Interested Organizations

Become a Salud y Vida partner organization

In order to share medical information, progress information, or any other additional personal identifiable
information between different entities, please follow steps below:

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Contact Program Manager at 956-755-0640 if you have any questions and/or concerns
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Learn More About RGVHIE

To RGV HIE

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Complete BAA Form

Fill Out Form

Once BAA has been signed and submitted, the Salud y Vida team will be able to provide the primary
care provider with a “Salud y Vida Committee Feedback form” when requested or when
Salud y Vida team feels the information needs to be communicated to the primary care provider.

If requirements are still pending completion and you would like to refer patient as soon as possible AND he/she has given you permission to
release name and telephone number, please call Program Manager at 956-755-0640 while participant is still there to schedule
an appointment to enroll in the program.

Wagner Chronic Care Model

Research on the Chronic Care Model and its individual components in practice continues to grow and evidence for its effectiveness strengthens as a result of recent studies (Coleman 2009).The Rio Grande Valley Chronic Care Management Program (RGVCCM): Salud y Vida-is a close adaptation with a bilingual approach that focuses on providing coordinated care services to every participant, based on the following six pillars of chronic care management of the Wagner model:

  • Delivery system redesign (changes in the organization of care delivery),
  • Self-management support strategies (increase participants involvement in their own care),
  • Decision support (guidelines, education, and expertise to inform care decisions),
  • Information systems (changes to facilitate use of information about participants, their care and their outcomes),
  • Community linkages (activities increasing community involvement),
  • Health system support (leadership, practitioner, and financial support).

These service elements will be integrated to ensure patients receive high quality initial and follow-up care.

Inclusion/Exclusion Criteria

If requirements are still pending completion and you would like to refer patient as soon as possible AND he/she has given you permission to release name and telephone number, please call Program Manager at 956-755-0640.

Inclusion Criteria
  • Uncontrolled diabetes
  • HbA1c > 8.0% Lives in RHP 5
  • Uninsured, Medicaid, Low income
    200% below poverty level
  • Aged 18 years or above
Exclusion Criteria
  • Home address outside RHP 5 area
  • Medicare, or commercial insurance
  • History of violent behavior toward others
  • Substance abuse
  • Dialysis participant, cancer patient
  • Open chronic wounds
  • Bipolar or personality disorders
  • Pregnant
  • Under 18 years of age
Referring patients to the program

Participants can be referred directly to our Transition Specialist in order to enroll in the program. A participant can also call the transition specialist directly without a clinic or organization involved. However, no information will be shared or released to second parties unless you become a salud y vida partner organization.

In order to be able to refer patients/participants to Salud y Vida, please use guidelines below:

Referring patients to the program

Participants can be referred directly to our Transition Specialist in order to enroll in the program. A participant can also call the transition specialist directly without a clinic or organization involved. However, no information will be shared or released to second parties unless you become a salud y vida partner organization.

In order to be able to refer patients/participants to Salud y Vida, please use guidelines below:

Contact Transition Specialists for appointment:

icon-contact Maria Zolezzi: 956-755-0640

Schedule appointment directly by going to our referral page to make appointment for participant.

Schedule

*Please make sure you complete the referral form and give to participant (if possible) or send to Transition Specialist prior to the day of the appointment. This will provide the Transition Specialist with the necessary information to enroll in the program (A1C, etc.)

*Please make sure you complete the referral form and give to participant (if possible) or send to Transition Specialist prior to the day of the appointment. This will provide the Transition Specialist with the necessary information to enroll in the program (A1C, etc.)

Interested Organization Form
(Physicians and Health Organizations Only)
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