Care Plan Request Form

PKB has a comprehensive library of care plan templates that have already been created and being used by teams with their patients, however, if you would like to create a care plan for your team to use with your patients, PKB will support you with the creation of three care plan templates, with two additional updates per plan.

To request the creation of care plan, please complete the PKB care plan request form below and submit it to PKB for review, your Success project manager will be in touch within five working days.

In the meantime, take a look through the care plan library in this toolkit.

For Google users

For non-Google users, copy this text and send your answers to PKB

This form is for requesting PKB to create a care plan template and adding it to the team's PKB sandbox environment, where it can be reviewed before being added to production.

Please ensure your team has been trained on the care plan functionality and is ready to start using the care plan with patients as soon as it has been created. Your Success PM will be in touch within five days of submitting the form to confirm if PKB will create the care plan.

If accepted the care plan will be added to your sandbox team within two weeks.

For PKB care plan templates, you can visit https://deploy.patientsknowbest.com/clinical/careplans


Please copy and paste this information and send your answers to success-requests@patientsknowbest.com


  1. The email address of requester (customer’s clinical engagement lead)

Your answer

  1. The email address of PKB project manager to receive this request

Your answer

  1. Name of requesting team

Your answer

  1. Name of Organisation

Your answer

  1. What is the name of the care plan you want PKB to build

Your answer

  1. Are all staff trained on the care plan feature in PKB and the purpose of the care plans?

Yes

No

Other:

  1. Does the team know how to create a care plan with a patient?

Yes

No

Other:

  1. Do you want patients to start care plans before their appointments with the team?

Yes

No

Maybe

Other:

  1. How does the team plan to track the usage of the care plans created?

Your answer

  1. What point in the patient’s treatment are you going to add the care plan to the patient’s record for them to read/edit?

Your answer

  1. Have you got a care plan workflow? Please share with your Success PM.

Yes

No

Other:

  1. What symptoms do you want?

Your answer

  1. What measurements do you want?

Your answer

  1. What tests do you want?

Your answer

  1. Do patients know what they have to do with the care plan? Do you need to add additional instructions in the library of PKB and patients comms?

Your answer

  1. Please attached the word doc of the care plan text here

Your answer