Care Plan 2.0 offers a streamlined and intuitive workflow for creating individualized patient care plans. Whether you're documenting a patient's first care plan, performing a monthly update, or reusing an existing plan, the module provides multiple creation methods to reduce documentation time while maintaining consistency.

Users can choose from several creation options depending on the patient's history and organizational workflow. Once a care plan has been created, the remaining sections become available for completion and review before submission for physician approval.

Before creating a Care Plan, ensure that:

The Care Plan page displays all care plans associated with the selected patient, including active, draft, completed, and legacy care plans (if applicable).

The Care Plan landing page serves as the central workspace for managing all patient care plans.

Depending on your organization's configuration, you may see:

This view allows care coordinators to quickly determine the current state of a patient's care plan before creating a new one.

Note: If a patient has an existing Care Plan from the legacy module, it remains available in a read-only format and can be referenced while creating a new Care Plan 2.0 record.

To create a new Care Plan:

HealthArc provides multiple creation methods to accommodate different clinical workflows.

Creating a Care Plan from scratch starts with a completely blank care plan. This method is recommended for:

After the initial save, the full Care Plan navigation menu becomes available, allowing you to complete each section sequentially.

Use this option when creating the patient's very first Care Plan or when no suitable template exists.

Templates allow organizations to standardize care planning by pre-populating common clinical information. Templates may include:

The template populates the applicable sections while allowing users to modify any information before publishing.

Always review template content before publishing to ensure it accurately reflects the patient's current clinical condition.

Care Plan 2.0 can reuse an existing Care Plan as the starting point for a new one.

Rather than recreating goals, interventions, and patient information each month, users can duplicate the previous plan and update only the information that has changed.

Previously documented information—including goals, interventions, preventive services, and tasks—can be reused, significantly reducing documentation time.

Always verify copied medications, goals, and interventions to ensure they remain clinically appropriate.

This method of care plan creation is an upcoming AI-assisted care plan creation option.

Once available, AI will assist in generating an initial care plan using existing patient information and clinical documentation. Care coordinators will be able to review, edit, and finalize the AI-generated content before publication.

Note: This functionality is a future enhancement and may not be available in the current environments.

Users do not need to complete every section in a single session.

Selecting Save stores the Care Plan as a draft, allowing work to continue later. Draft care plans:

Saving frequently is recommended to prevent accidental data loss.

To continue working on a draft:

Users may return to draft care plans as often as needed before submitting them for approval.

Once a Care Plan has been created, additional sections become available in the navigation panel. These sections guide users through the complete documentation process. Typical sections include:

Users can move between sections as information becomes available, making it easy to complete documentation over multiple sessions.

Step-by-step instructions with screenshots

The Personal Details section captures the patient's core clinical and social profile used to build the Care Plan. The left navigation keeps the major Care Plan sections accessible, while the main workspace presents the selected patient-information form. Complete each subsection and verify existing information before moving forward.

Basic Info: Basic Info captures foundational patient information and related clinical details. The screen provides structured fields and selectable options so the care team can document the patient's current profile and relevant conditions. Review populated information for accuracy and complete any required fields.

Family & Social History: Family & Social History is used to document relevant family medical history and social context that may affect the patient's care. Use the available questions and structured fields to capture significant history and supporting details.

Lifestyle & Risk Factor: Lifestyle & Risk Factor captures diet, exercise, appetite, food access, and substance-use information. The Diet & Exercise form includes selections for diet, meals per day, difficulty obtaining food, appetite, and exercise frequency. The Substance Use form records the substance, usage per day, and number of usage days per week.

Medications: The Medications section displays the patient's active medication list and allows a new medication to be added. The Add Medication form includes Drug Name, Drug Type, Time, Meal, Strength, Status, Prescription Reason, Unit, Frequency, and Likely End Date. Complete the applicable fields and save the medication.

Allergies: The Allergies section displays reported active allergies and provides an option to add a new allergy. The Add Allergy form captures Allergy Name, Allergy Description, Severity, Onset Date, and Who Reviewed It. Review existing allergies and record new or updated information as appropriate.

Behavioral Symptoms: The Behavioral Symptoms area captures patient-reported or clinically relevant symptoms and concerns. The screen provides selectable symptom options such as cough, fever, chest pain, headache, vomiting, diarrhea, leg swelling, joint pain, and anxiety. Select the symptoms applicable to the patient and document the relevant clinical context.

The Assessment section allows the care team to select standardized assessments and determine how they will be administered. Users can select an assessment and a method such as sending it to the patient. The assessment list shows fields including date created, date completed, score, result, status, and available actions, allowing completed assessments to be tracked over time.

The Barriers to Care section identifies obstacles that may affect the patient's ability to receive care or follow the Care Plan. The screen provides selectable categories such as sensory impairments, financial barriers, mobility aids, language, literacy, transportation, social isolation, housing insecurity, and insurance or medication-related barriers. Select all applicable barriers so they can be addressed through care-plan interventions.

The SDOH section assesses social, economic, community, and environmental factors that can influence health outcomes. Care Plan 2.0 organizes the questions into Economic Stability, Education Access, Healthcare Access, Environment, and Social & Community. Complete the applicable questions and record the patient's responses.

Economic Stability: Economic Stability captures factors related to food security and financial circumstances. The screen includes questions about whether the patient worried that food would run out before they had money to buy more, with response options such as Often, Sometimes, or Never.

Education Access: Education Access captures education and training needs. Questions shown include whether the patient speaks a language other than English at home and whether they want help with school, training, job training, or completing a high school diploma, GED, or equivalent.

Healthcare Access: Healthcare Access captures information about access to healthcare services, including insurance coverage and medication access. The screen provides fields for selecting the patient's insurance coverage and documenting medication-access considerations.

Environment: Environment captures housing and living-situation information. The screen asks about the patient's current living situation and provides options ranging from having a steady place to live to being temporarily housed or without a steady place to live.

Social & Community: Social & Community captures the patient's access to help with day-to-day activities such as bathing, preparing meals, shopping, and managing finances. Response options identify whether the patient does not need help, receives all needed help, could use a little more help, or needs a lot more help.

Vitals Monitoring defines the measurements that should be monitored as part of the Care Plan. The table includes Metric, Unit, Frequency, and Capture Method. Users can add or configure metrics such as Blood Pressure and Pulse, specify how often they should be captured, and document additional notes or descriptions.

Preventative Services lists recommended preventive activities and their monitoring schedule. The table displays the service, frequency, status, service date, next service date, and available actions. Examples shown in the image below include Kidney Function Tests (GFR & Creatinine) and Lipid Panel (Cholesterol Screening).

This section allows users to add a preventive service to the patient's Care Plan by selecting the Preventive Service and its Frequency. The Preventive Service dropdown includes searchable options such as Annual Wellness Visit, Influenza Vaccine, Pneumococcal Vaccine, COVID-19 Vaccine, Tdap Booster, Shingles Vaccine, and Colorectal Cancer Screening.

Users can also choose from predefined service frequencies, including Every year, Annually (before flu season), Every 10 years, Per CDC guidelines, or other configured options.

The screen also allows users to create a Patient Task and/or Care Team Task associated with the preventive service. For patient tasks, users can select a task category, define the task frequency (e.g., Daily, Weekly, Monthly, Yearly, or Custom), and add detailed instructions. The Description field supports up to 5,000 characters.

The SMART Goals section allows care teams to create and manage specific, measurable, and time-bound patient goals as part of the Care Plan. When creating a goal, users can define the Goal Title, Category, Lifecycle Status, Frequency, Target Value, Unit, Due Date, Measurable Outcome, and Description. Categories can be used to organize goals across areas such as dietary, behavioral, safety, independence, housing, legal, and nursing needs.

The Lifecycle Status tracks the goal's progress, with options such as Proposed, Planned, Accepted, Active, On Hold, Completed, and Cancelled. Users can also specify how frequently the goal should be pursued, such as one-time, daily, weekly, bi-weekly, monthly, quarterly, or half-yearly. Target values can be associated with units such as mmHg, bpm, mg/dL, mmol/L, lbs, or kg.

Once saved, goals are displayed in the Care Plan with their status, frequency, target value, due date, measurable outcome, and description, allowing the care team to monitor and update them throughout the patient's care journey.

The Interventions section allows care team members to create and manage activities that support the patient's SMART Goals and overall Care Plan. Users can define an Activity Title, Activity Type, Status, Duration, Frequency, and Instructions, with activity types including options such as Referral and Education.

Interventions can also be linked to relevant ICD codes and SMART Goals, include an external resource link, and have supporting Education Assets uploaded. Once saved, interventions are displayed with their lifecycle status, frequency, and duration, allowing the care team to track and manage the activities throughout the patient's care journey.

The Self-Management Tasks section allows care teams to create and track activities that the patient is expected to complete as part of their Care Plan. Users can define the Task Title, Activity Type, Default Status, ICD Codes, Start Date, Due Date, Frequency, Instructions, and the SMART Goal(s) associated with the task.

Tasks can be scheduled as one-time, daily, weekly, bi-weekly, monthly, quarterly, or half-yearly activities, with statuses such as Not Started, Scheduled, In Progress, On Hold, Completed, Cancelled, and Stopped. Once saved, tasks are displayed with their frequency, dates, status, and instructions, allowing the care team to monitor patient participation and progress.

Additional Notes provides a free-text area for documenting medical necessity and other supporting Care Plan information. Users can enter a subject and detailed description using the rich-text editor, with a character limit displayed on the screen.

Risk Classification provides a comprehensive risk assessment using a displayed scoring scale. The screen shows the patient's current risk classification and indicates how many assessment questions have been answered, allowing the care team to review the available scoring information before finalizing the patient's risk level.

Care Team Review records the providers and other care-team members involved in the patient's Care Plan. Users can add a team member by entering their Name, Role, Specialty, Email Address, and Mobile Number.

The Role dropdown includes options such as Primary Care Physician, Care Manager, Behavioral Health Provider, Psychiatrist, Nurse Practitioner, Specialist, and Care Coordinator, while the Specialty field allows selection of the provider's clinical specialty, such as General Practitioner, Health Coach, Psychiatry, Cardiologist, or Care Provider. Added team members are displayed in the Care Team Review list along with their contact and role information.

Call Notes & Tasks provides a workspace for reviewing patient calls and generating documentation and follow-up tasks. Users can select a Care Plan and call, then use Generate Notes to create call documentation. The resulting notes are organized into sections such as Subjective, Objective, and Assessment, while tasks can be reviewed separately or added manually with a title, category, description, assignee, and due date.

Next Evaluation schedules the next Care Plan evaluation. The screen requires an evaluation frequency and recommended date and time, and provides options to enable patient reminders through Email, SMS, or Mobile App. Use the scheduling fields to establish the next review point and select the appropriate reminder channels.

Review & Finalize is the final step before submitting the Care Plan. The section includes Patient Communication, Physician Notification, and Review History. Review the completed Care Plan, select the appropriate patient communication channel, determine whether physician approval is needed, and review any available approval or review history before submission.

Patient Communication: Patient Communication allows the care team to choose how Care Plan information will be shared with the patient. Available channels shown include Email, SMS, Print, and Mobile App, with an option to preview the patient Care Plan before sending or sharing it.

Physician Notification: Physician Notification asks whether physician approval is required for the Care Plan. Use this step to confirm the appropriate provider-review workflow before submission.

Review History: Review History displays previous reviewers, review comments, tags, status, and timestamps. If the Care Plan has not been reviewed previously, the screen indicates that no review history is available.

If the patient previously used the legacy Care Plan module:

This approach preserves historical documentation while allowing organizations to transition to the new workflow without losing patient history.

Verify that you have the required permissions and that the patient is enrolled in an eligible care management program.

Confirm that the correct template was selected and that it has been configured by your organization.

No. Once a care plan has been created, you cannot switch its creation method. If a different approach is required, create a new care plan using the preferred method.

Deletion options depend on your organization's permissions. Contact your administrator if you cannot remove a draft.