Satisfies Element 5C-6
PCMH 5C Factor 6 aligns with PCMH 2014 2A
Factor 4
Pediatric to Adult Provider Transition Policy
Initiated 4/8/14 JL
Updated 11/13/14 JL
Family Care Associates follows the guidelines set forth by the American Academy of Pediatrics
(AAP) for pediatric to adult transition.
Purpose: to ensure our patient make a smooth transition from pediatric to adult
health care.
• Family Care Associates will collaborate with young adults and their families
regarding the age for transferring to an adult provider by sending a letter
regarding the transition policy. We recommend this transfer to occur 6
months prior to their 18th or 21st birthday depending on their provider or if
a patient younger than 18 or 21 has a child of their own.
• Family Care Associates will assist with this transfer process, including but
not limited to, identifying an adult provider, transferring medical records
and communicating any pertinent information regarding the needs of the
patient.
• Dr. Bingham will see patients up to the age of 21.
• Dr. Bierman will see patients up to the age of 18.
• Jamie Niemerg will see patients up to the age of 18.
Colleen Bingham, M.D.
Jeffrey K. Brummer, D.O.
Michael G. Brummer, M.D.
Jeffrey Crowell, M.D.
Amanda Bierman, M.D.
Thomas Heischmidt, M.D.
Amanda Bierman, M.D.
Colleen Bingham, M.D.
Jeffrey Brummer, D.O.
Michael Brummer, M.D.
Jeffrey Crowell, M.D.
Thomas Heischmidt, M.D.
Lenora Drees, FNP
Dot Behrns, FNP
Jamie Niemerg, PNP
Richelle Dillon, FNP
Candi LeDuc, FNP
Family Care Associates
1106 N. Merchant St., P.O. Box 665
Effingham, Illinois 62401
Ph. 217-342-7000 F. 217-342-7002
www.familycareassociates.com
February 13, 2015
Satisfies Element 5C-6
Example of Pediatric to Adult Transition Letter
that is mailed out to patients.
«FirstName» «LastName»
«MailingAddress1»
«MailingAddress2»
Dear «FirstName»,
Did you realize that as your next birthday approaches, I will no longer be able to serve as your pediatrician? I have enjoyed caring for
you each time you have come through our doors and want to wish you all the best as you approach adulthood. I have listed below
my partners that I trust will take good care of you as you make this transition. Additionally, our excellent staff of nurse practitioners
is available to address all of your healthcare needs.
We would be happy to transfer your care to any one of our adult primary care physicians. They will continue to provide for your
healthcare needs and uphold the high standard of care you have come accustomed to at Family Care Associates. I will personally
communicate all pertinent medical history, conditions, etc. to my partners.
You can transfer your records to any of our physicians listed below simply by circling the physician of your choice and returning this
letter to us, or by calling our office to let us know of your decision.
Jeff Brummer, D.O.
Family Practice
Jeff Crowell, M.D.
Family Practice
Thomas Heischmidt, M.D.
Internal Medicine/Pediatrics
Additionally, we’d like to confirm all of your demographic information is up to date. Please review the enclosed form and alert us to
any changes. You can return the form with this letter, make changes when you call, or log in to your Patient Portal account and send
us your updates.
Haven’t activated your Portal account? We highly recommend doing so! With Patient Portal, you can send us messages or nonurgent questions, request appointments, view lab results, and more all at your convenience. To activate, simply provide us with a
valid email address and we’ll send you your log-in information. And, check out the mobile app, Healow, available on Iphone or
Android, and have access to your health information while on the go!
If you wish to transfer to a physician outside of our office, please complete the “Authorization to Release Medical Records FROM
FCA” form available on our website.
For more information about our adult physicians or the service we offer our adult patients, please visit us online at
www.familycareassociates.com or call 217-342-7000 and ask to speak to Sheila. We look forward to continuing to serve as your
medical home as you approach your next phase of life.
Sincerely,
Colleen Bingham, M.D.
Our Mission: “Providing the highest quality medical care to the patients and families we serve”