What is a Patient-Centered Medical Home?

A Patient-Centered Medical Home (PCMH) is a system of care in which a team of health professional’s work together to provide all of your health care needs by using evidence based care.We use technology such as electronic medical records to communicate and coordinate your care and provide the best possible outcomes for you.

You, the patient, are the most important part of PCMH. When you take an active role in your health and work closely with us, you can be sure that you are getting the care you need.

Who is the Patient-centered Medical Home Care Team?

Your primary care provider leads your care team, which may include providers, nurses, medical assistants, pharmacy, dental professionals, health educators, behavioral health professionals and other support staff. Our teams act as “coaches” who help you get healthy, stay healthy, and get the care and services that are right for you. You, of course, are at the center of your care team.

How does Patient-Centered Medical Home benefit you?

In a Patient-Centered Medical Home, we:

  • Are availablewhen you need us. You can get clinical advice easily and efficiently and get appointments quickly. We are also available to provide you with clinical advice by telephone when our clinic is closed.
  • Know you and your medical health history. We know about your personal and family situation and can suggest treatment options and resources that make sense for you.
  • Help you understand your condition(s) and how to take care of yourself. We explain and educate you about your conditions and give options and help you make decisions about your care.
  • Help coordinate your health care even if we are not the ones giving you the care. We will help you find specialists, get appointments and make sure specialist have the information they need to care for you.We also follow up with these specialists and other providers to keep up with any changes in your care.
  • Use technology such as electronic medical records and share records to help prevent medical errors and make sure that we are always on the same page.


1. Be in charge of your Health

  • Know that you are a partner in your care.
  • Understand your health situation and ask questions about your care.
  • Learn about your condition and what you can do to stay as healthy as possible.

2. Participate in your care

  • Follow the plan that we have agreed is best for your health.
  • Take medications as prescribed.
  • Keep scheduled appointments and attend follow-up visits when necessary.

3. Communicate with your care team

  • Tell us when you don’t understand something we said or us to explain it in a different way.
  • Tell us if you get care from other health professionals so we can help coordinate the best care possible.
  • Bring a list of questions and a list of medicines or herbal supplements you take to every appointment.
  • Tell us about any changes in your health or well-being.


1. Get to know you

  • Learn about you, your family, your life situation, and preferences. We will update your records every time you seek care and suggest treatments that make sense for you.
  • Listen to your questions and feelings and treat you as a full partner in your care.

2. Communicate with you

  • Explain your health situation clearly and make sure you know all of your options for care.
  • Give you time to ask questions and answer them in a way you understand.
  • Help you make the best decisions for you care.

3. Support you

  • Help you set goals for your care and help you meet these goals every step of the way.
  • Give you information about classes, support groups, or other resources that can help you learn more about your condition and stay healthy.
  • Send you to trusted experts when necessary.