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INDIANA FAMILY TO FAMILY

​INDIANA COMPLEX CARE COORDINATION COLLABORATIVE

The Indiana Complex Care Coordination Collaborative (IC4) is housed at Indiana University School of Medicine with a goal to coach and embed nurse care coordinators into primary care practices across the state of Indiana, aimed to provide care coordination for a population of 3,000 children with medical complexity and adults with intellectual disabilities primarily through the use of shared plans of care. This form was created for exclusive use by IC4 partners. 
If you have reached this form in error, please return to the 
INF2F Contact Us page.
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    For reporting purposes only, Check all that apply.
    For reporting purposes only.
    INF2F has Bilingual (Spanish / English) Resource Specialists available to support families in their preferred language.
    For families in need of other language support, please note specifics using the "Referral Summary" field at the bottom of this form.

    Any information that will simplify the process for the family.
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​Ste 190
​Indianapolis, IN 46240

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