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Transition Services

You're ready to move from the hospital. What you need now is a game plan.

Transition specialists help make sure that you continue to get:

  • The right care.
  • At the right time.
  • In the right setting.

They follow you regardless of where you transfer — to your home, rehab or skilled nursing facility.

Transition specialists are part of HonorHealth' s Accountable Care Organization — your team of doctors and other health care providers working together to help you get back in the game.

Care at the Right Time and Right Place

Transition specialists, who are medically trained military veterans, help recently discharged hospital patients make sure their transitions to home or another care facility are as smooth as possible.

The transition specialists call and visit you in your home or rehab/skilled nursing facility after discharge to be sure that you or your caregivers have what you need to manage and maintain your target level of wellness. The specialists help you with:

  • Follow-up medical care.
  • Blood pressure monitoring.
  • Medication management.
  • Nutrition education.

Special Training

The transition specialists served in the military where they received training to provide medical care for military personnel. As part of their transfer to civilian careers as transition specialists, each of these veterans received additional training in:

  • Patient communication.
  • Health privacy regulations.
  • Hospital and community resources.
  • Electronic health record systems.

Contact Us

To learn more about Transition Services or to schedule an appointment with an HonorHealth Medical Group physician, please call 623-580-5800.

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