Table:
Example of Medical Home Team Responsibility
Team Member
Champion

Care coordinator

Medical records staff

Receptionist

Medical assistants
Registered nurses




Physicians, nurse practitioners and physician
assistants




Clerical staff



Responsibility
Lead in promoting and implementing
the care coordination protocols in the
practice
Responsible for managing the care
coordination protocol of the medical
home
Prepare chart prior to office visit, insert
appropriate screening tool(s)
Offer families the screening tool
form(s), explain purpose
Offer assistance with completing form
Score the screening tools form(s)
Involve in screening, scoring, and
discussing child
developmental/behavioral concerns
with caregivers
Offer assistance with referrals to
community resources
Responsible for reviewing all
completed forms
If necessary, administer follow-up
screening
Discuss results and concerns with
families
Make appropriate referrals to
community resources
Plan for a follow-up appointment
Order, reproduce, reorder supplies
Formulate a plan on where to store
materials and how to distribute and
collect materials