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DescriptionSummary: Conducts advanced outreach to community. May coordinate charitable programs. Develops relationship with community and community leaders The Community Health Worker (CHW) provides culturally appropriate support and information for the patient and their families in a series of structured visits and follow-up phone calls in a variety of settings, including the patient's home Knowledge of resources in the community and refers patients to them Assists patients in their understanding of how to use healthcare and social services and manage their Patient Health Record (PHR) Assist patients in finding and understanding how to use a Medical Home (patient's primary choice of p