Hospitalization Risk Assessment - CHAMP 2026

1. Click ‘Get Form’ to open the Hospitalization Risk Assessment - CHAMP in the editor.
2. Begin by entering the Patient Name and Record Number at the top of the form. Ensure accuracy as this information is crucial for tracking.
3. In the 'Prior pattern' section, check all applicable boxes indicating any hospitalizations or ER visits within the past year.
4. Move to the 'Chronic conditions' section. Check all relevant conditions that apply to the patient, such as diabetes or COPD.
5. Next, review the 'Risk Factors' section. Carefully check all factors that may contribute to hospitalization risk, ensuring a comprehensive assessment.
6. Calculate and note the total number of checked boxes at the end of this section. This score can help identify patients at high risk.
7. Proceed to document any patient-specific interventions required based on identified risks, including referrals and education needs.
8. Finally, ensure that all necessary notifications are documented before signing and dating the form at the bottom.

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