[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-364029-105":53,"doc-detail-364029-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","medicare-care-plan-template-medicare-care-plan-cognitive-assessment-and-care-plan-template","Medicare Care Plan Template - Medicare Care Plan (Cognitive Assessment and Care Plan Template)","","Medicare Care Plan template for primary care use, combining cognitive assessment with a structured written care plan. Covers cognitive problem severity, type of dementia, and next follow-up date, with options for advance care planning, diagnostic testing (including biomarkers and neuroimaging), neurology/psychiatry referral, and aging in place versus assisted living. Includes action planning for neurologic, behavioral, medical, caregiver, and safety needs, plus recommended medications, labs, immunizations, therapies, and legal/financial support.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medicare-care-plan-template-medicare-care-plan-cognitive-assessment-and-care-plan-template/364029/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medicare-care-plan-template-medicare-care-plan-cognitive-assessment-and-care-plan-template/364029.png","ImageObject",442,249,{"name":88,"@type":89},"\tJames","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-23",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What sections are included in the written care plan template?","Question",{"text":108,"@type":109},"The template organizes a written care plan into cognitive problems, neurological/mental health/behavioral/functional problems, medical problems, and caregiver assistance, each with selectable actions.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the template guide diagnostic testing and specialist referrals?",{"text":113,"@type":109},"It lists diagnostic options such as biomarker testing and neuroimaging (MRI/CT/Amyloid PET) and provides checkboxes for referral to a neurologist, psychiatrist, or geriatrician.",{"name":115,"@type":106,"acceptedAnswer":116},"What care actions are suggested for dementia-related safety and daily living?",{"text":117,"@type":109},"It includes guidance on advance care planning, driving safety, exercise and diet, home safety and environmental “rounds,” sleep pattern support, medication management, and caregiver planning such as legal/financial support and safety planning.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},364029,1791330758,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Performing a Cognitive Assessment and Developing a Care Plan in Primary Care1-4  \nFull abbreviations, accreditation, and disclosure information available at  \n[PeerView.com/XUM40](PeerView.com/XUM40)  \nCognitive Assessment and Care Plan (CPT 99483) Template  \n| CACP_10: Written care plan Today’s date:   Next follow-up date:   |  |  |\n| --- | --- | --- |\n| Cognitive problems | Actions |  |\n| ❑ None\u003Cbr>❑ Mild cognitive impairment\u003Cbr>❑ Mild dementia\u003Cbr>❑ Moderate stage\u003Cbr>❑ Late stage Type of dementia ❑ Alzheimer’s\u003Cbr>❑ Vascular\u003Cbr>❑ Mixed\u003Cbr>❑ Lewy Body\u003Cbr>❑ Frontotemporal\u003Cbr>❑ Other\u003Cbr>❑ Unknown; need further evaluation | ❑ Advance care planning (living wills, family meeting)\u003Cbr>❑ Additional diagnostic testing (check all that apply)❑ Biomarker testing:  \u003Cbr>❑ Neuroimaging: MRI\u003Cbr>❑ Neuroimaging: CT\u003Cbr>❑ Neuroimaging: Amyloid PET\u003Cbr>❑ Neuroimaging: Other\u003Cbr>❑ Referral to neurologist/psychiatrist/ geriatrician:  \u003Cbr>❑ Aging in place planning vs assisted living ❑ Driving safely\u003Cbr>❑ Exercise your body\u003Cbr>❑ Exercise your brain (remediation, hobbies, games, computer, volunteering) | ❑ Healthy diet (dietician if needed, Meals on Wheels)\u003Cbr>❑ Lab testing: CBC/CMP/TSH/B12/folate/RPR/ HIV/Other  \u003Cbr>❑ Legal/financial planning (power of attorney, guardianship, advance directives)\u003Cbr>❑ Medication: donepezil/rivastigmine/galantamine/ memantine/donepezil + memantine\u003Cbr>❑ Medication: aducanumab/lecanemab\u003Cbr>❑ Medications to avoid (sleep aids, diphenhydramine)\u003Cbr>❑ Social engagement (clubs, church, sports) |\n| Neurological, mental health, behavioral, functional problems |  |  |\n| ❑ Aggression\u003Cbr>❑ Delusions\u003Cbr>❑ Depression/suicide\u003Cbr>❑ Hallucinations\u003Cbr>❑ Decision making (capacity)\u003Cbr>❑ Safety\u003Cbr>❑ Sleep | ❑ Alcohol avoidance\u003Cbr>❑ Autonomy promotion\u003Cbr>❑ Counseling\u003Cbr>❑ Driving safety\u003Cbr>❑ Environmental “rounds”\u003Cbr>❑ Exercise\u003Cbr>❑ Home safety\u003Cbr>❑ Medications: antidepressants/antipsychotics/\u003Cbr>anxiolytics/other:   | ❑ Music therapy\u003Cbr>❑ Reminiscence therapy\u003Cbr>❑ Relaxation therapy (art, pets, yoga,\u003Cbr>muscle relaxation)\u003Cbr>❑ Sleep patterns\u003Cbr>❑ Structure\u003Cbr>❑ Support group\u003Cbr>❑ Other |\n| Medical problems |  |  |\n| ❑ Lung disease ❑ Heart disease\u003Cbr>❑ Parkinson’s disease ❑ Vision and/or hearing\u003Cbr>❑ Swallowing\u003Cbr>❑ Cancer ❑ Dental\u003Cbr>❑ Kidney disease\u003Cbr>❑ Liver disease\u003Cbr>❑ Gastrointestinal\u003Cbr>❑ Urologic\u003Cbr>❑ Other | ❑ Cardiac rehabilitation\u003Cbr>❑ Dental care\u003Cbr>❑ Fall prevention\u003Cbr>❑ Hearing/vision evaluation\u003Cbr>❑ Hospice care\u003Cbr>❑ Immunizations (flu, pneumococcal, tetanus booster, shingles)❑ Incontinence\u003Cbr>❑ Physical/occupational therapy evaluation\u003Cbr>❑ Pulmonary rehabilitation\u003Cbr>❑ Speech therapy evaluation\u003Cbr>❑ Other:   |  |\n| Caregiver assistance |  |  |\n|  | ❑ Adult day care\u003Cbr>❑ Aging in place (home modification)❑ Alzheimer’s Association ❑ Assistance from other resources\u003Cbr>(clubs, church, family, coworkers)❑ Barriers to assistance\u003Cbr>❑ Behavior management skills\u003Cbr>❑ Communication skills\u003Cbr>❑ Disease-specific resources ❑ Environmental management\u003Cbr>❑ Home aides\u003Cbr>❑ Hospice | ❑ Legal/financial planning\u003Cbr>❑ Memory/communication aids (clock, calendar, glasses, hearing aids, pictures)\u003Cbr>❑ Medical/practical supplies ❑ Medication management\u003Cbr>❑ Safety planning (guns, stairs, home hazards, falls)❑ Self-care actions\u003Cbr>❑ Senior alert system\u003Cbr>❑ Support group |\n\n1. [https://www.alz.org/media/Documents/Cognitive-Impairment-Care-Planning-Toolkit_012623.pdf. 2. Borson S et al.](https://www.alz.org/media/Documents/Cognitive-Impairment-Care-Planning-Toolkit_012623.pdf. 2. Borson S et al. Alzheimers Dement. 2017)[ Alzheimers Dement](https://www.alz.org/media/Documents/Cognitive-Impairment-Care-Planning-Toolkit_012623.pdf. 2. Borson S et al. Alzheimers Dement. 2017)[. 2017](https://www.alz.org/media/Documents/Cognitive-Impairment-Care-Planning-Toolkit_012623.pdf. 2. Borson S et al. Alzheimers Dement. 2017);13:1168-1173.  \n3. Form adapted from [https://www.aafp.org/fpm/2019/0100/p1](https://www.aafp.org/fpm/2019/0100/p1)1.html. 4. [https://Champio","cbCaipqi2y98W4na","https://ap.wps.com/l/cbCaipqi2y98W4na","pdf",775579,"English","# Cognitive Assessment and Written Care Plan\n## Care Plan Details\n## Cognitive Problems\n## Neurological, Mental Health, Behavioral, and Functional Problems\n## Medical Problems\n## Caregiver Assistance","[{\"question\":\"What sections are included in the written care plan template?\",\"answer\":\"The template organizes a written care plan into cognitive problems, neurological/mental health/behavioral/functional problems, medical problems, and caregiver assistance, each with selectable actions.\"},{\"question\":\"How does the template guide diagnostic testing and specialist referrals?\",\"answer\":\"It lists diagnostic options such as biomarker testing and neuroimaging (MRI/CT/Amyloid PET) and provides checkboxes for referral to a neurologist, psychiatrist, or geriatrician.\"},{\"question\":\"What care actions are suggested for dementia-related safety and daily living?\",\"answer\":\"It includes guidance on advance care planning, driving safety, exercise and diet, home safety and environmental “rounds,” sleep pattern support, medication management, and caregiver planning such as legal/financial support and safety planning.\"}]","Medicare Care Plan Template - Medicare Care Plan (Cognitive Assessment and Care Plan Template) | PDF",1790155196]