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The Patient Aligned Care Team (PACT) Senior Social Worker participates in the Primary Care Clinic at the VA Medical Center and at Community Based Outpatient Clinics (CBOC). The PACT is a comprehensive team which delivers primary care to Veteran patients in a longitudinal rather than episodic fashion and which has as its focus: prevention; health promotion, coordination, and chronic disease management. The Social Worker in this Veteran-centric approach primarily functions as a direct-care provider for all psychosocial and behavioral health issues with an assigned panel of patients and participates as the medical Social Worker within the PACT. The PACT Senior Social Worker also functions as a care coordinator to ensure that access to and services provided for healthcare meets the needs of the patient, as defined by the Veteran/Caregiver.