NCQA Patient-Centered Medical Home Recognized Pracice

What is a patient centered medical home?
A patient centered medical home is a care team, led by a primary care physician that focuses on each patient’s health goals and needs, and coordinates that patient’s care across all settings. As a medical home, we place an emphasis on patients’ all-around well-being. Patient-Centered Medical Home is not an actual building, house or hospital.  It is a team approach to providing comprehensive health care in a high-quality and cost-effective manner. This style of care is based on a continuous relationship with a personal physician.  The physician leads a team of medical professionals who together take responsibility for a person’s care through all stages of life.  The patient has one place to call; they have greater access to services; they get personalized care; that care is safe and scientifically valid; and there is a focus on preventative care which keeps costs down and patients healthier.

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals) and the patient’s community (e.g., family, public and private community-based services). 

In order to run a successful medical home, both our office and our patients have roles that need to be filled in order to best serve the wide variety of patient needs.

As your primary care provider, I will:

  • Learn about you, your family, life circumstances, as well as health goals and preferences in order to provide treatment that works for you.
  • Allow for records to be easily transferred to and from our office. A small fee is required to release records, since a third party is employed. Please contact the office manager, Sharon, to request a records release or to ensure your records have made it to our office at 919-460-7676.
  • Provide quality care to you, regardless of source of payment/insurance type
  • Keep you up-to-date on all preventative screening tests and immunizations
  • Be available to you after hours for urgent needs
  • Notify you of test results in a timely manner
  • Provide you with tools for self-management and access to evidence based care
  • Listen to you, and communicate clearly with you so that you fully understand your condition and treatment options.
  • Help you make the best decisions for your care
  • Address behavioral health needs including depression, anxiety, ADHD, and other life stressors by listening and determining if medication and/or a referral would be the best option.

As a patient who is active in their own healthcare, I expect you to:

  • Come to visits prepared to discuss any medication updates, dietary supplements/natural remedies you are using, and any questions that you would like answered.
  • Provide a complete and honest medical history including current medications, recent test results, visits to other doctors/healthcare providers, behavioral health services, hospitals or ED visits
  • Notify us of your visits with other health care providers, so we can coordinate care with them
  • Understand/Learn about your health conditions. Ask us if you don’t understand something
  • Follow the plan that we have agreed is in the best interest for your health
  • Take medications as prescribed
  • Contact us if you haven’t received your test results within two weeks.
  • Contact us after hours (Only for urgent reasons that cannot wait until the next business day—call our regular office line at (919) 460-7676 and follow instructions for urgent/emergency call)
  • If possible, contact us before you go to the emergency room so that someone who has knowledge of your medical history is active in your care
  • Learn about your health insurance coverage and contact them (or us) if you have any questions about your benefits.
  • Pay your share of any fees
  • Give us feedback to help improve patient experience and satisfaction.


If you have any questions about Patient Centered Medical Home, please ask the staff.

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