Constant Care provides Chronic Care Management (CCM) software and support services to enable medical practices to meet recent Medicare CCM guidelines Nearly 35 million Medicare recipients having multiple chronic conditions such as heart disease, stroke, cancer, and diabetes qualify for monthly CCM service. Studies show that regular clinical engagement and care planning for these patients can improve their medical outcomes, and reduces ER visits, hospitalizations and medical costs. We provide a secure platform focused on integrating information from physician's existing clinical systems into our Certified EHR. Each patient is provided a custom electronic care plan consisting of medications, vitals, labs and overall wellbeing. Each component is scheduled to meet the lifestyle and current health status of the individual. Triage is performed by Constant Care clinical staff and escalated to primary care physicians if additional assistance is required. Physicians have complete access to their referred patients records along with the ability to import desired data into their existing EHR as well as assisting in the continued transitions of care and overall care coordination of the patient.