Utilization of appropriate documentation to communicate progress and status to PACE interdisciplinary team members, including physician, nurses, social workers, occupational therapist, recreation, dietary, home care, etc., in order to coordinate and manage care of PACE participants living at home, a nursing/skilled nursing facility. The Physical Therapist is expected to communicate with the PACE Interdisciplinary Team regarding the patient's treatment plan and progress, and deliver services consistent with policies and procedures governing the delivery of patient care by the PACE program.