form CCR.40)

E. Funding Assistance Forms and Eligibility Letters (PDF) (Word)

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III. Early Intervention/Education/Vocation (PDF) (Word)

A. Introduction, Tips and Worksheets (PDF) (Word)

• Education Information (PDF) (Word)
  (Form CCR.54)
  
• Education Record (PDF) (Word)
  (Form CCR.56)
  
• Notes (PDF) (Word)
  (Form CCR.40)

B. Child's Educational Plan and School Reports (PDF) (Word)

IV. Rights (PDF) (Word)

A. Introduction, Obtaining Medical Records and Appeals (PDF) (Word)

• Release of Information Form (PDF) (Word)
  (Form CCR.58)
  
• Notes (PDF) (Word)
  (Form CCR.40)
  

V. Other (PDF) (Word)

Introduction, Tips, Recommended Reading & Resources (PDF) (Word)

 

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