Submit a Case

Have a question? Want to learn more about disease management? Not sure whether to refer a patient out for a higher level care? Want tangible treatment recommendations? Present your patient to peers and specialists for best practice treatment recommendations.

How to Submit a Case

​​ If you would like to present a patient during a teleECHO session, please select and complete the appropriate case presentation form. Once complete, please submit the case form to the email address listed on the case form. No PHI or HIPAA information is requested or included as part of the case form. If you have any questions about any of the case forms, or want to learn more about patients who may be candidates for presentation, please don’t hesitate to reach out to the point of contact listed on the respective form.

Case Forms

Dementia Clinical Care Case Form (DOC)

Dementia Caregiver Case Form (DOC)

Diabetes Case Form (PDF)

Hepatitis C Case Form (PDF)

Harm Reduction Case Form (PDF)

HIV Case Form (PDF)

Infectious Disease Form (DOC)

MCH Case Form (PDF)

Peer Recovery Specialist Case Form (DOC)

Pharmacy Led SUD Patient Case Form (PDF)

Pharmacy Led SUD Systems Based Case Form (PDF)

PrEP Case Form (PDF)

Substance Use Disorder Case Form (PDF)