Senior Health Services Transition of Care Clinic

Senior Health Services

The Senior Health Services Transition of Care (SHS TOC) Clinic is for patients who need timely followup care after a hospital stay. Our staff is uniquely trained to provide you the care you need after you are discharged from the hospital. Our top priority to is help every patient recover and avoid a hospital readmission.

The SHS TOC Clinic is not a replacement for your regularly scheduled visits with your Primary Care Provider but works closely with your Primary Care Provider as a part of the Sentara Medical Group Patient Centered Medical Neighborhood. It is important that you continue to see your primary care provider, as well.

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Location Details

Senior Health Services Transition of Care Clinic
301 Riverview Ave., Suite 930
Norfolk, VA, 23510


Monday through Friday: 8 a.m. - 5 p.m.

What to Expect at and After Your Hospital Discharge

When it is time for you to leave the hospital, your care team will provide you with discharge instructions, a list of medications, and schedule any follow-up appointments. One of those appointments will be the SHS TOC Clinic.

Within 48 hours of discharge, a SMG Nurse Integrated Care Manager (ICM), will contact to you to check in on you and help answer any questions you may have.

What to Expect at Your SHS TOC Clinic Follow-Up Appointment

You will have an appointment with the physician who cared for you in the hospital or a provider on their team. Together, you’ll review your medications and education materials. You will also talk about your health since you were discharged from the hospital.