An apparatus for monitoring an ambulatory patient and establishing communication to a caregiver regarding the wellness parameters of such an ambulatory patient, said apparatus comprising: a pacemaker for generating an electronic signal representative of a value of a physiological parameter being monitored by said pacemaker; a central processor device operatively coupled to said pacemaker for processing said electronic signals generated by said pacemaker; an electronic communication device having a first and second portion, said first portion being operatively coupled to said processor and said second portion being operatively coupled to a communication network; an output device operatively coupled to said processor characterized in that the output device te provides a series of queries to the ambulatory patient each query in the series of queries is representative of a symptom the ambulatory patient may be experiencing: an input device operatively coupled to said processor and configured to receive inputs from the ambulatory patient in response to the series of queries output by the output device, wherein the processor receives the electronic signal generated by the pacemaker and inputs from the input device wherein each input is assigned a score representing the severity of the symptom and the scores are tallied at a remote location where if the tallied score exceeds a predetermined value, an exception is issued notifying a remote healthcare professional that the ambulatory patient requires immediate attention. a pacemaker for generating an electronic signal representative of a value of a physiological parameter being monitored by said pacemaker; a central processor device operatively coupled to said pacemaker for processing said electronic signals generated by said pacemaker; an electronic communication device having a first and second portion, said first portion being operatively coupled to said processor and said second portion being operatively coupled to a communication network; an output device operatively coupled to said processor characterized in that the output device te provides a series of queries to the ambulatory patient each query in the series of queries is representative of a symptom the ambulatory patient may be experiencing: an input device operatively coupled to said processor and configured to receive inputs from the ambulatory patient in response to the series of queries output by the output device, wherein the processor receives the electronic signal generated by the pacemaker and inputs from the input device wherein each input is assigned a score representing the severity of the symptom and the scores are tallied at a remote location where if the tallied score exceeds a predetermined value, an exception is issued notifying a remote healthcare professional that the ambulatory patient requires immediate attention. an input device operatively coupled to said processor and configured to receive inputs from the ambulatory patient in response to the series of queries output by the output device, wherein the processor receives the electronic signal generated by the pacemaker and inputs from the input device wherein each input is assigned a score representing the severity of the symptom and the scores are tallied at a remote location where if the tallied score exceeds a predetermined value, an exception is issued notifying a remote healthcare professional that the ambulatory patient requires immediate attention.