Health Care Coordination

San Ysidro Health offers care coordination services to help patients with their individual healthcare journeys. These services are built around patient needs and preferences and are focused on delivering high quality, care to improve overall health outcomes with effectively coordinated care throughout all stages of treatment.

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As part of this Program, patients will be connected with a Care Coordinator, who will provide them with hands-on support and coordinated care services including: 

• Support in improving overall patient health and in making healthier lifestyle choices 

• Assistance with healthcare services, including preventive and maintenance medical appointments and referrals to different departments based on patient needs 

• Education on medication and how to manage chronic conditions such as diabetes, hypertension, and others 

• Guidance regarding nutrition and exercise to help improve health 

• Linkage to different San Ysidro Health resources, including behavioral health, social services, referrals, health education, the home health program, and other programs focused on patients with chronic conditions 

• One-on-one follow-up every two to three weeks between visits with their primary care provider (follow-up is provided in-person, over the phone, or via telehealth video calls) 

• Education on due care guidelines such as vaccinations, tests, and medical exams 

• Access to group sessions of the Project Dulce Program for patients with diabetes. Classes are provided in-person and online in three different languages (English, Spanish, and Arabic). 

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Care Coordinators use electronic health records to secure health information, coordinate patient care, and make sure everything is part of a clear, organized care plan.

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Services are available to all registered patients of San Ysidro Health. If you are interested, please call (619) 662-4100 and ask to be scheduled with a Care Coordinator.