Tammy Tyler

• Interviewed clients, families or groups to assess situations, limitations and issues and implement services to address needs.
• Explained medical care options to help families make informed healthcare decisions.
• Formulated treatment plan strategies with multidisciplinary teams to provide comprehensive and continuous care plan.
• Developed and facilitated goal-oriented psycho-education and therapy groups to improve residents' quality of life.

Sees patients on dialysis and completes psychosocial assessments and plans of care. Arranges community resources as needed. Participates in monthly quality improvement meetings.

Sees patients on home health services to determine psychosocial needs and makes referrals as appropriate. Links patients to community resources to improve quality of life. Assists as appropriate with advance directives.

Works with home health and hospice patients to understand needs and coordinate necessary services. Completes psychosocial assessments and makes referrals as needed. Assists with completion of advance directives including Out of Hospital DNR forms. Processes referrals to obtain community resources for housing, public assistance, and healthcare services for patients.

Completed comprehensive psychosocial assessments in coordination with interdisciplinary team and completed plans of care for patients on dialysis. Completed reports as assigned and reported monthly in Continuous Quality Improvement meetings. Arranged referrals to community resources as appropriate. Traveled as needed to sister clinic in Abilene.

Completed interdisciplinary assessments and discharge planning for patients admitted to inpatient rehabilitation. Completed reports as needed. Participated in team conference meetings weekly.