Complex Care Program

• A primary care medical home for patients with complex medical conditions and their siblings
  • As patients of the Complex Care Program, children will receive:
    • Primary care services (annual well child exams, vaccines, etc.)
    • Frequent care coordination visits
    • Same day sick visits
    • Access to telehealth services (coming 2020)
    • Patient portal access for communication with providers and care team members
    • Extended appointment times
    • Transitional Care Management (to aid in the transition from the hospital to home/subacute/rehabilitation facility)
    • Care from an interdisciplinary team (nurses, case managers, parent navigators, social work, psychology)
• Support in identifying comprehensive medical, social and developmental needs
• Communication among specialists, home care agencies, nursing agencies, equipment companies, community resources, educational institutions and primary caregivers
• Connections with both internal Children’s National specialists and community-based resources such as home care companies, schools, state agencies and insurance companies to maximize quality of life
• Continuum of care to the inpatient setting:
  • HELP Team: a Hospitalist Consult Service for patients with complex medical conditions
  • Complex Care Unit: Dedicated 5-10 bed unit staffed by experienced physicians
  • Pre-Operative Care Clinic
  • Palliative Medicine

• Children with multi-system, complex medical conditions, often with technology dependence (such as g-tubes or tracheostomies)
• Children followed by multiple specialists often within Children's National
• Children who are frequently admitted to the emergency department or the hospital 
• A sibling of a child with complex medical conditions 

The Complex Care Program accepts patients via a referral process. Referrals may be submitted by primary care providers, subspecialists, insurance case managers, early intervention programs, parents and patient caregivers.

Before the intake process, we will obtain a detailed medical history to help our team understand the needs of your child and family.

You also may complete the following forms — Referral and Assessment (PDF) and Authorization to Release Medical Information (PDF) — and email them to us or fax them to us at 202-476-7612.