Referral & Care Coordination Tools

Referral Algorithms

Standardized pathways for positive screens, urgent concerns, and ongoing management across care settings.

  • Warm handoff templates for memory assessment centers and community partners
  • Care coordination checklists and follow-up schedules
  • Guidance for integrating dementia capability into existing care management

Practice Protocols for Diagnosis, Follow-Up Care, and Appropriate Referrals

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Clinical Provider Practice Tool

Walk through dementia screening, diagnostic work-up and management. Includes a discussion around disclosing a dementia diagnosis.

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After a Diagnosis

Provide this resource to the patient and family. This will help them think about next steps and connect them with resources and supports available in the community.

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Care Coordination Practice Tool

This tool can help your practice coordinate care for those diagnosed with dementia. This tool includes a care plan checklist and stage-by-stage description of dementia progression.

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Community Organization Practice Tool

This tool is aimed at organizations and agencies that provide services and supports in the community for people living with dementia, their families and care partners/caregivers.

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Virginia No Wrong Door Cognitive Impairment Identification Tool

This tool will help your organization identify people with memory concerns during intake in order to provide them with appropriate referrals, services and supports.

Helpful Resources


This program is managed by Dementia Capable Virginia.