forløbsplan

Forløbsplan is a plan used in Danish health and social services to coordinate and document the course of a person’s care, rehabilitation, or support over time. The purpose is to ensure continuity of care across different settings and providers and to make goals and responsibilities explicit for the patient and the professionals involved.

A typical forløbsplan describes the person’s needs, the overall objectives, concrete actions or interventions, who is responsible for each action, the time frame, and the intended services or support to be delivered. It may include indicators for progress and a plan for follow-up and reassessment.

The plan is usually developed in collaboration between the person (and their family or informal carers when appropriate) and a multidisciplinary team that can include general practitioners, hospital clinicians, nurses, therapists, and social services staff. It is commonly used during transitions, such as hospital discharge, entry into municipal care, or initiation of a rehabilitation program.

The forløbsplan is reviewed and updated regularly to reflect changes in the person’s situation and goals. Access to the plan is typically shared among authorized professionals and the person, with consent and privacy considerations respected.

In practice, the forløbsplan supports coordinated care, reduces fragmentation, and helps allocate resources efficiently. Challenges can include ensuring consistent communication, keeping information up to date, and aligning different organizations’ systems.