Horizon's Highly Qualified Staff:
• Works with discharge planners and case managers to provide a seamless transition from the hospital to home care.
• Performs Skilled Systems assessments to determine the unique needs of the patient.
• Develops and updates an individual care plan and treatment goals in conjunction with the physician and other team members.
• Coordinates care by maintaining effective ongoing communication with the physician and other members of the team.
• Actively involves the patient and family.
• Works with DME (Durable Medical Equipment) companies to obtain the equipment the patient needs.
• Coordinates with community agencies for services the patient needs.
