01Detailed SOP draft
Comprehensive assessment
All 49 tasks cover the initial assessment, required annual assessment, bounded reassessment, baseline handoff, evidence, roles, labor, and exceptions.
49source-bound tasks
Current review stageEight-pillar service integrationAssessment baseline, Care Plan action, Ongoing return, and exact cross-service handoffsOpen the sequence atlas
Proxi GUIDE operating manual
The work, in the order a person actually performs it.
A human-readable project brief for delivering eight CMS GUIDE service domains through Proxi. The website organizes the operating meaning; the Markdown files remain the source of truth.
8 services in scope8 detailed service SOPs359 detailed service tasksRespite excluded
Detailed service manuals
All eight pillars are built at task level.
359 literal service tasks. All eight remain draft and require named owner approval before field use.
02Detailed SOP draft
Person-centered care plan
Fifty-two task-level procedures for building, explaining, distributing, executing, and revising the beneficiary-led care plan.
52source-bound tasks
03Detailed SOP draft
Ongoing monitoring and support
All 37 tasks make Ongoing the longitudinal return engine for useful navigator contact, exact follow-through, material-change routing, and workload oversight.
37source-bound tasks
04Detailed SOP draft
24/7 access
All 29 tasks detail pooled human coverage, actual first answer, clinical transfer, caregiver support, follow-through, recovery, and quality review.
29source-bound tasks
05Detailed SOP draft
Care coordination and transitions
Outside-PCP coordination, specialist referral loops, care-setting transitions, and additional clinical coordination.
63source-bound tasks
06Detailed SOP draft
Referral and services supports
All 57 tasks detail need intake, choice, referral, receipt, intake, service start and outcome, inventory, aging-network, and Medicaid HCBS coordination.
57source-bound tasks
07Detailed SOP draft
Medication management and reconciliation
Medication history, prescribing-authority reconciliation, medication-change execution, instruction, and monitoring.
38source-bound tasks
08Detailed SOP draft
Caregiver education and support
All 34 tasks detail caregiver applicability, skills training, diagnosis information, support groups, one-on-one support, optional services, and reassessment.
34source-bound tasks
Cross-pillar sequence atlas
See the episode, then open the exact branch.
The atlas shows the Assessment → Care Plan → distinct service work → Ongoing return spine, lateral 24/7 entry, truthful handoff milestones, count-once labor, and nested worked episodes.
Assessment baselineCare Plan actionDistinct service resultOngoing return
Open the clickable sequence atlas →Service-system truth
One contact may feed several services—without pretending they are complete.
Prepare before judgment
Software, AI, and support staff organize the facts. The specifically authorized person executes judgment.
Handoff is not completion
Packet, delivery, receipt, owner acceptance, first action, and the receiving service result remain distinct.
One contact, count labor once
Distinct services may be furnished together. The same conversation and human act are never multiplied.
Reading key
Four questions this manual keeps separate
What is required?
Public CMS GUIDE obligations and other necessary delivery work are labeled distinctly.
What can Proxi do?
Preparation and coordination are separated from clinical, legal, or external authority.
Which human is required?
The manual names the actual role and the judgment that cannot be substituted.
What proves completion?
An attempt, transmission, appointment, or task assignment is not silently treated as the outcome.
Current-phase boundary
Human operating meaning comes first.
This reading layer is for the semantic SOPs: literal work, human authority, communication, evidence, and unresolved decisions. Fault Gate 2, Fault Gate 17, machine representation, and automation mechanics remain later work.