Your De-Identified Case Story

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Case stories are an important element of the Project ECHO® process, enabling the chance to learn from one another through the sharing of experiences and knowledge. Please give some thought to challenges you are experiencing or have already overcome that we could discuss as a group, guided by our expert Hub Team. If a case does not come to mind yet, our meeting presentations may surface ideas later. The cases may align with the current meeting topic or previous meeting topics. Please use this Project ECHO as a conduit to a group consultation with our Hub Team of experts as well as a large group of experienced peers who may have experienced similar situations. "All teach, all learn!"

PLEASE NOTE that Project ECHO® case consultations do not create or otherwise establish a provider-patient relationship between any clinician and any patient/client whose case is being presented in a Project ECHO® setting. While the case consultations may offer recommendations regarding effective evaluation, care, and treatment options, these represent recommendations only. Please be sure to de-identify all patient information and do not share any confidential information (name, etc.) when presenting your case during the ECHO session.

With this story, I want to:

Present a challenging situation and gather ideas and recommendations from the group.

Share a creative or innovative response to a situation we've made progress on.

Follow-up on a case my workplace presented in a past meeting.

Other

Please keep my organization anonymous and present this story on our behalf.

Case Provider:

Your name, organization, role and a brief description of your organization's services and service recipients. (If you have chosen to provide a case anonymously, the ECHO planning team will only use this information to confirm with you our understanding of the story.)

Phone:

Email:

Fictitious client name(s) to ensure privacy:

Story Background

This should include information such as the client's age, sex, gender, height & weight, type of disability, comorbidities, their living environment/setting, primary language, length of time you have known them, support systems and family situation and dynamics?

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The story and questions or concerns you would like to raise:

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(Optional) Attach any relevant (but fully de-identified!) medical record notes, test results or other documents that help tell this story.

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(Optional) We are big proponents of the NTG-Early Detection Screen for Dementia (NTG-EDSD) tool. While its primary use is starting the critical conversation between clinical personnel and care partners about changes in health or behaviors that may signal a need for cognitive assessment, it also lends itself to care planning. If you'd like to attach an NTG-EDSD form, printable and fillable forms are available to download at https://www.the-ntg.org/ntg-edsd.

Upload file

Current Medications

Medication	Dosage	Date Began	Reason / Comments
example: levothyroxine	50 mcg tablet >> 75 mcg tablet	11/2019	Hypothyroidism

An ECHO team member will be in touch with you to talk about your story. A copy of this story form will be emailed to you. Thank you!

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