MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C4F4EA.853C9080" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C4F4EA.853C9080 Content-Location: file:///C:/132AC094/rhcpolicyandproceduremanualinmicrosoftwordformat.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Rural Health Clinic Policy and Procedure Manual

Name of RHC


Rural Health Clinic Policy & Procedure Manua= l


Updated: Date of Update=



        &= nbsp; On Date of Update, the Annual Evaluation Committee of Name of RHC updat= ed the rural health clinic policy and procedure manual of the clinic.

        &= nbsp;

        &= nbsp;















 <= /span>






Name of RHC Physici= an

Medical Director



Nurse Practitioner<= /span>



Office Manager





Mark R. Lynn=

Healthcare Consulta= nt







Name of RHC

Rural Health Clinic



&= nbsp;

&nbs= p;


&nbs= p;

This policy manual is s= pecific to the operation of the rural health clinic in Your City, Your State and supplements the policies and procedure guidance provided in other policy and procedure manuals prepared by Name of RHC.=   Your Medical Director makes a sustained and substantial effort to ke= ep the rural health clinic in full compliance with applicable State, Federal (OSHA, CLIA, etc.) and this policy manual is one of the tools that helps en= sure compliance.  This policy manua= l only address items specific to rural health and does not address other issues wh= ich are more appropriately addressed in other forms of guidance.  Such guidance includes the followi= ng list of resources:


            =             &nb= sp;           1.         = Personnel Manual

            =             &nb= sp;           2.         = Laboratory Manual

            =             &nb= sp;           3.         = OSHA Manual

            =             &nb= sp;            =             &nb= sp;            =          

&nbs= p;

If the guidance in the = Rural Health Clinic policy manual is found to conflict or differ from guidance in some other policy manual, the specific guidance should be brought to the attention of the Office Manager who will resolve the conflict through appropriate channels based upon the specific situation.  This manual should be reviewed on = an annual basis by the Medical Director, Mid-Level Practitioner, Office Manager and the annual evaluation committee and such review should be documented.














Condition I:<= span style=3D'mso-tab-count:2'>        &= nbsp;          Complian= ce with Federal, State and Local Laws


          100    Compliance with Federal, State and Local Laws

            =             <= /p>

The C= linic will make a sustained and substantial effort to be in full compliance with = all applicable State, Federal (OSHA, CLIA, etc.), and local.


          110    Policy and Procedure Re= view


The O= wner of the clinic is NAME OF RHC PHYSICIAN dong business as Name of RHC in Your Ci= ty, Your State and is responsible for the operation of the clinic. This clinic = is organized under the laws of Your State as a for-profit sole proprietorship.=   The Medical Director, Mid level Practitioner, Office Manager, and  &nb= sp;          non-clinic personnel will review and approve the policy and procedures of the clinic annually.


Name of RHC is the Medic= al Director and is responsible for the overall direction of the facility. The = Office Manager is responsible for the business functions and the overall function = of the clinic operation, including scheduling and supervising billing and cler= ical personnel.   The Mid-level practitioner position reports to the Medical Director for Medical/operation= al issues and to the Office Manager for business office matters.  The Organization chart is presente= d as Appendix A in Section 11 of this manual.


The clinic is under the = Medical Direction of Name of RHC The responsibility of the Medical Director(s) is further delineated in the policy section headed "Physician Responsibility".


The c= linic has a Midlevel Practitioner on site at least fifty percent of its scheduled days of operation.  The clinic maintains other ancillary support staff as required by patient volumes.  The office Manager schedules and supervises clinical and ancillary personnel.  The office hours of the clinic are= as follows:


Clinic Hours of Operation


   &n= bsp;            = ;        Monday   Tuesday   Wednesday   Thursday         Friday     Saturday      Sunday

   &n= bsp;            = ;        8 to 5        =   8 to 5         8 to 5     = ;       8 to 5         8 to 5     8:30 to 12        None





Physician Office Schedule


   &n= bsp;            = ;        The schedule for Name of RHC, medical director for the facility, is as    follows:

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;     

   &n= bsp;            = ;            &n= bsp;       Monday   Tuesday   Wednesday   Thursday         Friday   Saturday   Sunday

   &n= bsp;            = ;            &n= bsp;       8:30 to 5   8:30 to 5 &nbs= p;  8:30 to 5<= span style=3D'mso-spacerun:yes'>     8:30 to 5    8:30 to 5     None      None


Mid-Level Office Schedule


   &n= bsp;            = ;        The work schedule for the clinics Mid-Level practitioner, is more than 50% of t= he time the clinic is open and is as follows:

   &n= bsp;            = ;            &n= bsp;      

   &n= bsp;            = ;            &n= bsp;       Monday   Tuesday   Wednesday   Thursday          Friday    Saturday   Sunday

   &n= bsp;            = ;                =    8:30 to 5<= span style=3D'mso-spacerun:yes'>   8:30 to 5 &nbs= p;  8:30 to 5<= span style=3D'mso-spacerun:yes'>      8:30 to 5      8:30 to 5   9 to 12      None


The Physician, Midlevel Practitioner and other members as required, annually review the policies and procedures of the clinic.  This review includes all patient care policies and is performed before approval = is made.


Healthcare Business Spec= ialists will perform an annual evaluation of the program, which will include both utilization review of services, policy and procedure update, medical record review of open and closed records and quality review of records.  This annual evaluation will be per= formed with the annual evaluation   &nbs= p;         committee that will include the medical director of the clinic, Mid-Level practitione= r, office manager, a nonmember of the clinic staff, Executive Director of the corporation, and a representative from Healthcare Business Specialists.  The Annual Evaluation Committee is comprised of the following people:

            =             &nb= sp;   

            =             &nb= sp;    Name of RHC      &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;      Medical Director

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    Nurse Practitioner

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    Office Manager

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    Nonmember

   &nbs= p;            &= nbsp;           &nbs= p;       Mark R. Lynn      =             &nb= sp;            =             &nb= sp;       Healthcare Consultant




          120    Anti-Discrimination Pat= ient Policy


The services provided by= the Name of RHC or any other operations it might in the future support, are available to all persons desiring those services regardless of race, color, national origin, religion, age, physical or mental          handicap.<= /p>




          125    Personnel Summary<= /o:p>


   &n= bsp;            = ;        The following table is a listing of the professionally licensed employees of         &= nbsp;           &nbs= p; Name of RHC, P.A..


<= o:p> 

N= ame

<= o:p> 

P= osition

H= ire

D= ate

E= nd

D= ate

L= icense

N= umber

R= enewal

D= ate

Name of RHC






























          130    Physician Documentation=


The documentation for Name of RHC is located behind the tab             =             &nb= sp;           for Professional Licensure located in the Credentials File.


            =             &nb= sp;    State License

   &n= bsp;            = ;            &n= bsp;       Diploma

   &n= bsp;            = ;            &n= bsp;       Curriculum Vitae

   &n= bsp;            = ;            &n= bsp;       Drug Enforcement Authority Prescriptive Permit

   &n= bsp;            = ;            &n= bsp;       State Prescriptive Permit

   &n= bsp;            = ;            &n= bsp;       Hospital Privileges

Certification of Liabili= ty Insurance according to Facility Policy is    located        &= nbsp; behind the tab for Liability insurance.











          140    Midlevel Practitioner Documentation


The documentation for the Midlevel Practitioner is located behind the tab for Professional Licensure = in the Credentials File.

   &n= bsp;            = ;            &n= bsp;      

   &n= bsp;            = ;            &n= bsp;       State License

Board of Examiners' Lett= er approving as a Midlevel Practitioner

   &n= bsp;            = ;            &n= bsp;       Diploma

   &n= bsp;            = ;            &n= bsp;       Curriculum Vitae

   &n= bsp;            = ;            &n= bsp;       Certification of Liability Insurance according to Facility Policy


          150    Professional Nursing or Licensed Personnel Documentation

            =             &nb= sp;   

The documentation for any Licensure of RN’s, LPN’s, or Medical Assistants is located behi= nd the tab for Professional Licensure in the Credentials File.

   &n= bsp;            = ;            &n= bsp;      

   &n= bsp;            = ;            &n= bsp;       State License

   &n= bsp;            = ;            &n= bsp;       CPR Certificate

   &n= bsp;            = ;            &n= bsp;       Continuing Education Information   &nbs= p;     


   &n= bsp;        160  &= nbsp; Ancillary Professional Personnel Documentation (Lab/X-Ray)

            =             &nb= sp;   

            =        The documentation for any Licensure of any laboratory professional or        &= nbsp;           &nbs= p;     radiological professional is located behind the tab for Professional             =             &nb= sp;            =   Licensure in the Credentials File.

   &n= bsp;            = ;            &n= bsp;      

   &n= bsp;            = ;            &n= bsp;       State License

   &n= bsp;            = ;            &n= bsp;       CPR Certificate

   &n= bsp;            = ;            &n= bsp;       Continuing Education Information   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   


          170    CLIA/X-Ray Certification Documentation


            =        The documentation for the laboratory (CLIA) or X-Ray equipment is         &= nbsp;           &nbs= p;      located behind the tab for Professional Licensure in the Credentials File.


   &n= bsp;            = ;            &n= bsp;       CLIA Certificate:      =    

   &n= bsp;            = ;            &n= bsp;       X-Ray:               &= nbsp;                NA

   &n= bsp;            = ;            &n= bsp;      

  &n= bsp;         <= span style=3D'font-size:14.0pt'>

Condition II:=         &= nbsp;        Location of Clinic=



          200    Map showing Location of= the RHC


   &n= bsp;            = ;        The documentation for the location of the clinic is located               = ;            &n= bsp;      


   &n= bsp;            = ;            &n= bsp;       In Appendix B.

            =             &nb= sp;   

210  &= nbsp; Letter from the State Department of Health determining clinic is eligible for certification.


The documentation for the approval of the rural health clinic status for Name of RHC was in the first rural health policy and procedure manual and cannot be located.

            =             &nb= sp;   

220  &= nbsp; Medically Underserved Area and/or Health Professional Shortage Area designation documentation.


            =        The documentation for the underserved status of the area can be obtained         &= nbsp;           &nbs= p;            by calling or writing:


   &n= bsp;            = ;            &n= bsp;            = ;       Mr. David Brand

   &n= bsp;            = ;            &n= bsp;            = ;       Division of Shortage Designation

   &n= bsp;            = ;            &n= bsp;            = ;       Bureau of Primary Health Care

   &n= bsp;            = ;            &n= bsp;            = ;       4350 East-West Highway

   &n= bsp;            = ;            &n= bsp;            = ;       Rockville, MD  20857=

   &n= bsp;            = ;            &n= bsp;            = ;       Telephone:  (301) 594-3813


          230    The physical address and phone/fax number of the clinic


            =             &nb= sp;            = Name of RHC

   &n= bsp;            = ;            &n= bsp;            = ;       1020 Ventura Avenue

   &n= bsp;            = ;            &n= bsp;            = ;       Your City, Your State 93610

   &n= bsp;            = ;            &n= bsp;            = ;       Telephone Number: (559) 665-0275

   &n= bsp;            = ;            &n= bsp;            = ;       Fax Number: (559) 665-7126








Condition III= :        &= nbsp;       Physical Plant and Environment<= /o:p>


          300    City, county or Fire Marshall's Inspection Report


The documentation for th= e Fire Marshall's report is located behind the tab titled Preventive Maintenance a= nd is obtained every three years.


          310    Maintenance Program


The Office Manager will = check periodically to insure that the staff is maintaining the building in accord= ance with the following guidelines:


   &n= bsp;            = ;        Maintenance Items      &n= bsp;            = ;            &n= bsp;            Maintenance Schedule


   &n= bsp;            = ;        Custodial Services (interior)    =             &nb= sp;            =             &nb= sp;            Daily

   &n= bsp;            = ;        Custodial Services (exterior)    =             &nb= sp;            =             &nb= sp;           Mont= hly

   &n= bsp;            = ;        Mechanical and air handling    &nb= sp;            =             &nb= sp;            =             A= nnually

   &n= bsp;            = ;        System adjustment     &nb= sp;            =             &nb= sp;            =             &nb= sp;            Annually

   &n= bsp;            = ;        Inspect fire extinguisher    &n= bsp;            = ;            &n= bsp;            = ;       Monthly

   &n= bsp;            = ;        Inspect and test general medical   &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       Daily

           &n= bsp;            and laboratory equipment

   &n= bsp;            = ;        Inspect existing sign age    &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;     Annual

   &n= bsp;            = ;        Termite inspection     &nb= sp;            =             &nb= sp;            =             &nb= sp;            = Annual

   &n= bsp;            = ;        Exterminator services      = ;            &n= bsp;            = ;            &n= bsp;            = ;        Annual


The preventive maintenan= ce plan is maintained in the clinics Log Book that has copies of the preventive maintenance plan for the clinic and includes control for laboratory services and temperature logs for refrigerators and freezers.  Copies of     the Maintenance Log and Control Logs are inclu= ded in the Preventive Maintenance Tab.


Any contracted maintenan= ce service contracts will be evidenced by a contract for these services behind= the preventive maintenance Tab and copies of relevant invoices will be maintain= ed for one year and then placed in the Outdated RHC Policy Manual File. 


   &n= bsp;            = ;        Specific Equipment will have a preventive maintenance program.






          320    Storage and Care of Sup= plies and Equipment


Laboratory and other med= ical equipment are calibrated daily before the equipment is used. See Log Book.<= /p>


is contracted to provide external laboratory services and provides a daily cou= rier service to collect specimens.     Test reports are provided on = hard copy through a telecommunications hookup within 24 hours. Positive values w= ill be called directly into the medical center in as short a time as possible. Information on the laboratory is as follows:


_________= ________________

_________= ________________

_________= ________________



Preventive maintenance inspection and testing pr= ogram is to insure:


A.        That the equipment is operating properly.  If it is a measuring instrument, its output should have satisfactory fidelity and accuracy.  If it = is a therapeutic instrument it should deliver accurately and safely the therapeu= tic effect at the proper time.  (V= alues of proper operation should be furnished by the supplier)


B.        That equipment and all accessories, cables, and power cords are safe.


C.        That the equipment is mechanically in good condition with no missing parts, loose 'switches or knobs, and no broken glass.&n= bsp; Casters should be free and lubricated (if required) so that mobile equipment will not tip or make unpleasant noises.


D.        That a full set of accessories, spare recording paper, and other consumable supp= lies necessary for operation is available with the equipment.


E.         = All operating manuals are reading accessible to person operating equipment.


F.         = Maintenance manuals are provided for engineering.


G.        That the optimum reliability and life of the equipment is obtained by carrying o= ut manufacturer's recommended maintenance procedures.


H.        &= nbsp;           Th= at the equipment and its accessories are clean, untarnished, and of good appearance, both for sanitary reasons and to improve confidence in the equipment and the part of the user, the patient, and observers.



        &= nbsp;  



        &= nbsp;   Prior to testing any patient care or non-patient care equipment for electrical safety,       = ;  it shall be visually inspected for any physical defects, such as damaged fords= or plugs, missing or broken knobs or switches, etc.  Any defects found will be corrected immediately.  It shall also be checked to see that all cables, accessories, and consumable supplies are readily available.


        &= nbsp;           &nbs= p;   DEFINITION: Electro medical equipment shall be defin= ed as that       &n= bsp;            = ;            &n= bsp;                   &= nbsp;   electrically operated instrumentation with which patients normally come         &= nbsp;           &nbs= p;            &= nbsp;   into contact.  It includes therapeu= tic, diagnostic, and monitoring   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       instrumentation.


          330    Manufacturer's recall of supplies


{ = ;         On receipt of a drug recall, clinic personnel will immediately inspect all medication areas for the affected lot numbers.

   &n= bsp;            = ;        { = ;         Affected medication will be immediately removed from stock and             =             &nb= sp;                &= nbsp;   destroyed or returned as directed.

   &n= bsp;            = ;        { = ;         A drug recall file will be maintained indicating all actions taken.

{ = ;         A device recall will be handled in the same manner as a drug recall.


          340    Biomedical Waste Plan


This plan prescribes min= imum sanitary practices relating to the identification, segregation, handling, labeling and storage of biomedical waste.&= nbsp; Such practices are necessary to ensure that waste is properly manage= d in order to eliminate the exposure of employees, patients, and the public to disease-causing agents.  This = plan also describes required training of personnel involved with biomedical wast= e, and indicates how spills or leaks of biomedical waste should be cleaned up = and disinfected.


   &n= bsp;            = ;        I.        &= nbsp; Normal Protocol


Biomedical waste shall be identified and segregated from other solid waste at the point of origin wit= hin this facility.


   &n= bsp;            = ;            &n= bsp;       Biomedical waste shall not be mixed with hazardous waste.


Biomedical waste that is= mixed with radioactive material shall be managed and disposed.


   &n= bsp;       

Any other solid waste, w= hich is neither hazardous nor radioactive in character, mixed with biomedical waste, shall be managed as biomedical waste.


   &n= bsp;            = ;            &n= bsp;       A.        Identification


Biomedical waste is defi= ned as any solid or liquid waste that may present a threat of infection to humans.  The term includes, bu= t is not limited to, non-liquid tissue and body parts from humans and other primates; laboratory and veterinary wastes which contain human disease -cau= sing agents; discarded sharps; and blood, blood products, and body fluids from humans and other primates.  The following are also included:



(a)        Used, absorbent materials that are saturated with blood,            body fluids, or excretions/secretions contaminated with blood.  Absorbent material includes items = such as bandages, gauze's and sponges.


(b)        Nonabsorbent, disposable devices that have been contaminated with blood, body fluids, or blood-contaminated secretions/excretions.&= nbsp; Contaminated gloves, wooden spatulas or plastic brushes for pelvic <= span style=3D'mso-tab-count:1'>     exams and plastic suction tips from dental offices (ejectors, evacuators, etc.) would be incl= uded here.


(c)        All contaminated solid waste produced by treating a person       who has either chicken pox or shingles. Biomedical waste also includes those body fluids that have the potential to harbor pathogens such as human immunodeficiency virus and hepatitis B virus, and includes lymph, semen, vaginal secretions, cerebrospinal, synovial, plural, peritoneal, pericardial and amniotic fluid= s.  Body excretions such as feces and secretions      = such as nasal discharges, saliva, sputum, sweat, tears, urine and vomitus shall = not be treated as biomedical waste, unless visibly contaminated with blood.


Also included as biomedi= cal waste are sharps, which are devices that are capable of puncturing, lacerat= ing, or otherwise penetrating the skin.  These devices include, but are not limited to needles, scalpels and needles attached to disposable syringes.&n= bsp; Also included are intact or broken glass and intact or broken hard plastic, when contaminated with blood or other body fluids.  Suction canisters, or similar disp= osable medical items, filled with blood or body fluids that are gelled by a polymerizing agent prior to on-site transport may be handled and packaged as non-sharp biomedical waste.


   &n= bsp;            = ;            &n= bsp;       B.         = Segregation


Biomedical waste, except= sharps, shall be packaged in red bags that meet the strength specifications.  Also, red bags shall have a 6-inch biological hazard symbol imprinted on them, unless the bag is 19" x 14= " or smaller, when a 1-1/2" symbol shall suffice.  All bags also shall be imprinted w= ith the phrase "Biohazard", "Biohazardous Waste", "Biomedical Waste", or "Infectious Waste".


Discarded sharps shall be segregated from all other waste and shall be placed directly into sharps containers that meet the specifications.&n= bsp; Sharps containers (and sharps-container holders or sleeves for wall mounting, if they are used) shall be marked with a biomedical hazard symbol that is at least 1-1/2" across and with the phrase.


A 275-pound bursting str= ength, double-walled corrugated cardboard box may be used as a sharps container for contaminated items made of glass or hard plastic.  The box shall be lined with a larg= e, labeled red bag.


Biomedical waste may be = put down a drain into a sewer system if the waste is in a liquid or semi-so lid form= , if aerosol formation from the waste material is minimal, and if protective app= arel is worn by the person discharging the material into the sewer.


   &n= bsp;            = ;            &n= bsp;       C.        Handling


Filled red bags are fill= ed sharps containers shall be sealed at the point of origin.


Persons handling sealed = red bags or sharps containers, or cleaning spills or leaks of biomedical waste, shall wear personal protective equipment, as required by OSHA.


Non-sharp biomedical was= te shall be red-bagged at the point of origin.  Sharps shall be put into sharps containers at the point of      origin.


Nothing shall ever be re= moved from a red bag or from a sharps   = ;          container.


All red bags shall be containerized in preparation for off-site transport.  Home health agencies shall transpo= rt red bags from clients' homes to the home office in sanitizable containers that = are marked with a 6-inch symbol and the phrase.  Sharps containers may be transport= ed without further containerization.


Sharps containers shall = not be overfilled and, when inserting sharps into the containers, the opening shal= l be observed to make sure nothing is sticking out.


Contaminated needles sha= ll never be cut, bent, or recapped, except when recapping is required by the procedu= re being performed.  If recapping is done, it shall be done one-h= anded, or by using a    recapping device.


   &n= bsp;            = ;            &n= bsp;       D.        Labeling


Labels need to be placed= on transport containers (boxes or tubs),  = ;        and shall have printed on them this facility's name, address and a date.  The date is not required on anythi= ng if biomedical waste is removed from the facility at least once every 15 days.<= /p>


Red bags, including thos= e used to line boxes or tubs, shall be labeled on the same day that they are put i= nto use.  If small red bags are pl= aced into a labeled, large red bag (box liner) prior to off-site transport, then= the small bags need to be dated only, if the waste is picked up monthly.  If the waste is picked up at least= once every 15 days, then no date or other labeling is required on these       small red b= ags that go into a large, labeled, red box liner.

   &n= bsp;            = ;            &n= bsp;            = ;      

Boxes and tubs shall be = labeled and dated (the date may not be required) prior to off-site transport. A registered biomedical waste transporter may provide labels that are generat= or-specific, such as bar codes, for red bags, sharps containers, and outer containers.  These labels shall provide the generator's name, as well as the transporter's name, address, emergency telephone number and registration number.&= nbsp; These labels shall be dated by the generator, unless the waste is pi= cked up at least once every 15 days.


   &n= bsp;            = ;            &n= bsp;            = ;       Labeling shall be done!  If labels are = not available, see your     = ;            &n= bsp;            = ;         &= nbsp;   supervisor immediately.


   &n= bsp;            = ;            &n= bsp;       E.         = Storage


Storage of biomedical wa= ste shall not be for a period greater than 60 days.  The 60-day time period shall comme= nce when the first non-sharps item of biomedical waste is placed into a red bag= or sharps container, or when the sharps container is closed.  Our Biomedical waste will be remov= ed from our facility by BFI, a registered transport company.  We will keep all records provided = to us by our transporter for a minimum of three (3) years.


Biomedical waste must be= stored in designated areas that are located away from pedestrian traffic.  Therefore, our biomedical waste sh= all be stored in the laboratory.


Our storage area(s) shal= l be made accessible only to authorized personnel by keeping the door(s) locked = at all times.


Our storage containers s= hall be marked with a biological hazard   = ;          symbol that is at least 6 inches across and also with the phrase "Biohazard", "Biohazard Waste", "Biomedical Waste", or "Infectious Waste".

   &n= bsp;            = ;            &n= bsp;            = ;      

Our storage area(s) shal= l be free to vermin and insects, and shall be maintained in a sanitary condition= .


If we choose to store our biomedical waste in an outdoor area, the area will meet all the above crite= ria and in addition will be    &= nbsp; designated by a biological hazard symbol that is at least 6 inches across, and will be secured against vandalism.


   &n= bsp;            = ;            &n= bsp;       F.         = On-site Transfer


Sealed red bags and clos= ed sharps containers shall be transferred from the point of origin to the stor= age area by persons wearing gloves, and any other appropriate protective clothi= ng required by OSHA.


   &n= bsp;            = ;            &n= bsp;      

Every effort shall be ma= de to insure that sealed red bags and closed sharps containers are not broken open during on-site transfer between the point of origin and the storage area.


Red bags and sharps cont= ainers shall not be put down trash chutes, nor shall they be moved by use of autom= ated transfer methods.


There shall be neither r= ecycling efforts nor intentional removal of biomedical waste from red bags or sharps containers.


   &n= bsp;            = ;        II.         = Training


All new employees who de= al with biomedical waste shall be given initial &nb= sp;           trai= ning in the concept and function of our waste-handling system before their duties commence.  Employees wh= o deal with biomedical waste shall be updated after a rule change or waste-handling system change, and in addition shall attend an annual refresher trai= ning session with regard to biomedical waste.


All training phases (ini= tial, updates and annual refresher training) shall take into consideration the following aspects of biomedical waste management: identification, segregati= on, handling, labeling, storage, on-site transfer, training of employees and contingency plans for cleaning up and disinfecting spills and/or leaks of biomedical waste.


Training records signed = by employees shall be kept for all participants in all training sessions, and shall be maintained on-site for a minimum of three (3) years.


Specifically, in our fac= ility, training will be accomplished in the following manner:  Prior to undertaking tasks invo= lving exposure to biomedical waste, and at least yearly thereafter, employees will read this biomedical waste plan and will be walked through our biomedical w= aste handling and disposal system, when they will be encouraged to ask any quest= ion involving our system.  Trainee= s will sign a training record after each training session, which will be kept for = at least 3 years.

   &n= bsp;       




            <= /span>III.       Conti= ngency Plan for Spills


In case of a leak or spi= ll of biomedical waste, any solid material shall be picked up and put into appropriate containers by people wearing gloves and any other appropriate clothing.  Sharps shall be pic= ked up using hemostats or other appropriate tools, and not hands.


   &n= bsp;       

   &n= bsp;            = ;       

The contaminated surface= (s) then shall be cleaned with a solution of industrial strength detergent to remove visible soil, before being disinfected by one of the following methods:  a) Steam for a minimum of 30 secon= ds; b) Rinsing for at least 3 minutes with a hypo chlorite (bleach) solution containing at least 100 parts per million available free chlorine; or iodine solution containing at least 25 parts per million available iodine; or c) U= se   of chemical germicides that are tub= erculocidal and are registered by the Environmental Protection Agency as hospital disinfectants.


Specifically, in our fac= ility, we will use the following method to disinfect a leak or spill of biomedical waste: 


   &n= bsp;            = ;            &n= bsp;       Clean with CitruGuard wearing special gloves.&nb= sp; All waste     &n= bsp;            = ;            &n= bsp;            = ;            &= nbsp;   materials will be placed in the red -bag hazardous material bag.            =             &nb= sp;            =             &nb= sp;            =             <= span style=3D'mso-tab-count:4'>        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; 


Liquid waste created by = any such disinfect ion operation shall be disposed of down a drain into a sewer syst= em.


Reusable containers for = holding red bags (waste baskets or cans, kick-buckets, etc.) shall be sanitized each time the red bag is changed out, by either method a), b) or c) above.  Home health agencies shall use one= of these methods to sanitize their containers for transporting red bags, after= each use.


          360    Drugs and Biological St= orage Plan


All storage, handling, a= nd administration of drugs and biologicals shall be under the supervision of t= he Medical Director.  This indivi= dual is responsible for assuring that medications and treatment materials, both prescription and nonprescription are stored properly and securely.


In order to assure that = drugs and biologicals are properly cared for, the following steps are taken:


1.         = All medications are to be kept plainly labeled which may involve periodic re-la= beling in the event of illegibility.  Contents from illegibly marked medications are not to be used.


2.         = All drugs and biologicals are stored according to instructions on the package.<= span style=3D'mso-spacerun:yes'>  Efforts are taken to protect such = drugs and biologicals from damage and exposure to moisture, heat, light and air.<= /p>



   &n= bsp;            = ;        3.         = Distinctive labels to mark poisons are used.


4.         = To insure against deterioration, stock is rotated when a fresh supply comes in.  Old reserves are moved to= the front and used before new supplies. Upon receipt of new stock, expiration d= ates are checked on old stock and those expired drugs and biologicals are dispos= ed of in the appropriate manner.


5.         = Drugs and biologicals are handled by authorized personnel only as designated by t= he Medical Director.


6.         = No unauthorized person is allowed to handle or have access to drugs and biologicals which are stored in the clinic.


   &n= bsp;            = ;        7.         = No controlled substances are maintained at the clinic.


   &n= bsp;            = ;        8.         = Authorized personnel only shall administer drugs and biologicals.


9.         = Before administering a drug or biological, the label on the container is checked t= hree times:  Once before the contai= ner is handled, one after the     <= /span>container is removed from the storage area, and once immediately before         &= nbsp; administration.


10.       Drugs= and biologicals administered orally or via any other body orifices are given un= der clean conditions.  Drug and biologicals given by injection and administered in sterile conditions.


11.       A sea= rch for expired drugs, solutions, and injections will take place on the first w= ork day of each month in the sample room, emergency kit and patient exam rooms.=


361    Pharmaceutical Core Lis= t for Emergency Crash Cart


          For= a listing of the emergency kit drugs see the listing attached to the Kit.         &= nbsp;           &nbs= p;            &= nbsp;           


362    Access and security of = drugs


          ~ = ;        All medications will be stored in a secure area without patient access.

   &n= bsp;       




363  &= nbsp; Maintenance of Records Drug Storage Area Inspection Sheet/Documentation for Expired Medications/Drug Disposal Procedure


Extreme care must be exe= rcised that no expired medications are dispensed &= nbsp;           &nbs= p;            &= nbsp;     for patient use or allowed to remain in the clinic.


            =        ~ = ;        The clinic personnel will check monthly all medication physically         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  for dated items and remove all expired packages from the shelves.

        &= nbsp;           &nbs= p;   ~ = ;        If the expired items indicated no usage over a six-month period,         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;          &= nbsp;   this fact will be called to the attention of the Medical Director who         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;          will make judgment about replacement.

        &= nbsp;           &nbs= p;   ~ = ;        Expired controlled drugs will be disposed of following the             =             &nb= sp;            =             &nb= sp;               &= nbsp;   Your State State Board of  regulati= ons.

        &= nbsp;           &nbs= p;   ~ = ;        Expired non-controlled medication will be placed in a biohazard             =             &nb= sp;            =                   &= nbsp;   bag and picked up on   an "at request" basis.

   &n= bsp;            = ;        ~ = ;        Medication will be inventoried on an as needed basis to assure that         &= nbsp;           &nbs= p;                  &= nbsp;   adequate supplies are available.

            =        ~ = ;        The expiration dates on all medication will be monitored monthly         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; and documented.


            =             &nb= sp;    Recording for Refrigerator Temperatures


            =             &nb= sp;    A sample of the refrigerator and Freezer temperature log is in the         &= nbsp;           &nbs= p;            &= nbsp;            tab labeled Preventive Maintenance and this is performed daily.



          380    Fire and Evacuation Pla= n

            =             &nb= sp;   

            =        Floor Plan of Building and Exits

            =             &nb= sp;            =

            =             &nb= sp;    Please see Preventive Maintenance Tab for Fire and Evacuation             =             &nb= sp;                  &= nbsp;   Floor plan.



          390    Non-medical Emergency P= lan


The Midlevel Practitione= r shall be in charge during a non-medical emergency.  In his/her absence the Office Mana= ger is in charge.  The following items shall be readily available:  flashlight with fresh batteries, battery powered radio and an emerge= ncy first aid kit.


   &n= bsp;            = ;        Drills:


Annual non-medical emerg= ency drills shall be carried out and documented.


   &n= bsp;            = ;        1.         = Fire


The fire plan for the cl= inic is to be used in case of an actual emergency.=   It      &nb= sp;   will be placed on clinic bulletin boards for reference.


   &n= bsp;            = ;            &n= bsp;       Procedures:


1.         = Evacuation Routes - Always use the closest route that is available to evacuate the clinic.  Routes and exits are = drawn on the attached diagram.


Please = see Preventive Maintenance Tab for Fire and &nb= sp;            =             &nb= sp;           &= nbsp;   Evacuation Floor plan and evacuation Route.


2.         = Employee/Patient Plan - All employees and patients are to meet in front of the clinic immediately following the evacuation.


   &n= bsp;            = ;            &n= bsp;            = ;       3.         = Responsibilities -


A.        Patient evacuation and accountability:  Receptionist: To evacuate from  waiting rooms and rest rooms - Nurses from exam rooms, offices, staff rest room, lab and lounge.

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;      B.         = Employee Roll Call:  Office Manager

C.        Calling the Fire Department:  Whoever = finds the fire call Your City Fire Department at 911.

D.        Fire Extinguisher Operators:  Receptionist, Nurse, Midlevel Practitioner and/or Physician.

E.         = Removing key and essential data diskettes and efforts to secure all records:  Office Manager.

F.         = Turning off equipment and closing doors:  Last person out.

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;      G.        Use common sense always!


   &n= bsp;            = ;        The safety program is everyone's responsibility, however, it is the Office         &= nbsp;           &nbs= p;            &= nbsp; Managers responsibility to direct the program.


   &n= bsp;            = ;        General Fire and Fire Extinguisher Information


   &n= bsp;            = ;        There are three types of fires:   =             


Class= A:        &= nbsp;  Fires involving paper, wood and similar solid combustible materials.


   &n= bsp;            = ;            &n= bsp;       Class B:       = ;     Fires involving flammable liquids.

   &n= bsp;       

   &n= bsp;            = ;            &n= bsp;       Class C:       = ;    Fires involving electrical equipment.


There are several types = of fire extinguishers.  Each type is u= sed on a different sort of fire:


1.         = Water pump can:  Class A - Do not us= e on electrical fires, or flammable liquid.

   &n= bsp;            = ;            &n= bsp;       2.         = Carbon Dioxide:  Class B and C fires.=

   &n= bsp;            = ;            &n= bsp;       3.         = Water or Antifreeze Extinguisher:  C= lass A

   &n= bsp;            = ;            &n= bsp;       4.         = Dry Chemical Extinguisher:  Class = A, B, or C fires

   &n= bsp;            = ;            &n= bsp;       5.         = Multi-user Extinguishers:  Class A, B, or= C fires


   &n= bsp;            = ;        Use of Fire Extinguishers


1.         = Remove extinguisher from shelf.  Pull= the pin, breaking the plastic seal ring.  Direct hose to base of fire.

2.         = The range of extinguishers is 5-30 feet.  Do not attempt to use extinguishers on fires that are unsafe to appr= oach at this range.

3.         = The discharge time of extinguishers is 5-30 seconds.  Use the extinguisher in brief blast= s, stopping to see if you have been effective, thus saving the time for repeat= ed attempts.  Locate the area not= under control and try again.



   &n= bsp;        Locations of Fire Extinguishers


Locations of fire exting= uishers are designated in the diagram located in the Preventive Maintenance Tab for Fire Extinguisher Designation Diagram.

   &n= bsp;            = ;            &n= bsp;            = ;      

   &n= bsp;            = ;        Fire Safety Instructions


   &n= bsp;            = ;            &n= bsp;       1.         = Do not shout "FIRE"!!!  Avoid panic.

   &n= bsp;            = ;            &n= bsp;       2.         = Evacuate patients in immediate danger.

   &n= bsp;            = ;            &n= bsp;       3.         = Contain the fire by closing the door.

   &n= bsp;            = ;            &n= bsp;       4.         = Call Your City Fire Department at 911. &nbs= p;          

   &n= bsp;            = ;            &n= bsp;       5.         = Follow clinic procedures for individual responsibilities. 


The greatest danger in b= uilding fires is panic.  In case of fi= res, remember; do not shout "FIRE".&n= bsp; This causes confusion and leads to panic.  It is the duty of every employee to prevent patients from becoming unnecessarily frightened in any emergency.  If there is a fire, every effort s= hould be made to confine it to the immediate area in which it started.  All personnel should be notified immediately in the event of a fire anywhere in the building so that they can move promptly to their regular stations.&n= bsp; All personnel should be prepared to take whatever steps are thought = best by those in charge. 



            =        2.         = Tornado, Hurricane and Severe Thunderstorm


Lightening, flash floods, tornadoes and down bursts typically accompany thunderstorms.  Tune a radio to receive weather bulletins when weather appears threatening.  In the event of threatening weathe= r ask staff, patients and other visitors to remain inside the clinic.  Avoid using the phone.


   &n= bsp;            = ;            &n= bsp;       Procedures:

   &n= bsp;       

In the event a tornado t= hreatens the medical clinic building, proceed according to the following plan:


a.         = A tornado WATCH stating that tornadoes are probable will be received by staff= through radio or other means.  Remain = inside the clinic.


(1)        The Office Manager will be notified by the staff.

(2)        The Office Manager will continue to listen for weather advisory information.        &= nbsp;  

(3)        The Office Manager will inform all staff and patients of the conditions.

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;      (4)        Regular activities will be continued.

(5)        The Office Manager, if practical, will designate persons to serve as lookouts.<= /p>


b.         = A tornado WARNING stating that a tornado has actually been sighted will be received by staff by radio or by local law enforcement officials.

(1)        The patients and staff will be alerted immediately.

(2)        All employees and staff will proceed to the interior bathroom or inside wall of= the medical clinic     &nbs= p; facility.

(3)        The Office Manager will make efforts to secure all records and the computer tap= es.

(4)        The Office Manager will turn off all utilities    &n= bsp;            = ;    possible.

(5)        All patients and staff will assume a curled position so as to protect their eyes and heads once in the appropriate shelter.

(6)        The Office Manager will determine if anyone is missing.

(7)        If someone is missing, the Office Manager will either organize a search or not= ify law enforcement officers of the missing persons.

(8)        Patients and staff will remain in the interior bathroom or near the inside wall of t= he building until the Office Manager or designee declares it safe.


c.         = If there is NO WARNING, but a tornado is sighted approaching the medical clini= c, staff will direct patients to do the following and then do so themselves:

            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =     

(1)        If time permits, go to the interior bathroom or inside wall of the building.

(2)        If time does not permit, get into the safest area of           the = room which you are in (the inside wall farthest away from doors and windows).

(3)        Avoid windows and areas with wide roof spans.

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;      (4)        Do Not attempt to open windows.   &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;          &= nbsp;           &nbs= p;   (5)        Get under heavy furniture, if available.

(6)        Assume a curled position so as to protect the head and eyes.

   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;      (7)        Remain in position until the tornado passes.

(8)        Proceed as in a medical emergency if injuries have occurred.

            =             <= o:p>

d.         = In the event of severe thunderstorms, proceed according to the following plan.=


(1)        The Office Manager will advise all patients and staff of severe weather conditi= ons upon notification of the condition's existence.

(2)        The Office Manager will recommend that all patients and staff remain indoors and not venture out unless absolutely necessary.

(3)        The office manage will instruct patients and staff to stay away from doors and windows, metal pipes, sinks and plugs in electrical equipment such as offic= e, lab equipment, and computers, etc. &nb= sp;      

(4)        The Office Manager will advise all patients and staff that the telephone is = not be used.

(5)        Personnel will remain alert to the possibility of worsening weather conditions that m= ay cause tornadoes and take appropriate action in such a case.


e.         = In the event of a Hurricane WATCH the Office Manager will monitor weather advisories for worsening conditions.


   &n= bsp;            = ;            &n= bsp;            = ;       f.        &= nbsp; In the event of a Hurricane WARNING:

(1)        The Office Manager will decide whether or not to close the building and inform = the owner(s).  Appropriate action = will be taken to secure property (protect windows with boards, shutters, or tape= ).

(2)        The Office Manager or designee will inform all clinic personnel if the clinic i= s to be closed.

(3)        The receptionist should make an effort to contact all patients scheduled for the period of closure to inform them of the closing.  Rescheduling should be done as soo= n as possible.

(4)        If a hurricane strikes during regular hours and the building is open, all persons on-site will be advised by the Office Manager or designee not to venture out since driving can be hazardous.  They will also be advised to go into the interior hallway of the building and to stay away from windows.

(5)        If law enforcement officials advise the evacuation of the building, the Office Manager or designee will advise patients and staff to travel with care to another appropriate shelter as will be designated.

(6)        At all times, the Office Manager or designee will advice that the instructions= and advice of the local government be followed.




   &n= bsp;            = ;        3.         = Snow and Ice


Snow and ice conditions = can usually be forecast in advance so that emergency action can be initiated be= fore such conditions affect the medical practice.  It is not anticipated that snow an= d ice conditions will affect the medical clinic building, but transportation to t= he office may be effected.  In su= ch an event, proceed according to the following plan:

a.         = The Office Manager will receive notification by radio or some other means of hazardous road conditions due to snow and ice.

b.         = The Office Manager will make a decision to close, delay, or open and notify the staff and owner(s) and a decision will be made as to        the status of the clinic.

c.         = In the event of closing, the receptionist should try to contact all patients a= nd request the local radio stations, to announce the clinic's closure and prob= able time of reopening.


   &n= bsp;            = ;        4.         = Bomb Threat


In the event a bomb thre= at is received at the medical clinic, proceed according to the following plan:


   &n= bsp;            = ;            &n= bsp;       Procedure:


a.         = A bomb threat may be received by various means, but will usually be by teleph= one.

b.         = The recipient of the call will attempt to obtain for such information, which includes:


   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         time and date reported

   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         how reported

   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         exact words of caller

   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         caller's description of the bomb and its location

   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         caller's identity and why he/she placed the bomb

   &n= bsp;            = ;            &n= bsp;            = ;       { = ;         description of the caller's voice


c.         = The recipient of the call will immediately notify the Office Mgr., Medical Dire= ctor and/or Midlevel Practitioner, but no one else.


d.         = The Office Manager or Medical Director and/or Midlevel Practitioner will immediately notify the local law enforcement  officials.


   &n= bsp;            = ;            &n= bsp;            = ;       County  Police Department

   &n= bsp;            = ;            &n= bsp;            = ;       Telephone:  (559)


   &n= bsp;            = ;            &n= bsp;            = ;       (SHERIFF) Department

   &n= bsp;            = ;            &n= bsp;            = ;       Telephone:  (559)


   &n= bsp;            = ;            &n= bsp;            = ;       Your State Highway Patrol

   &n= bsp;            = ;            &n= bsp;            = ;       Telephone:  (559)


e.         = No search of the premises will be made by the medical clinic personnel.  However, unusual items should be n= oted and reported to the law enforcement search team.


f.        &= nbsp; The Office Manager or designee will inform all patients and staff of the bomb threat and begin evacuation proceedings.&n= bsp; To avoid the risk that the bomb threat is real, the building will be evacuated in all cases.


g.         = Staff will assist all patients from the building and then themselves evacuate the building through the appropriate exits as conditions may suggest.


h.         = If time permits, staff should see that a few windows are opened and the doors = are propped open when leaving the building.


i.        &= nbsp; The Office Manager or designee will see that everyone evacuates at least 500 fe= et from the building.

   &n= bsp;            = ;       

j.        &= nbsp; The Office Manager or designee will inform the law enforcement officials of any missing persons.


k.         = No personnel shall conduct any search for missing persons.  This should be left up to the appr= opriate officials.


l.        &= nbsp; Patients and staff will not return to the building until it has been declared safe by appropriate authorities.


   &n= bsp;        5.         = Earthquake

           &n= bsp;            Procedure

&= nbsp;

1.         = Move individuals inside the clinic to an inner wall, under heavy desks or inside supported doorways when possible.

   &n= bsp;            = ;            &n= bsp;       2.         = Take an initial body count. 

   &n= bsp;            = ;            &n= bsp;       3.         = Keep all individuals away from glass.

   &n= bsp;            = ;            &n= bsp;       4.         = Do not allow persons to run in and out of the clinic, as most         &= nbsp;           &nbs= p;                 &= nbsp;   injuries occur at and around outer doorways.

   &n= bsp;            = ;            &n= bsp;       5.         = Do not use open flame items.

   &n= bsp;            = ;            &n= bsp;       6.         = Be prepared for after shocks following the initial tremor.

7.         = Account for and check persons in the clinic for injury.  Proceed as in a medical emergency = as necessary.

8.         = Check for fumes, electrical shorts and water and sewage breakage.  Shut off any malfunctioning utilit= ies.

   &n= bsp;            = ;            &n= bsp;       9.         = Do not use the phone except for genuine emergencies.

   &n= bsp;            = ;            &n= bsp;       10.       Clean= up drug and chemical spillage.


The electrical breaker b= ox is located in the closet. Call the City of Your City for water shutoff.  In all situations, patients come f= irst and common sense must prevail.


   &n= bsp;            = ;        5.         = Nuclear Emergency


In the event that a nucl= ear emergency threatens the medical clinic, proceed according to the following plan.


   &n= bsp;            = ;            &n= bsp;       Procedure

a.         = Upon notification of the threat of a nuclear emergency, the office manager will attempt to gain further information either by radio or by other means that = may seem appropriate.


   &n= bsp;            = ;            &n= bsp;       b.         = The receptionist will inform all patients and staff.


c.         = If there is sufficient time for patients and staff to get home before         &= nbsp;  the blast:


(1)        Efforts should be made by the Office Manager or designee to instruct patients and s= taff in the best ways to seek shelter.

   &n= bsp;            = ;            &n= bsp;            = ;       (2)        Patients and staff will go home.


d.         = If there is not sufficient time for patients and staff to get home before the blast, the Office Manager or designee will instruct patients and staff to:<= /p>


(1)        Move away form the windows and doorways and into hallways.

   &n= bsp;            = ;            &n= bsp;            = ;       (2)        Do not look at the blast.

   &n= bsp;            = ;            &n= bsp;            = ;       (3)        Lie prone on the floor.

   &n= bsp;            = ;            &n= bsp;            = ;       (4)        Take shelter under heavy pieces of furniture.


e.         = If there is sufficient time for patients and staff to go home after the blast,= but before fallout arrives:

&= nbsp;

(1)        The Office Manager or designee will give all patients and staff information on = how to set up a home fallout shelter or where to go to a designated fallout shelter.

   &n= bsp;            = ;            &n= bsp;            = ;       (2)        Patients and staff will go home.


   &n= bsp;            = ;            &n= bsp;       f.        &= nbsp; Fallout shelter areas in the community include:


   &n= bsp;            = ;            &n= bsp;            = ;       Location        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;


   &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;            = ;     


Condition IV:=         &= nbsp;       Organizational Structure=


          400    = Mission Statement of the Clinic


We believe that the estab= lishment of the Name of RHC, in Your City, Your State as a Certified Rural Health Cl= inic will make quality entry level pediatric&nbs= p;    care available and financially accessible to all persons in the community.  The addition of a Midlevel Practit= ioner allows Your Medical Director to   = ;    provide quality care in a cost effective manner.


As a Certified Rural Heal= th Clinic we will be able to provide a wide range of             =      ancillary services while still maintaining continuity through shared medical         &= nbsp;       records.  The clinic acts as an entry point = for healthcare services in the   &nbs= p;            &= nbsp;           &nbs= p;   community.  This helps to ensure that individu= als in need of healthcare obtain the   &= nbsp;                &= nbsp;   necessary type and amount of care.

   &n= bsp;            = ;       


   &n= bsp;            = ;        Name of RHC is a sole proprietorship located in the state of  &n= bsp;            = ;            &n= bsp;            = ;  Your State.


The organization was est= ablished exclusively to establish, maintain, and operate suitable facilities to prov= ide primary medical care for persons suffering from illness or disabilities wit= hin the service area.


1.         = To administer healthcare of the highest quality to all clients; to practice disease prevention and health maintenance.

2.         = To provide comprehensive care by making available a wide range of healthcare services.

3.         = To maintain continuity of care by designing and maintaining a logical       system of p= aper flow and record keeping.

4.         = To educate patients regarding disease process, the treatment program and appropriate interventions for potential problem situations.

5.         = To allow the Physician(s) the flexibility to provide primary care to all citiz= ens of Lincoln county and surrounding areas.

6.         = To maintain and increase a primary care program to provide preventative care a= nd health care education to citizens desiring those services, especially for t= hose who have limited access to adequate medical care of Lincoln county and surrounding areas.

7.         = To continually improve and expand the quality and comprehensives of services by placing the practice in the hands of qualified, responsible     health   care professionals who will work in cooperation with other public and private health resources.

8.         = To develop and maintain medical care outcome standards which reflect the stand= ards of national medical organizations, the laws, rule and regulation of the Sta= te of Your State.

9.         = To maintain an organization that can support quality medical care through the recruiting and retention of excellent medical care personnel.

10.       To continually improve quality and develop interventions to maintain and upgra= de the quality of patient care.


Clinic Organization= al Chart


The organizational chart for Name of RHC is located in             =             &nb= sp;            =            the Tab labeled Appendices.<= /p>


          420    Clinic's Owners


        &= nbsp; The clinic’s owner is:


   &n= bsp;            = ;            &n= bsp;            = ;       Name of RHC

   &n= bsp;            = ;            &n= bsp;            = ;       Your City, Your State 












Condition V:<= span style=3D'mso-tab-count:2'>        &= nbsp;         Staffing and Staff Responsibilities


          500    Job Descriptions/Perfor= mance Evaluations

            =             &nb= sp;   

            =             &nb= sp;    Physician/Medical Director


Phys= ician Responsibility


This agreement includes providing Medical Directorship, professional supervision to the Midlevel Practitioner and to provide medical care to the patients of the clinic.


Supervision shall inclu= de maintaining an appropriate set of standing orders, providing on site consultation, providing telephone back-up consultation and reviewing patient records against an appropriate standard of care.



Job De= scription


Job Title: &nbs= p;            &= nbsp;       Medical Director/Physician


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Basic Job Summary:


A licensed professional P= hysician who is responsible for the clinical direction of patient care at the medical clinic.


II.   = ;      Qualifications:


   &n= bsp;        A.        Education/Registrations:

   &n= bsp;            = ;        1.         = Medical School Graduate, MD

   &n= bsp;            = ;        2.         = Currently licensed in Your State.

   &n= bsp;            = ;        3.         = Must have current Federal DEA and State DEA as appropriate to         &= nbsp;           &nbs= p;                   &= nbsp;   Your State regulations.

   &n= bsp;            = ;        4.         = Must be in good standing with the Your State Board of Medical         &= nbsp;           &nbs= p;            &= nbsp;         &= nbsp;   Licensure.

   &n= bsp;        B.         = Experience:

&= nbsp;

1.         = Preferably (5) five years in private or group practice:  Pediatrics, family practice, general practice or internal medicine.


   &n= bsp;        Principal Duties and Responsibilities:


   &n= bsp;        A.        Co-Directs the Quality Assurance Program in accordance with the clinic.

B.         = Oversees Midlevel Practitioner to assure clinical competence.  May discipline up to and including termination, according to the clinic.  The clinic completes annual Midlevel Practitioner and Office Manager evaluations.

C.        Provides clinical evaluation of nursing, lab and x-ray personnel employed by the         &= nbsp;   clinic.  Provides input in hiring, discipli= nary action and termination decisions of clinical personnel.

D.        Annually reviews clinic written policies and makes recommendations for revision.

   &n= bsp;        E.         = Provides medical direction for the clinic medical care activities.

F.         = In conjunction with the Midlevel Practitioner, reviews Nursing Protocols and revises as necessary.

   &n= bsp;        G.        Provides direct medical care and consultation to the patients of the clinic.

H.        Must be at the clinic as scheduled according to contractual agreement.  This agreement provides that the Physician will be available, at minimum, 40 hours during a one-week period.=

I.        &= nbsp; Must make certain that the Midlevel Practitioner has Physician back-up available when Physician is not present at clinic.

   &n= bsp;        J.        &= nbsp; Assists with annual program evaluation and chart audit.

        &= nbsp;   K.        Works cooperatively with the rural health clinic Office Manager in         = providing clear medical record documentation.


Physical Demands


   &n= bsp;                May be exposed to patient elements

   &n= bsp;                Prolonged, extensive or considerable standing/walking


Physician services are defined as, "services th= at are performed by a Physician at the clinic by a Physician whose agreement with = the clinic provides that she/he will be paid for such services".



            =             &nb= sp;            =            = Midlevel Practitioner


Job Description


Job Title: &nbs= p;            &= nbsp;       Midlevel Practitioner


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Basic Job Summary:


A registered nurse/ Nurse Practitioner certified as a Midlevel Practitioner responsible for the deliv= ery of quality patient care, working under the supervision of a Physician.


II.   = ;      Qualifications:


   &n= bsp;        A.        Education:


   &n= bsp;            = ;        1.         = High school graduate

   &n= bsp;            = ;        2.         = Graduate of approved School of Nursing

   &n= bsp;            = ;        3.         = Registered as a Midlevel Practitioner (NP, PA, etc.)

   &n= bsp;            = ;        4.         = Current Your State License


   &n= bsp;        B.         = Training:


   &n= bsp;            = ;        1.         = Hospital orientation program

   &n= bsp;            = ;        2.         = Current CPR certification


   &n= bsp;        C.        Experience:


   &n= bsp;            = ;        1.         = Minimum of 5 years acute care nursing and 1 year as Midlevel             =             &nb= sp;            = Practitioner, or;

   &n= bsp;            = ;        2.         = 3 years as a Midlevel Practitioner

III.  &nbs= p;    Duties:


   &n= bsp;        A.        Technical Skills:


   &n= bsp;            = ;        1.         = Able to perform thorough patient history and physical assessments         &= nbsp;           &nbs= p;                   &= nbsp;   including psycho/social, on all age/sex classifications.

2.         = Able to diagnose disease states and administer appropriate treatment.

   &n= bsp;            = ;        3.         = Knows own limits and consults with Physician as appropriate.

4.         = Able to order, perform and interpret laboratory and x-ray procedures as         &= nbsp; appropriate.

   &n= bsp;        B.         = Utilization of Clinical Staff:


1.         = Able to make efficient use of Clinical Assistants and Medical Assistants skills = and abilities.


   &n= bsp;        C.        Communication Skills:

   &n= bsp;            = ;        1.         = Develops rapport with patients and families.

   &n= bsp;            = ;        2.         = Works well with clinic staff, including Physician.

   &n= bsp;            = ;        3.         = Participates in staff meetings to identify and solve clinic problems.

   &n= bsp;            = ;       

   &n= bsp;        D.        Documentation Skills:


1.         = Documents assessment and treatment plan clearly and concisely in patient          = chart, in a timely fashion.

   &n= bsp;            = ;        2.         = Documents charge documents clearly and fully.


   &n= bsp;        E.         = Teaching:        &= nbsp;

   &n= bsp;       

   &n= bsp;            = ;        1.         = Makes provisions and arrangements for necessary patient teaching,         &= nbsp;           &nbs= p;          whether completed by self or delegated.

   &n= bsp;        F.         = Other:


1.         = Reviews clinic policies, procedures and standards (clinical and non-clinical) and offers recommendations for revision at least annually.

2.         = Maintains cooperative attitude with clinic personnel, physicians, patients and famili= es as needed to enhance continuity of care and a positive working environment.=

   &n= bsp;            = ;        3.         = As requested by the Medical Director and/or Physician in charge.

4.         = Maintains established departmental policies and procedures, objectives, quality assur= ance program and safety standards.

   &n= bsp;            = ;        5.         = Assists Physician(s) with chart completion.

6.         = Maintain established clinic procedures, objectives and safety policies.

   &n= bsp;            = ;        7.         = Performs all other duties as assigned.


IV.   = ;    Job Relationships:


   &n= bsp;        A.        Supervises:


   &n= bsp;            = ;        1.         = Medical Assistants

   &n= bsp;       

B.         Supervised By:


   &n= bsp;            = ;        1.         = Clinically - Physician in charge

   &n= bsp;            = ;        2.         = Administratively - clinic Office Manager   &n= bsp;            = ;       


Physical Demands

   &n= bsp;                Regularly exposed to risk of blood borne pathogens

   &n= bsp;                Exposed to unpleasant elements

   &n= bsp;                Lift, position, pushes and/or pulls and transfers patients

   &n= bsp;                Lifts supplies and equipment

   &n= bsp;                Light physical effort (lift/carry up to 20 pounds)










            =             &nb= sp;            =         =    Office Manager


Job De= scription


Job Title: &nbs= p;            &= nbsp;       Office Manager


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Basic Job Summary


Coordinate and supervise = the billing, collection and cashiering function of the clinic.  &n= bsp;     Reconcile accounts receivable balances to general ledger, control accounts as directed.  Coordinates all off= ice services and related activities of registration, cashiering, billing, collections and data processing.  Coordinates operations with facility units and Medical Staff.  Perform functions associated with patients treated, retrieval and re-file of medical records and prepares rel= ease of medical information for authorized receivers.



II.   = ;      Principal Duties and Responsibilities:


A.        Implement appropriate billing and collection procedures, ensuring that the accounts receivable records are kept in accordance with established procedures.


B.         = Maintain appropriate internal controls over accounts receivable and cash receipt functions.  Monitor activities= with collection agencies, insurance companies, computer center, patient and physicians.  Keep abreast of a= ll reimbursement billing procedures.


C.        Maintains cooperative attitude with clinic personnel, physicians, patients and famili= es as needed to enhance continuity of care and a positive working environment.=


D.        Maintains established departmental policies and procedures, objectives, quality assur= ance program and safety standards.


   &n= bsp;        E.         = Maintains departmental reports and records and collects statistical data for         &= nbsp;                  &= nbsp;   administrative and regulatory purposes.


F.         = Supervises office services including telephone, reception, filing, collection of patie= nt accounts, logging and key punch.


G.        Supervise the charge posting, billing and collection operation, advising Medical Dire= ctor on the day-to-day implementation and interpretation to insure compliance wi= th all policies and procedures.


H.        Implement controls to insure appropriate submission, billing and payment cycles.

I.        &= nbsp; Establish appropriate procedures for follow-up on billing and collection on all overd= ue accounts.  Prepare monthly rep= ort of open accounts for submission to Medical Director.


J.        &= nbsp; Supervise, train/orient business office personnel.&nb= sp; Plan and coordinate monthly education programs for the clinic.


K.        Collects and records quality assurance statistical data according to established collecting criteria.  Establis= hes and maintains files and records on an ongoing basis.  &n= bsp;    Retrieves records for release of information and copying.  Duplicates documents and forms as directed and mails to outside individuals and agencies.


L.         = Assist in care and maintenance of department equipment and supplies.  Justify needs and purchases.  Document maintenance schedules for department equipment.  Document cleaning and maintenance schedules for the clinic.

&= nbsp;

M.        Destroys outdated records on a periodic basis following clearly defined procedures f= or retention and destruction.


   &n= bsp;        N.        Assists Physician(s) and Midlevel Practitioner with chart completion.


   &n= bsp;        O.        Maintain established clinic procedures, objectives and safety policies.


   &n= bsp;        P.         = Performs all other duties as assigned.




Minimum Education:&n= bsp;            = ;    High School


Minimum Experience:&= nbsp;   2 years in Physician business office


Speci= al Skills:        &= nbsp;           &nbs= p;      Ability to communicate effectively, must be able to type 60 words per minute.  Must be proficient in using typewr= iter, computer terminal, personal computer, copy machines and calculator.  Must be able to balance figures, c= ompile statistics, compose letters/memorandums, coordinate meetings, develop office procedures, and establish filing systems and research information.




Physical Demands


   &n= bsp;                Light physical effort (lift/carry up to 20 pounds)

   &n= bsp;                Regularly exposed to risk of blood borne pathogens

   &n= bsp;                Exposed to unpleasant elements.



            =             &nb= sp;            =            = Clinical Assistant I


Job De= scription


Job Title: &nbs= p;            &= nbsp;       Clinical Assistant I


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Basic Job Summary:


   &n= bsp;        Provide patient care to clinic patients, under supervision of Office Manager.


II.   = ;      Principal Duties and Responsibilities:


   &n= bsp;        A.        Consult with and keep supervisor informed of clinic activities, needs and         &= nbsp;           &nbs= p;            &= nbsp; problems related to patient care.


B.         = Comply with established patient care standards.&n= bsp; Maintain established clinic  &n= bsp;    policies, procedures, objectives, quality assurance, safety, environmental and infect= ion control.  Follow established routines and utilize supplies and equipment in a cost-effective manner.  Maintain a clean, orderly, safe environment for patients and personnel.


C.        Cooperate with other personnel to achieve department objectives and maintain good employee, interdepartmental and public relations.  Maintain patient rights and confidentiality of patient information and abide by established communicati= ons code.


D.        Greet patients and escort to exam room.  Take and record vitals and patient &= nbsp;    medical information in chart.  Prepare patient and room for examination.  Assist Midlevel Practitioner and/or Physician in procedures as neces= sary (administrators injections as ordered).&nb= sp; Complete ordered laboratory procedures. Communicate results to Midle= vel Practitioner or Physician.  Discharge patient to receptionist / biller with Physician/Midlevel Practitioner orders and prescriptions. Clean and disinfect rooms and equipm= ent as appropriate.  Restock suppl= ies, linens, equipment and check for defects and outdating.


   &n= bsp;        E.         = Attend required meetings, in-services, and educational programs.


F.         = Maintain professional growth and development through seminars, workshops and professional affiliations.


   &n= bsp;        G.        Other duties as assigned.


Working Conditions:


Prolonged standing and walking.  Lifting and moving patients, equipment and supplies Repeated bending, stooping and squatting.<= span style=3D'mso-spacerun:yes'>  Exposed to all patient elements.


Knowledge, Skills, Experience Required:


Completion of LPN registr= ation or course for nursing assistants or on-the-job training. CPR update.  Sufficient previous clinical exper= ience (during training) in Physician office/medical clinic.



Physical Demands:


   &n= bsp;                Regularly exposed to risk of blood borne pathogens.

   &n= bsp;                Exposed to unpleasant elements.

   &n= bsp;                Lift, position, pushes and/or pulls and transfers patients.

   &n= bsp;                Lifts supplies and equipment.

   &n= bsp;                Light physical effort (lift/carry up to 20 pounds).




















        &= nbsp;           &nbs= p;            &= nbsp;    Clinical Assistant II

&= nbsp;

Job Description


Job Title: &nbs= p;            &= nbsp;       Clinical Assistant II


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Basic Job Summary:


Provide professional pati= ent care under supervision in clinic, according to established standards and practic= es.


II.   = ;      Principal Duties and Responsibilities:


A.        Consult with and keep supervisor informed of activities, needs and problems.


B.         = Comply with established patient care standards.&n= bsp; Maintain established clinic policies, procedures, objectives, quality assurance, safety, environmental and infection control.  Follow established routines and ut= ilize supplies and equipment in a cost-effective manner.  Maintain a clean, orderly, safe environment for patients and personnel.


C.        Cooperate with other personnel to achieve department objectives and maintain good employee, interdepartmental and public relations.  Maintain patient rights and confidentiality of patient information and abide by established communicati= ons code.


D.        Clinical duties include the following:  file x-ray and lab reports or staple reports to records.  Maintain record files.  Set up scheduled procedures.  Fill out forms for procedures.


E.         = Other duties or responsibilities for delegation include the following:  restock supplies and equipment, cl= ean equipment after use, wrap instruments for sterilization, set up and clean tables and work area according to established procedures, dispose of soiled linens and waste, alert supervisor to defective supplies and equipment, arr= ange for replacement, take vitals and record patient information, provide instruments and supplies as needed and assist with emergency procedures as directed, administer medications and perform treatments         as directed, write charges, discharge patients to receptionist/biller with Physician or Midlev= el Practitioner orders and prescriptions, complete x-ray and lab procedures as=      ordered and attend required meetings, in-services, educational programs.


F.         = Maintain professional growth and development through seminars, workshops and professional affiliations.


   &n= bsp;        G.        Other duties as assigned.


Working Conditions:


Prolonged standing and walking.  Exposed to patient elements.  Lifting equipment a= nd patients.  Repeated bending, stooping and squatting.


Knowledge, Skills, Experience Required:


Graduate of an accredited= program for licensed practical nurses or sufficient previous clinical experience in Physician office/medical clinic.  CPR update.


Physical Demands:


   &n= bsp;                Regularly exposed to risk of blood borne pathogens.

   &n= bsp;                Exposed to unpleasant elements

   &n= bsp;                Lift position, pushes and/or pulls and transfers patients.

   &n= bsp;                Lifts supplies and equipment.

   &n= bsp;                Light physical effort (lift/carry up to 20 pounds).

























            =             &nb= sp;            =            = Receptionist


Job De= scription


Job Title: &nbs= p;            &= nbsp;       Receptionist


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Brief Summary:


Greet and assist patients= and visitors, answer telephone, schedule appointments, file, and collect paymen= ts.


II.   = ;      Principal Duties and Responsibilities:


   &n= bsp;        A.        Greet all patients and visitors cheerfully.


   &n= bsp;        B.         = Answer telephone, triage calls, and maintain a log of same.


   &n= bsp;        C.        Schedule appointments and referrals to other providers.


D.        Register patients, help with the completion of necessary forms, and direct to the appropriate staff person if needed.


   &n= bsp;        E.         = Complete encounter forms upon arrival and checkout.


   &n= bsp;        F.         = Pull charts of the patients to be seen the following day.


G.        Provide Physician, Midlevel Practitioner, clinical assistants, and Office Manager w= ith copy of daily schedule each morning.


H.        Collect fees from patients for services rendered, if due, and also any outstanding = balance.


   &n= bsp;        I.        &= nbsp; Reconcile receipts at end of day and prepare deposit.


   &n= bsp;        J.        &= nbsp; Maintain neat, clean, and professional work area.




   &n= bsp;        L.         = Maintain established department policies, procedures, objectives, quality         &= nbsp;           &nbs= p;         &= nbsp;   assurance, safety, environmental and infection control.


M.        Assist in care and maintenance of department equipment and supplies. Alert Office Manager to any equipment malfunction.


   &n= bsp;        N.        Attend in-services and other required meetings.


O.        Enhance professional growth and development through in-service meetings, educational programs, etc.


P.         = Perform other duties as assigned by Office Manager and/or Medical Director.  


General Skills and Qualifications:


a)         = Ability to deal with the public, patients, and fellow staff in a position of modera= te stress.


   &n= bsp;        b)         = Ability to handle busy, multi-line telephone in a pleasant and professional         &= nbsp;           &nbs= p;            &= nbsp; manner.


   &n= bsp;        c)         = Must possess typing and/or data processing skills.


   &n= bsp;        d)         = Knowledge of medical terminology helpful.


   &n= bsp;        e)         = Experience in physicians office preferred.


   &n= bsp;        f)        &= nbsp; Desire to learn.






















   &n= bsp;            = ;       


        &= nbsp;           &nbs= p;   Billing/Insurance Specialists


Job De= scription


Job Title: &nbs= p;            &= nbsp;       Billing/Insurance Specialists


Department: &nb= sp;            =     Rural Health Clinic


I.   =        Brief Summary:


   &n= bsp;        File claims, bill patients and third parties, performs those duties associated w= ith         &= nbsp;    collections.


II.   = ;      Principal Duties and Responsibilities:


   &n= bsp;        A.        Assumes responsibility for all or part of accounts receivable.


   &n= bsp;        B.         = Research all information to complete billing process.


   &n= bsp;        C.        Follow up accounts until zero balance.


   &n= bsp;        D.        Answer all inquiries regarding assigned accounts.


   &n= bsp;        E.         = Process and distribute copies of billings as required.




   &n= bsp;        G.        Maintain established departmental policies, procedures, objectives, quality         &= nbsp;           as= surance, safety, environmental and infection control.


H.        Assist in care and maintenance of department equipment and supplies. Alert Office Manager and/or Medical Director to equipment malfunction, etc.


   &n= bsp;        I.        &= nbsp; Maintain required records, reports, files.


   &n= bsp;        J.        &= nbsp; Attend in-services and other required meetings.


K.        Enhance professional growth and development through in-service meetings, educational programs, etc.


   &n= bsp;        L.         = Keep abreast of all reimbursement policies and procedures.


M.        Prepare and distribute end of month accounts receivable reports to immediate Office Manager and/or Medical Director.


   &n= bsp;        N.        Other duties as assigned by Office Manger and/or Medical Director.


General Skills and Qualifications:


   &n= bsp;        a)         = Ability to deal with the public, patients, and fellow staff in a pleasant and         &= nbsp;           &nbs= p;            &= nbsp; professional manner.


   &n= bsp;        b)         = Knowledge of CPT and ICD coding systems preferred.


   &n= bsp;        c)         = Basic typing and word processing skills required.


   &n= bsp;        d)         = Answers telephone in a pleasant and professional manner.


   &n= bsp;        e)         = Knowledge of anatomy, physiology, and medical terminology helpful.


Physical Demands


   &n= bsp;                Light physical effort (lift/carry up to 20 pounds).

   &n= bsp;                Regularly exposed to risk of blood borne pathogens

   &n= bsp;                Exposed to unpleasant elements



























          510    Retention of Clinic Rec= ords


            =        Accounting                &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            Retention Period

        &= nbsp;           &nbs= p;   Accounts payable: invoices and credits  &n= bsp;            = ;            &n= bsp;          3 years

        &= nbsp;           &nbs= p;            &= nbsp;  (if no audits are pending)   &nb= sp;            =             &nb= sp;            =             &nb= sp;     3 years

        &= nbsp;           &nbs= p;   Accounts receivable: ledger cards (unpaid) &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;    3 years

        &= nbsp;           &nbs= p;   Accounts receivable: ledger cards (paid)  =                   &= nbsp;           &nbs= p;            &= nbsp;  3 years

        &= nbsp;           &nbs= p;   Accounts receivable: trial balances   = ;            &n= bsp;            = ;            &n= bsp;            = ;    3 years

        &= nbsp;           &nbs= p;   Accounts receivable: interim reports  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; 3 years

        &= nbsp;           &nbs= p;   Bank statements, reconciliation's, stop- payment notices,             =           3 years

        &= nbsp;           &nbs= p;            &= nbsp;  canceled checks, other than payroll   = ;            &n= bsp;            = ;            &n= bsp; 

        &= nbsp;           &nbs= p;   Capital asset records     =             &nb= sp;            =             &nb= sp;            =                       3 years

        &= nbsp;           &nbs= p;   Cash-receipt books or vouchers    &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;     3 years

        &= nbsp;           &nbs= p;   Deposit books and slips    &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;    3 years

        &= nbsp;           &nbs= p;   Employee's travel-expense reports   &nb= sp;            =             &nb= sp;            =             &nb= sp;  3 years

        &= nbsp;           &nbs= p;   Financial statements     &nb= sp;            =             &nb= sp;            =             &nb= sp;            =           3 years    

        &= nbsp;           &nbs= p;   General Ledger      &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    3 years

        &= nbsp;           &nbs= p;   Journals of charges and receipts   &n= bsp;                &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  3 years

        &= nbsp;           &nbs= p;   Remittance advices (Medicare/Medicaid)  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;     3 years

        &= nbsp;           &nbs= p;   Uncollectible accounts and related records  &nb= sp;            =             &nb= sp;            =     3 years


        &= nbsp;           &nbs= p;   Inventory/Purchasing

        &= nbsp;           &nbs= p;   Acknowledgments of orders     &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;          3 years      &n= bsp;            = ;                     &= nbsp;   Contracts with vendors (after termination)  = ;            &n= bsp;            = ;            &n= bsp;     3 years

        &= nbsp;           &nbs= p;   Inventory records      =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            = 3 years

        &= nbsp;           &nbs= p;   Purchasing orders (after termination)   = ;            &n= bsp;            = ;            &n= bsp;            = ; 3 years


        &= nbsp;           &nbs= p;   Medical

        &= nbsp;           &nbs= p;   Professional liability insurance policies   &n= bsp;            = ;            = Indefinitely  

Patients' medical records (inactive)              &= nbsp;           &nbs= p;     Indefinitely

        &= nbsp;   Patients' medical records (deceased)   = ;            &n= bsp;            = ;             <= /span>Indefinitely

        &= nbsp;           &nbs= p;        


        &= nbsp;           &nbs= p;   Patient Visits

        &= nbsp;           &nbs= p;   Appointment records      =             &nb= sp;            =             &nb= sp;            =         One year

        &= nbsp;           &nbs= p;   Patient service slips     =             &nb= sp;            =             &nb= sp;            =             O= ne year

        &= nbsp;           &nbs= p;   Recall records      =             &nb= sp;            =             &nb= sp;            =             &nb= sp;      One year









          520    Clinic Schedule


            =        Medical coverage for clinic will be during the following office hours:


   &n= bsp;            = ;        Day              &= nbsp;           &nbs= p;   Physician        =      PA

         &= nbsp;           &nbs= p;          &= nbsp;           &nbs= p;            &= nbsp;  Hours        &= nbsp;      Hours

   &n= bsp;            = ;       

   &n= bsp;            = ;        Monday        &= nbsp;           &nbs= p;  8:30 to 5:00     8:30 to 5:00

   &n= bsp;            = ;        Tuesday        &= nbsp;           &nbs= p;  8:30 to 5:00     8:30 to 5:00     

   &n= bsp;            = ;        Wednesday        &= nbsp;         8:30 to 5:00     8:30 to 5:00

   &n= bsp;            = ;        Thursday        &= nbsp;           &nbs= p; 8:30 to 5:00      8:30 to 5:00    =  

   &n= bsp;            = ;        Friday        &= nbsp;           &nbs= p;     8:30 to 5:00      8:30 to 5:00

   &n= bsp;            = ;        Saturday        &= nbsp;           &nbs= p;  On Call      &nb= sp;     9:00 to 12:00

   &n= bsp;            = ;        Sunday        &= nbsp;    On Call

   &n= bsp;            = ;       

The Clinic closes (does n= ot schedule patients) from 12:0= 0 to 1:00 PM for st= aff lunch hour.


   &n= bsp;            = ;        + Physician available

   &n= bsp;            = ;        * Midlevel Practitioner available


   &n= bsp;            = ;        At least two weeks notice shall be given to the public at large in the local        &= nbsp;           &nbs= p;            &= nbsp;  newspaper if permanent changes in the office hours are to be made.  <= o:p>


          525    After Hours Coverage


In the event of a medical emergency, patients seeking care when the clinic is closed. The phone will = be answered by the answering service and the physician or physician on call wi= ll be paged when appropriate.  The physician will then direct the patient medical care by phone. The Emergency Room physicians will cover when Your Medical Director is not available.


During the hours the cli= nic is not open, the Emergency Room Physician(s) at Madera Community Hospital will be available to cover emergency cases. In the absence of the Midlevel Practitioner(s) during or after office hours, patients will be seen by the Medical Director or will be referred to Madera Community Hospital and seen i= n the Emergency Room.


Regardless of where a clinic patient is seen by either a Midlevel Practitioner or the physician(s), it will be the responsibility of the clinic to attempt to col= lect payment from the patient. It is the Physician(s) or Midlevel Practitioner's responsibility to inform the Office Manager of the time and nature of the visit. There will be no financial responsibility of clinic to the hospital = for patients seen in the Emergency Department or admitted into the hospital. Likewise, there will be no financial responsibility of clinic to the Physician(s) or the Midlevel Practitioner(s) when these individuals see patients and are not representing the clinic.


   &n= bsp;            = ;        Emergency care after hours or during clinic closures is supplied by         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;                  &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; 

   &n= bsp;            = ;            &n= bsp;            = ;       Chowchilla District Memorial Hospital

         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             =

Dr.        =             &nb= sp;      , who also provide back-up coverage for Midlevel Practitioner when t= he Medical Director is not available.


          530    Emergency Care during C= linic Hours

            =        Preparations for medical emergencies

a.         = The medical providers, on the basis of the medical protocols, will distinguish between emergencies, which can be handled on-site, and those         &= nbsp;  necessitating referral.

   &n= bsp;            = ;        b.         = The hearing room will contain the drugs and biological outlines         &= nbsp;           &nbs= p;            &= nbsp;    below in an easily accessible location:


   &n= bsp;            = ;            &n= bsp;            = ;       (1)        Decadron mg X 4 for IV injection

   &n= bsp;            = ;            &n= bsp;            = ;       (2)        Benadryl

   &n= bsp;            = ;            &n= bsp;            = ;       (3)        Narcan 2 amps for IV or IM use.

   &n= bsp;            = ;            &n= bsp;            = ;       (4)        D5W 500 cc for IV injection.

   &n= bsp;            = ;            &n= bsp;            = ;       (5)        NS 500CC for IV.

   &n= bsp;            = ;            &n= bsp;            = ;       (6)        Sodium Bicarbonate

   &n= bsp;            = ;            &n= bsp;            = ;       (7)        Syrup of Ipecar

   &n= bsp;            = ;            &n= bsp;            = ;       (8)        Epinephrine 1:1000 amps (1cc) x 1.


   &n= bsp;            = ;        c.         = The Minor Trauma Room will also contain the following:


   &n= bsp;            = ;            &n= bsp;            = ;       (1)        Ambu bags with adult and pediatric masks.

            =             &nb= sp;            = (2)        Oxygen tank and tubing.

   &n= bsp;            = ;            &n= bsp;            = ;       (3)        Airways in sizes infant to adult

   &n= bsp;            = ;            &n= bsp;            = ;       (4)        Vacuum suction device with tubing.

(5)        Various instruments and dressings commonly used in emergencies.

   &n= bsp;            = ;            &n= bsp;            = ;       (6) Seizure stick

   &n= bsp;       

These items shall be kep= t in a central location and shall be in sufficient supply necessary to treat those emergencies.   It is mand= atory that all employees are familiar with the location of the emergency supplies= and able to recognize the name of same.  It is also strongly encouraged that the staff maintain current CPR certification.

&= nbsp;

&= nbsp;

d.         = The Medical Director develops a protocol for the staff for specific emergency situation and reviews the protocols at least annually and has a surprise dr= ill at least annually.


   &n= bsp;            = ;        In the event of a medical emergency:


Medical emergency proced= ure at the Clinic will be handled on a case-by-case basis, but will generally foll= ow the steps outlined below:


1.         = The person encountering the emergency shall immediately notify the Physician or Midlevel Practitioner and other staff members as warranted.


2.         = The Physician or Midlevel Practitioner shall evaluate the emergency and treat t= he patient as directed in the Protocols. The Physician or Midlevel practitioner shall enlist the aid of any of the clinic staff he/she deem necessary.


3.         = The receptionist or assistant, when instructed, shall immediately call the appropriate emergency response team and request that an emergency unit be dispatched to the Clinic. The following emergency units are available depen= ding upon the severity of the patient:


   &n= bsp;            = ;            &n= bsp;       a.         = EMS/Ambulance (ground and/or air)



4.         = The phone number for the Poison Center Hotline is (800) __________.         &= nbsp; 


5.         = When instructed, the receptionist or assistant shall notify the hospital in which the patient is being transferred and request the appropriate Physician or department, as directed by the Physician or Midlevel Practitioner. The numb= ers most often used will be:


   &n= bsp;            = ;            &n= bsp;       A.        Telephone Number (209) 665-3781

   &n= bsp;            = ;            &n= bsp;            = ;      


The goal of the Physicia= n or Midlevel Practitioner is to stabilize the patient for transport to the appropriate facility.


          535    House Calls Policy=


Your Medical Director wi= ll make house calls to patients requiring attention at home if possible.


          540    Clinic Holidays


All holidays will be pos= ted one (1) week prior to closure. The clinic recognizes most national holidays suc= h as the following.



   &n= bsp;            = ;            &n= bsp;            = ;      

   &n= bsp;                &= nbsp;           &nbs= p;   Christmas Eve      &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;     ½ Day

   &n= bsp;            = ;            &n= bsp;       Christmas        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           Full Day

   &n= bsp;            = ;            &n= bsp;       New Year’s Eve    &nb= sp;            =             &nb= sp;            =      ½ Day

   &n= bsp;            = ;            &n= bsp;       New Year’s Day    &nb= sp;            =             &nb= sp;            =     Full Day

   &n= bsp;            = ;            &n= bsp;       Fourth of July      =             &nb= sp;            =             &nb= sp;       Full Day

   &n= bsp;            = ;            &n= bsp;       Memorial Day      &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;     Full Day

   &n= bsp;            = ;            &n= bsp;       Labor Day      &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           Fu= ll Day

   &n= bsp;            = ;            &n= bsp;       Thanksgiving        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       Full Day


          550    Clinic Staffing Pattern= s


In the event that there = should be no Midlevel Practitioner or physician coverage due to vacations or educational leave, one (1) week notice will be given prior to closure.  Unexpected Midlevel practitioner a= bsences will be covered if staffing permits.  If no coverage exists, the receptionist shall attempt to contact all schedule patients for that day and reschedule.


          560    Physician Supervision P= olicy


Name of RHC is the Medic= al Director and is responsible for the establishment, implementation, review a= nd revision of the medical policies of the medical clinic.  Provide professional supervision t= o the Midlevel Practitioner and to provide medical care to the patients of the clinic.


Supervision shall include maintaining an appropriate set of standing orders, providing on-site consultation, providing telephone back-up consultation and reviewing patient records against an appropriate standard of care.


The following Physicians= have been enlisted by Your Medical Director to serve as secondary supervising Physician to the Midlevel Practitioner when he is unavailable:




   &n= bsp;            = ;       



Back-Up Procedures


The above supervising Ph= ysician supervises the Midlevel Practitioner as follows:

   &n= bsp;            = ;       

{ = ;         Insures maintenance of an appropriate set of standing orders.

            =             &nb= sp;    { = ;         Provides on-site consultation on a weekly basis.

{ = ;         Provides telephone consultation during all of the medical clinic's office hours.

{ = ;         Reviews and co-signs documentation of patient encounters in patient charts in keepi= ng with the conditions specified by the Your State Board of Medical Examiners = in the document authorizing the practice of the Physician extender at the medi= cal clinic.



          570    Personnel Policies=


            =        See the personnel policy and procedure manual for personnel policies.



























Condition VI:=         &= nbsp;       Provision of Services


          600    Rural Health Clinic Ser= vices


            =        Name of RHC provides outpatient health services adult patient from         &= nbsp;           &nbs= p;        the ages 18 and older.


The services that are pr= ovided by the clinic include, but are not limited to the following:


   &n= bsp;            = ;        Basic Scope of Service:


   &n= bsp;            = ;        1.         = Illness prevention

   &n= bsp;            = ;        2.         = Immunization

   &n= bsp;            = ;        3.         = Patient health education

   &n= bsp;            = ;        4.         = Management of acute and chronic illnesses

   &n= bsp;            = ;        5.         = Complete physicals (routine physical examinations, including well         &= nbsp;           &nbs= p;             =         &= nbsp;   child/developmental exams)

   &n= bsp;            = ;        6.         = Minor surgery

   &n= bsp;            = ;        7.         = Emergency stabilization

   &n= bsp;            = ;        8.         = Diagnostic laboratory procedures, including:

   &n= bsp;            = ;            &n= bsp;       a.         = urinalysis, by dipstick

   &n= bsp;            = ;            &n= bsp;       b.         = Hemoglobin

   &n= bsp;            = ;            &n= bsp;       c.         = blood sugar

   &n= bsp;            = ;            &n= bsp;       d.         = examination of stool specimens for occult blood

   &n= bsp;            = ;            &n= bsp;       e.         = pregnancy testing (urine)

   &n= bsp;            = ;            &n= bsp;       f.        &= nbsp; primary culturing for transmittal to reference lab

   &n= bsp;            = ;            &n= bsp;       G.        Group A strips - Rapid Test

   &n= bsp;            = ;            &n= bsp;       .        &= nbsp; 

The basic scope of servi= ces include those diagnostic and therapeutic services and supplies that are commonly furnished in a medical practice or at the entry point into the hea= lth care delivery system.  This is accomplished by the following direct services:


{ = ;         Prevention of illness and promotion of health through complete physical exams, annual checkups, well childcare and patient education.


{ = ;         Diagnosis of problems presented at the medical clinic by taking health    histories, doing appropriate physical exams, lab tests, EKG's, pap smears, pregnancy tests and other diagnostic procedures.


{ = ;         Treatment of immediate problems and chronic illnesses with drug             =                   &= nbsp;   prescriptions, injections, and other procedures as necessary.


{ = ;         Emergency care for minor injuries such as cuts, wounds, animal bites and falls.  Ambulance service, if needed, avai= lable through the local service.   &nbs= p;

{ = ;         Counseling regarding questions patients may have about their physical or mental health= .


{ = ;         Referral of patients with special needs to medical specialists, public and private health and social services agencies.


{ = ;         Referral and follow-up treatment to patients who require hospitalization, emergency = room care, nursing home or home medical care.


{ = ;         Specimens requiring testing not available at the clinic are referred to one of the following laboratories:


   &n= bsp;            = ;            &n= bsp;            = ;       Chowchilla District Memorial Hospital

   &n= bsp;            = ;            &n= bsp;            = ;       ____________________



610    Other Ambulatory Servic= es


            =             &nb= sp;   

   &n= bsp;            = ;            &n= bsp;      


          615    Laboratory Services




  &nbs= p;         1.         = GENERAL LABORATORY RULES:


  &nbs= p;           A.         = All equipment must be kept clean and in an orderly fashion.

  &nbs= p;           B.         = Pour any stains directly into drain and flush with water.

  &nbs= p;           C.         = If any acid or alkaline solution comes in contact with skin, flush with         &= nbsp;           &nbs= p;                water.=

  &nbs= p;           D.         = Use extreme care when handling laboratory instruments and specimens.=

  &nbs= p;           E.         = Clean up work area after activity.


  &nbs= p;         2.         = MIDLEVEL/ASSISTANTS RESPONSIBILITIES:


  &nbs= p;           A.         = Preparation of the patient.

  &nbs= p;           B.         = Maintenance and care of the equipment.

  &nbs= p;            C.         = Ordering supplies.

  &nbs= p;           D.         = Collection of specimen:

  &nbs= p;            &= nbsp;           1.=          = Make sure you have the right patient.

  &nbs= p;            &= nbsp;           2.=          = Be certain you have sufficient quantity of the specimen.

  &nbs= p;            &= nbsp;           3.=          = Be sure the specimen is collected using the proper method of         &= nbsp;           &nbs= p;            &= nbsp;             collection and pr= oper tubes.

  &nbs= p;            &= nbsp;           4.=          = See that all specimens are labeled correctly.

  &nbs= p;           E.         = Prepare all specimens to be sent out.

  &nbs= p;           F.         = Report accurate results in the patient's chart.

  &nbs= p;           G.         = Keep all logs accurate and up to date.


  &nbs= p;         3.         = LABORATORY PROCEDURES


  &nbs= p;           A.         = Organize all necessary supplies and equipment before starting any         &= nbsp;           &nbs= p;            &= nbsp;      procedure.

  &nbs= p;           B.         = Follow each test's directions accurately.

  &nbs= p;           C.         = Perform Quality Control as necessary and directed.

  &nbs= p;           D.         = Be sure supplies are stored at the proper temperature and in the         &= nbsp;           &nbs= p;            &= nbsp;         appropriate place= .

  &nbs= p;           E.         = Make sure there are adequate supplies and reagents for the next time the         &= nbsp;           &nbs= p;            &= nbsp;       test will be run.=

  &nbs= p;           F.=          = Clean up:

  &nbs= p;         a)         = Put the reagents away

  &nbs= p;         b)         = Dispose of specimens


  &nbs= p;         4.         = LABORATORY EQUIPMENT


  &nbs= p;           A.         = General rules


        &= nbsp;        1.  &n= bsp;      Equipment must be kept in clean and proper working order.

  &nbs= p;            &= nbsp; 2.         = Maintenance should be performed and logged as directed.

  &nbs= p;            &= nbsp; 3.         = Quality control must be kept up to date and logged.

<= span style=3D'font-size:11.0pt'> 

  &nbs= p;            &= nbsp;           &nbs= p; B.    Microscope


  &nbs= p;            &= nbsp;           &nbs= p;        1.         = Care and Cleaning

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       a)         = Do not remove oculars

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       b)         = Keep oculars clean and free of lint

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       c)         = Keep cover slips and slides free from fingerprints

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       d)         = Clean surface of lens before and after use with lens             = ;            &n= bsp;            = ;             paper=

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       e)         = Always turn light off after use and cover with dust          `        &= nbsp;           &nbs= p;            &= nbsp;        cover= .

  &nbs= p;            &= nbsp;           &nbs= p;        2.         = Usage

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       a)         = Focus by moving objectives away from the slide

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       b)         = Always observe on low power first and then switch to             =             &nb= sp;            =           high<= o:p>

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       c)         = Place back on low power after use

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       d)         = When using dry objectives and wet specimens, always             = ;            &n= bsp;            = ;          use c= over slips

  &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       e)         = Be sure to adjust eyepieces according to the width of             =             &nb= sp;            =            your = eyes.


  &nbs= p;            &= nbsp;           &nbs= p; C.    Centrifuge<= /o:p>


  &nbs= p;            &= nbsp;           &nbs= p;        1.         = Make sure pads are in the bottom of cylinders

  &nbs= p;            &= nbsp;           &nbs= p;        2.         = Be careful to balance tubes before turning instrument on

  &nbs= p;            &= nbsp;           &nbs= p;        3.         = Do not stop manually.


  &nbs= p;            &= nbsp;           &nbs= p; D.    Refrigerator


  &nbs= p;            &= nbsp;                &= nbsp;   1.         = Temp Log      &nbs= p; 


            =             &nb= sp;            =            RHC Waived Lab

            =             &nb= sp;    CLIA Laboratory Certificate (See Professional Licenses)


The following tests are performed on-site at Name of RHC  &nbs= p;    and has received certification as a waived lab under the 1992 CLIA standards.


The clinic provides basic laboratory services essential to the immediate diagnosis and treatment of t= he patient, including:


1.         = Chemical examinations of urine by stick or tablet methods or both (including urine keytone);

   &n= bsp;            = ;            &n= bsp;       2.         = Hemoglobin or hematacrit;

   &n= bsp;            = ;            &n= bsp;       3.         = Blood sugar;

   &n= bsp;            = ;            &n= bsp;       4.         = Examination of stool specimens for occult blood;

   &n= bsp;            = ;            &n= bsp;       5.         = Pregnancy tests;

   &n= bsp;            = ;            &n= bsp;       6.         = Primary culturing for transmittal to a certified laboratory;

   &n= bsp;            = ;            &n= bsp;      


          620    X-Ray Services


            =             &nb= sp;    Patients are referred to the hospital for X-Rays.










          640    Clinic Office Policy


            =        TELEPHONE PROCEDURES


  &nbs= p;            &= nbsp;        ANSWERING THE TELEPHONE





It is the responsibility of the receptionist to answer all incoming telephone calls and direct the call to the appropriate party.  Assistance should be provided by t= he Midlevel practitioner and other office staff.


Long distance business telephone calls made by employees should be documented wi= th the date, name and number of party called, the name of the person placing t= he call, and the purpose of the call.



Personal phone calls are permitted if limited in length and frequency.


        &= nbsp;           &nbs= p;            &= nbsp; 

        &= nbsp;           &nbs= p;            &= nbsp;  PREFERRED GREETING

        &= nbsp;           &nbs= p;            &= nbsp; 

"Name of RHC, this is (name of person).  May I help you."

Always identify yourself by name when speaking to someone on the telephone.

 <= /o:p>

               = ;            &n= bsp;        INSTRUCTIONS


Do not answer and put the caller on hold, except under rare circumstances.  If it becomes necessary to do this frequently, bring the matter up at staff &n= bsp;           mee= tings and attempt to find a solution.  If "hold" is unavoidable and continues more than a short period, bre= ak in every 30 seconds or so and say ' "Thank you for waiting; the line is still busy.  May I call you back?"




All messages should be in written form and distributed promptly.  When taking calls, always obtain t= he caller's name and purpose of the call.&nbs= p; The following is a list of responses for different types of calls:



        &= nbsp;           &nbs= p;   { = ;         MEDICAL -- Before giving patient messages to the Midlevel practitioner or physician= s, always pull the patient's medical chart and clip the message to it. Message will include call back number, name of person calling and time call came in.  After-the call has been returned, the message should be checked to indicate it has been taken care = of and then filed in the patient's chart.


        &= nbsp;           &nbs= p;   { = ;         NEW RX's -- When a patient calls in complaining of an illness and wants a prescription called in:


        &= nbsp;           &nbs= p;            &= nbsp;  1)         = Check to see if it is an established patient who has been seen within the last 6 months.  If the patient is new= or has not been seen within the last 6 months, must make an appointm= ent.

        &= nbsp;           &nbs= p;            &= nbsp;  2)         = Get symptoms.  Only take messages = for minor illnesses.  If there is = any question as to whether the patient should come in, always ask a nurse, Midl= evel Practitioner or the Physician.  NEVER make a medical-judgment call!

        &= nbsp;           &nbs= p;            &= nbsp;  3)         = Get name of pharmacy and a return number for the patient.


        &= nbsp;           &nbs= p;   { = ;         REFILLS -- Ask when the patient was last in the office.  Unless it is just for a routine maintenance Rx, if the patient has not been in within 6 months, they must m= ake an appointment.


        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;             =

Get the name of their medication, the dosage, the name of their pharmacy, and t= he patient's return phone number.


Explain that refills are called in the afternoon and that they should check with th= eir pharmacy after 4:00 pm.  If the Physician decides not to prescribe a refill, then the Midlevel Practitioner or nurse will return the= ir call.


        &= nbsp;           &nbs= p;   { = ;         TEST RESULTS -- Get the patient's name, type of test, date performed, and the location.  Patients calling fo= r lab results need to be reminded that the Physician must review the results befo= re the Midlevel Practitioner can return their call.  If it has been more than 2 days an= d we still do not have the test results, make a note for the nurses to check int= o.

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;

        &= nbsp;           &nbs= p;   { = ;         CALLS FOR PHYSICIAN(S) -- When someone asks to speak to one of the doctors, tell = them the Physician is seeing patients and ask if he/she is expecting their call.  Try to determine the na= ture of the call, if it is    m= edical, business, or personal.  Screen= calls as best as possible.

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;

        &= nbsp;           &nbs= p;            &= nbsp;  If a caller insists on speaking to a Physician and refuses to leave a         &= nbsp;           &nbs= p;            &= nbsp;                   &= nbsp;         message, explain that they must give some type of reference to their call or         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    the Physician will not call them back.



        &= nbsp;           &nbs= p;   { = ;         CALLS FOR MIDLEVEL PRACTITIONER -- These calls also need to be screened.  Always ask if the Midlevel Practit= ioner is expecting their call. These calls will most often be from patients wanti= ng lab or test results or prescriptions.  Handle these as instructed above unless a Midlevel Practitioner has = left specific instructions on a particular patient.  You would then refer the call to t= he Midlevel Practitioner.


        &= nbsp;           &nbs= p;   SCHEDULING PATIENTS


        &= nbsp;           &nbs= p;   Scheduling of patients will be from 8:3= 0:00 am to 5:00 pm.  New patient             =             &nb= sp;                  &= nbsp;   appointments should be scheduled allowing 30 minutes per visit.  Follow-up or             =              routine visits should be allowed 15 minutes each.


When making appointments, list in the computer the patient's name, phone number,= and the reason for the visit.  Lis= ting the nature of the visit will help in the allowance for walk-ins and work-in= s.  If there is a question concerning = the urgency of a patient seeing the Physician before an opening is available, r= efer the call to the Midlevel Practitioner or nurse.

 <= /o:p>

        &= nbsp;           &nbs= p;   TELEPHONE APPOINTMENTS


Telephone appointments are made by the receptionist, but can be made by anyone answer= ing the phone and following proper procedure.&= nbsp; If there is a problem with   the schedule or a patient must be worked in a full schedule, let the Midlevel Practitioner or nurse determine the best time for the appointment.


Ask the caller if he/she has ever been seen in the clinic before, and the reason for the visit.  New patient sh= ould be instructed to arrive 10-15 minutes early to complete new patient informa= tion forms.



        &= nbsp;           &nbs= p;   FOLLOW UP APPOINTMENTS


Follow up appointments are to be made by the receptionist as the patient checks         &= nbsp; out before leaving the clinic.  Gi= ve the, patient an appointment card showing date and time of appointment.  If the patient doesn't have to ret= urn to the clinic for several months and the schedule hasn't been made out that fa= r in advance, you may instruct the patient to call back at a later date to sched= ule the appointment.




Greeting patients and visitors is the responsibility of the receptionist.  All visitors and patients are to be greeted pleasantly and treated courteously.


As patients sign in, locate their medical charts and attach a charge ticket to= it if patient is new, have them complete the "new patient information for= ms and make a chart for them.  Ma= ke copies of any insurance cards and update any patient information in their chart.  Check computer printou= t for their account balance,    &n= bsp;        complete the top portion of the charge ticket, and then give the chart to the Midlev= el      Practitioner.


   &n= bsp;            = ;        If patients have to wait more than a few minutes beyond their scheduled         &= nbsp;           &nbs= p;           &= nbsp;   appointment, explain that the Physician has been delayed, he's out on an   &nb= sp;            =             &nb= sp;       emergency or whatever response is reasonable to reassure them.            =          


          645    Clinic Fee Schedule


            =        The Clinic fee schedule is included in the Tab labeled Appendices         &= nbsp;           &nbs= p;            &= nbsp;     includes charges for the most common items.


          650    Billing - Patient Charg= es, Payment and Collection Policy




        &= nbsp;           &nbs= p;   MAKING FINANCIAL ARRANGEMENTS WITH THE PATIENT


This is the responsibility of the receptionist.=   The Physician should avoid any discussions with the patients regardi= ng their accounts; he should refer them to the front office.


        &= nbsp;           &nbs= p;   PROCEDURE:


Fina= ncial arrangements must be made with all patients.  However, no patient will be denied= emergency treatment because of his or her inability to pay.


        &= nbsp;           &nbs= p;   1.         = We prefer cash at the time of treatment for all office visits.  If patients question this policy, explain to them that this reduces our paper work and expenses and helps us = hold fees in line.  The payment amo= unt is written on the charge ticket, and a computer generated receipt is given to = the patient as his/her receipt.


        &= nbsp;           &nbs= p;   2.         = If the patient states he/she cannot pay in full, the receptionist should        attem= pt to collect a minimum of 25% of the total charges and ask for a date when the payment for the balance can be expected.&n= bsp; Give the computer receipt of the charge ticket to the patient and ask them to mail in the payment as soon as possible.  A statement will be sent to them; payment in full is expected upon receipt.

        =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;           

        &= nbsp;           &nbs= p;   3.         = Insurance patients are responsible for any portion of their bill not covered by their insurance (deductible & coinsurance, etc.) This should be explained to = the patient at the time of the first visit and arrangements made for payment of= the balance.


        &= nbsp;           &nbs= p;   4.         = Medicaid patients are responsible for providing copies of their current Medicaid car= ds. They will be billed for non-covered services.


        &= nbsp;           &nbs= p;   RECORDING CHARGES AM PAYMENTS


It is the responsibility of the receptionist to complete the charge sheet, col= lect the fees, and review the charge sheet for pertinent information (i.e., name, address, account number, diagnosis and correct charges) before balancing and batching the day's tickets for computer entry.

 <= /o:p>

        &= nbsp;           &nbs= p;   CASH DRAWER


A minimum of $100 cash should be allotted to the cash drawer for use in making change when patients pay on their accounts.  The cash drawer should always         maintain at least its $100 balance.  At= the end of the day, the cash drawer should contain that day's collections plus $100.  The daily deposit is to= be made out to equal that days receipts, thus leaving the $100 still in the ca= sh drawer.  The cash drawer is to= be locked at the end of each business day.


        &= nbsp;           &nbs= p;   CASH RECEIPT CONTROL PROCEDURE


        &= nbsp;           &nbs= p;   1.         = Mail payments: List all payments on the mail payments log and attach EOB's (Explanation of Benefits) to back.  Make a separate deposit. Deposit must equal the total amount of the payments.


        &= nbsp;           &nbs= p;   2.         = In-office payments must be posted on the charge tickets and totaled at the-and of the day.  A deposit will be made f= or that amount.


        &= nbsp;           &nbs= p;   3.         = Deposits should be made daily and must always include all receipts, i.e., the deposit should be in balance and if not, an explanation must be made on the batch summary report explaining any difference.



        &= nbsp;           &nbs= p;   CREDIT POLICY


        &= nbsp;           &nbs= p;   1.         = All patients are required to pay cash in full for each visit, with the         &= nbsp;           &nbs= p;            &= nbsp;                    &= nbsp;   exception of PPO arrangements and Medicaid patients.


        &= nbsp;           &nbs= p;   2.         = All Medicaid patients will be required to pay in full for non--covered services= at the time of service.


        &= nbsp;           &nbs= p;   3.         = We are participating providers in the Medicaid Program, which means we will ac= cept assignment on all claims.  Each patient will be responsible for any deductible and/or coinsurance amounts.<= span style=3D'mso-spacerun:yes'>  If the patient has a supplemental insurance, we will file that for them.


        &= nbsp;           &nbs= p;   4.         = For PPO patients. We will accept assignment on all claims for covered services.  After we hear from insurance, we will then bill the patient for            any remaining unpaid balance.  Co-payments are due at the time of service.


        &= nbsp;           &= nbsp;   5.         = If it is necessary to bill the patient, tell the patient he/she can mail in the payment and ask him/her when we can expect the payment; write that date on = the charge ticket.  Give him/her t= he yellow copy of the ticket and show him/her our mailing address and the date= we expect to receive the payment. Stress to the patient that we must hear from him/her by that date.

        &= nbsp;  

        &= nbsp;   PATIENT STATEMENTS



  &nbs= p;            &= nbsp;        {          The office manager (Fadwa) will be responsible f= or printing, reviewing,    &nbs= p;            &= nbsp;           &nbs= p;                  &= nbsp;           &nbs= p;   sorting and mailing patient account statements on or around the 1st of each         &= nbsp;         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  month.  This puts the statement in their h= ands at the most opportune time to pay.  <= /span>        &= nbsp;        And, it has been demonstrated that people will tend to pay bills in the order th= ey         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;       are received.


  &nbs= p;            &= nbsp;        {          Statements will include past due messages accord= ing to the age of the account.  The messages will be similar to the following:


  &nbs= p;            &= nbsp;           &nbs= p;        1st Statement  (Age  0)=             &nb= sp; No message.

  &nbs= p;            &= nbsp;           &nbs= p;        2nd (Age 1 month)     =             &nb= sp;  "Past Due Please remit today."

  &nbs= p;         3rd (Age 2 months)     = ;            &n= bsp; "Please contact our office today regarding your past due account!"        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; 

  &nbs= p;         4th (Age 3 months)     = ;            &n= bsp;  "We are willing to work with you to prevent &nb= sp;            =             &nb= sp;             &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p; collection agency action."

  &nbs= p;            &= nbsp;        5th (Age 4 months)     = ;            &n= bsp;  "If not paid in 15 days, this account will be turned over for collection."=


  &nbs= p;            &= nbsp;        {          Collection letters will be sent with Final Notice statements and a copy of that statement will be sent to the clinic Office Manager for his/her review.  H= e/she      should determine accounts to be written off and/or referred to the collection agency.=


  &nbs= p;            &= nbsp;        {          Should a patient who has been turned over for collection attempt to return to the clinic for further (non-emergency, non-follow up care) treatment, please follow the procedure as described in collection agency procedures.





  &nbs= p;       655    Normal Daily Routine of= the Clinic


        &= nbsp;           &nbs= p;   The following is a step-by-step outline for daily routine:

 <= /o:p>

        &= nbsp;           &nbs= p;   A.         = Receptionist


        &= nbsp;     1.         = The receptionist will greet and "check-in" each patient.


        &= nbsp;     2.         = New patients must complete the "new patient" information forms,         &= nbsp;           &nbs= p;            &= nbsp;            and then a medical record is constructed for each.


        &= nbsp;     3.         = For previous patients, check the date on the registration form.  If it             = ;            &n= bsp;            = ;       is more than one year old, have the patient complete another, or         &= nbsp;           &nbs= p;            &= nbsp;         verbally verify all the information -on the form, date and initial.


        &= nbsp;     4.         = Any change of address or phone number should be updated in the         &= nbsp;           &nbs= p;                chart and a copy included in the daily batch to update the &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;       computer.  Remember to ask the patient if the= re are any changes to     &nbs= p;            &= nbsp;           &nbs= p;          make to his/her account.


        &= nbsp;     5.         = The following information should be placed on the charge ticket:

        &= nbsp;           &nbs= p; a)         = Patient's name

        &= nbsp;           &nbs= p; b)         = Account number

        &= nbsp;           &nbs= p; c)         = Previous balance

        &= nbsp;           &nbs= p; d)         = Provider to be seen

        &= nbsp;           &nbs= p; a)         = Type of insurance (specify if Medicaid)


        &= nbsp;     6.         = Attach the entire charge ticket with a paper clip to the patient's         &= nbsp;           &nbs= p;            &= nbsp;   medical record, and place them in the rack for the Midlevel             =             &nb= sp;            =             &nb= sp;          Practition= er.


        &= nbsp;           &nbs= p;   B.         = The Nurse


The Nurse will take the patient's medical record, call the patient to the exami= ning area and obtain and record the patient's vitals and update any medicines wi= thin the chart.  The Nurse is also responsible for marking on the charge ticket any lab tests or x-rays taken.=


The medical record should then be placed in the chart holder on the door of the room in which the patient is to be examined.  This allows the Provider to review= the chart prior to entering the room and also acts as a signal to the Provider = that the patient is ready for examination.


        &= nbsp;  

        &= nbsp;   C.        The Provider (Physician or Mid-Level Practitioner


        &= nbsp;           &nbs= p;            &= nbsp;  1.         = Indicate all services rendered by either checking off the appropriate box or by ente= ring a specific dollar amount if it differs from the standard charges.

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           

        &= nbsp;           &nbs= p;            &= nbsp;  2.         = List all diagnoses for patient on charge ticket.


        &= nbsp;           &nbs= p;            &= nbsp;  3.         = Indicate whether patient is being referred for further treatment, to return to the clinic for follow-up care, or dismissed home.            &= nbsp;     

        &= nbsp;  

        &= nbsp;           &nbs= p;            &= nbsp;  4.         = Indicate approximate scheduling for next appointment.


        &= nbsp;           &nbs= p;            &= nbsp;  5.         = Sign at bottom of charge ticket.


        &= nbsp;           &nbs= p;            &= nbsp;  6.         = Provider should hand the charge slip and chart to the patient and request this slip = be given to the receptionist or hand the charge ticket to the receptionist himself.


        &= nbsp;           &nbs= p;   D.         = Receptionist responsibility as patient completes appointment:


        &= nbsp;           &nbs= p;            &= nbsp;  1.         = Accept the charge slip from the patient.


        &= nbsp;           &nbs= p;            &= nbsp;  2.         = Write in the appropriate fee and/or total for the services rendered that day on t= he face of the charge slip.


        &= nbsp;           &nbs= p;            &= nbsp;  3.         = Collect the payment from the patient using the following;            =             &nb= sp;            =                    &= nbsp;           &nbs= p;   technique: Make a direct in-office collection effort by merely             =             &nb= sp;            =             &nb= sp;   saying, "Your charge today is $ ________ and your previous

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  Balance is $      ___= __, Ms. Jones.  Your total is $ ________.


        &= nbsp;           &nbs= p;            &= nbsp;  4.         = This is all you should have to do.  It is the responsibility of the patient to make a statement.  The patient will either make a pay= ment or ask to receive a bill.  An explanation may then be offered to the patient: "The Physician is attempting to keep fees down by collecting office charges at the time the service is rendered."


        &= nbsp;           &nbs= p;            &= nbsp;  5.         = If payment is received, it is written down in the treatment space of the charge slip and current balance updated and written in that         space.  A zero balance is placed in the ba= lance if there is no remaining balance.


        &= nbsp;           &nbs= p;            &= nbsp;  6.         = If no payment is received, today's charges are to be added to the previous bal= ance and the sum is to be placed in the current balance space.


        &= nbsp;           &nbs= p;            &= nbsp;  7.         = If a return appointment is necessary, consult the appointment schedule after noting Providers request and suggest to patient a suitable specific time for his next appointment.   Complete an appointment card and give it to the patient along with t= heir charge slip-receipt.


        &= nbsp;           &nbs= p;   E.         = Receptionist's responsibilities at the end of the day:


        &= nbsp;           &nbs= p;            &= nbsp;  1.         = Make sure all information on each charge ticket has been             =             &nb= sp;            =                  &= nbsp;           &nbs= p;   completed.


        &= nbsp;           &nbs= p;            &= nbsp;  2.         = Total all charges and payments.  Att= ach a copy of the adding machine tape for both charges and payments.  Enter totals on the Batch Summary Report, along with mail payment totals.&nb= sp; Staple charge tickets, mail payment log, and summary report together= to form the Daily Batch.

        &= nbsp;           &nbs= p;            &= nbsp;  3.         = Complete cash control by completing the deposit slip.  The total deposit should equal the= total of the amount shown on the "payments tape".


        &= nbsp;           &nbs= p;            &= nbsp;  4.         = The following is a letter that may be used is the clinic deems       necessary:<= /p>



(City,    State,   Zip)


Dear Patient:


Your account balance of ($$$) is seriously past due.  Unless we hear from you = within 15 days of the above date, this account will be referred to a professional collection agency.  To avoid f= urther legal action, please send your payment in full today.



If you have questions, you may contact us at (55= 9) 665-0275.








          660    Referral Specialists and Facilities


            =        Patient Transfer to Another Acute Care Facility


   &n= bsp;            = ;        PURPOSE:


To establish a prescribe= d method to be followed in the ongoing treatment of Rural Health Clinic patients.


   &n= bsp;            = ;        POLICY:


   &n= bsp;            = ;        In the event a Rural Health Clinic patient requires more definite care, an         &= nbsp;           &nbs= p;            &= nbsp;  appropriate transfer is arranged per the Emergency Room Physician.


   &n= bsp;            = ;        PROCEDURES:


1.         = Assessment made by the Midlevel Practitioner/Physician indicating need for care not available at this facility.


2.         = The patient and family will be consulted, if possible, regarding preference of transfer facility.


3.         = The Midlevel Practitioner/Physician will secure accepting Physician and facilit= y to finalize the transfer arrangements.


4.         = The Midlevel Practitioner will arrange for transportation and personnel accompaniment as needed.


5.         = Copies of the Rural Health clinic chart, lab reports, EKGs, X-rays, and transfer f= orm or notes will be sent with the patient.


6.         = Patient will be stabilized to the degree possible in the Rural Health Clinic prior = to transfer.


665  &= nbsp; Agreements or Arrangements to Provide Services to Clinic Patients


See Medical Record Forms= Tab for arrangements with other providers to provide services to clinic patients.


670  &= nbsp; Policy for Protocol(s), and/or Standing Order Development and         

&= nbsp;

Review (Protocols should= be kept in a separate notebook(s) available to the Physician and Midlevel Practitio= ner and/or CNM in patient care areas of the clinic.)



          680    Policy regarding suicid= al phone calls



Suicidal calls will be kept on the open line and a provider summoned immediately by = code 99. The provider will direct staff to summon sheriff for either phone track= ing for location of caller and/or going to site of caller to render appropriate aid.







Condition VII= :        &= nbsp;      Patient Medical Records<= /span>


          700    Patient Medical Record = System

            =             &nb= sp;   

            =        Contents


            =             &nb= sp;    Procedure


Medical records are init= iated for each new clinic patient. The following documents are contained in the medical record. It is the responsibility of the Receptionist to initiate the record and see that the information is updated at each visit:


   &n= bsp;            = ;            &n= bsp;       } = ;        Patient Information Form

   &n= bsp;            = ;            &n= bsp;       } = ;        Assignment of Benefits Form

   &n= bsp;            = ;            &n= bsp;       } = ;        Superbill

   &n= bsp;            = ;            &n= bsp;       } = ;        Consent to treat-annual


Medical Record chart not= ations must be signed and dated by the caregiver. The LPN or Clinical Assistant ta= king the initial assessment information, or recording results, must sign the ent= ry. Chart notes must contain:


*        &= nbsp; Measure of vital signs: weight, height (under age 18), pulse, blood pressure, and temperature

   &n= bsp;            = ;            &n= bsp;       *        &= nbsp; Description of complaint or problem

   &n= bsp;            = ;            &n= bsp;       *        &= nbsp; Detailed statement of physical examination

   &n= bsp;            = ;            &n= bsp;       *        &= nbsp; Assessment of problem or health status

   &n= bsp;            = ;            &n= bsp;       *        &= nbsp; Diagnosis and treatment orders, including prescriptions and             =             &nb= sp;              &= nbsp;   injections

   &n= bsp;            = ;            &n= bsp;       *        &= nbsp; X-ray and laboratory procedures ordered

   = ;            &n= bsp;            = ;        *        &= nbsp; Notations must be legible

*        &= nbsp; Indication of how a drug was dispensed, whether administered by injection, provided wi= th a sample, or given a prescription

*        &= nbsp; Orders given to the Midlevel Practitioner by the Physician which are outside of the protocols or standing orders must be documented as Physician orders in the medical record


Medical records are stor= ed in such a manner that the general public does not have access. Original medical records are not to be taken from the clinic unless personally transported by the clinic Receptionist or designee of the Office Manager. Subpoena is the = only reason for removing the    &= nbsp;        original medical record.

 <= /span>

 <= /span>

 <= /span>

            =             &nb= sp;    Filing System

            =             &nb= sp;   

            =             &nb= sp;    PATIENT CHARTS/RECORDS


Each patient seen in the clinic is assigned his own individual medical record.


REG= ISTRATION FORM - to be completed by each patient or the responsible party on the patient's initial visit.


        &= nbsp;           &nbs= p;            &= nbsp;  A.        Patient's name, address, and phone number.

        &= nbsp;           &nbs= p;            &= nbsp;  B.         = Age, sex, and date or birth of the patient

        &= nbsp;           &nbs= p;            &= nbsp;  C.        Information on the responsible party

        &= nbsp;           &nbs= p;            &= nbsp;  D.        Medical Insurance, Medicaid, or Worker's compensation             =             &nb= sp;            =                 &= nbsp;           &nbs= p;   information and numbers

        &= nbsp;           &nbs= p;            &= nbsp;  E.         = Authorization for Medical Care

        &= nbsp;           &nbs= p;            &= nbsp;  F.         = Referral Information


Make 2 copies each of the new patient registration form and all insurance cards:= put one in the chart and attach the other to the charge ticket.


        &= nbsp;           &nbs= p;            &= nbsp;  MEDICAL CHART EXTERIOR


        &= nbsp;           &nbs= p;            &= nbsp;  A.        Patient's Chart/Account Number - This is assigned to the patient            nume= rically by the order in which the patient arrives at the office.         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;    

        &= nbsp;           &nbs= p;            &= nbsp;  B.         = Year Sticker - A sticker for the current year is placed on the chart and updated every year the patient continues to return to the clinic.

        &= nbsp;           &nbs= p;            &= nbsp;  C.        Patient's Name - typed on a name label in capital letters (last name first, then first name).

        &= nbsp;           &nbs= p;            &= nbsp;  D.        Alpha Labels - for first letter of last name.

        &= nbsp;           &nbs= p;            &= nbsp;  E.         = Allergy labels - applied when necessary to alert medical staff of any drug allergie= s.


        &= nbsp;           &nbs= p;            &= nbsp;  MEDICAL CHART INTERIOR


The patient registration form is placed inside the chart on the left side with copies of insurance cards, insurance forms or other business information     placed directly behind = the registration form.

        &= nbsp;           &nbs= p;  

All medical information including progress notes and lab & x-ray reports are placed on the right side of the chart.



        &= nbsp;           &nbs= p;            &= nbsp;  A.        Medical History Sheet

        &= nbsp;           &nbs= p;            &= nbsp;  B.         = Progress Notes - filed in date order.  = To be completed at the time of each office visit and including:

        &= nbsp;           &nbs= p;            &= nbsp;  1.         = S-subjective: Information told by the patient about the problems.

        &= nbsp;           &nbs= p;            &= nbsp;  2.         = O-Objective:  Information from the physical exam= and         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;   laboratory testing.

        &= nbsp;           &nbs= p;            &= nbsp;  3.         = A-assessment: Interpretation by the provider of the  = ;            &n= bsp;            = ;            &n= bsp;            = ;            &= nbsp;           &nbs= p;   subjective and objective data; identification of problem and             =             &nb= sp;            =             &nb= sp;           patient's c= urrent medical and functional status; discussion &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp; of diagnostic questions to be answered.


        &= nbsp;           &nbs= p;            &= nbsp;  C.        Laboratory Reports

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  1.         = On-site laboratory testing results placed in chart when a lab test is reported.

        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  2.         = Outside lab testing reports are to be placed with the chart on the Physician's desk= for him to review and initial

        &= nbsp;           &nbs= p;            &= nbsp;  D.        Medication Sheet

        &= nbsp;           &nbs= p;            &= nbsp;  E.         = Operative Notes

        &= nbsp;           &nbs= p;            &= nbsp;  F.         = Consultation Reports and Hospital Documents

        &= nbsp;           &nbs= p;            &= nbsp;  G.        Miscellaneous Reports and Correspondence


        &= nbsp;           &nbs= p;            &= nbsp;  OTHER MEDICAL RECORD FORKS


        &= nbsp;           &nbs= p;            &= nbsp;  A.        Records Release Authorization

        &= nbsp;           &nbs= p;            &= nbsp;  B.         = Physician Introduction of Patient to Referred Physician

        &= nbsp;           &nbs= p;            &= nbsp;  C.        Disability Certification Letter

        &= nbsp;           &nbs= p;            &= nbsp;  D.        Medicare Consent Form


        &= nbsp;           &nbs= p;            &= nbsp;  MANAGEMENT OF THE PATIENT RECORDS


        &= nbsp;           &nbs= p;            &= nbsp;  PULLING RECORDS OF PATIENTS TO BE SEEN


The clerical persons are responsible for pulling patient charts at the beginnin= g of each day and re-filing them at the end of the day.  They will also file within the med= ical charts all other medical information such as lab reports, x-ray reports, and any other pertinent medical information.


As the patient arrives, they are to be entered into the system by assigning a = charge ticket to the patient and entering-the date on the patient's medical record= .


At the end of the day, any medical records that have been pulled, but not        &= nbsp;  seen, indicate a patient did not keep their appointment.  Open all charts and record the dat= e, time, and reason for the missed appointment on the remarks and Medication sheet located in the front left side of the chart.  All patients who miss appointments= will received a missed appointment letter.


        &= nbsp;           &nbs= p;            &= nbsp;  MAKING CLINICAL RECORD ENTRIES


        &= nbsp;           &nbs= p;            &= nbsp;  This is the responsibility of the Nurse to gain pre-examination         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            information= .  The Physician or Midlevel will then enter       &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;           by hand or by   dictation all information to be entered into the medical=         =             &nb= sp;            =              record.



        &= nbsp;           &nbs= p;   **NOTE:         = Medical records are the sole and exclusive property of the             =             &nb= sp;            =                &= nbsp;           &nbs= p;   clinic.  They do not belong to the patient, however the      &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;             patient doe= s have a right to copies of that information.&nbs= p; Our      &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;    policy in that copies will be given to another Physician,             =             &nb= sp;            =             &nb= sp;            =             &nb= sp;     hospital insurance agency, federal agency, attorney, or other             =             &nb= sp;            =             &nb= sp;            =        individual at the patient's request.  This request should be in    &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           wr= itten and specify the-designated parry. (A signed "release         &= nbsp;                 &= nbsp;           &nbs= p;   of Information" form must be used and filed in the patient's         &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;               chart.)


   &n= bsp;            = ;            &n= bsp;       Responsibility for Record


Medical record tracking = is the responsibility of the Receptionist at the clinic. This person is also responsible for transporting of subpoenaed record, unless otherwise designa= ted by the Office Manager, or hand carried by the Medical Director.


   &n= bsp;            = ;            &n= bsp;       Retention of Record


Records are maintained f= or a minimum of 7 years after the date of last encounter, unless the patient is under the age of 13.  In this = case the record must be retained until the patient reaches the age 21 of Records= are destroyed by shredding or supervised burning.  The State of Your State statute for record retention should be referred to determine the appropriate time to maintain the medical record.


            =             &nb= sp;   





710  &= nbsp; Patient Consent Procedures Authorization to Release/Obtain Medical Information=


            =             &nb= sp;    General Policies


The Clinic undertakes a = legal and ethical responsibility to foster and preserve the privacy and confidentiality of patient information.&nb= sp; There      = shall be strict adherence to this basic principle: prior consent of the patient <= span style=3D'mso-tab-count:1'>   is required before informatio= n is released or disclosed or made available for review except where a specific = law or regulation or the internal administrative needs of the facility require = or permit such access without patient consent.


   &n= bsp;            = ;            &n= bsp;       Responsibility for Release of Information


All requests for release= of information and/or access to patient care records for the facility shall be coordinated by Carmen Parra so that uniform, timely processing, consistent = with the specific legal and regulatory constraints associated with each type of request, is achieved.  This comprehensive system involves the following six functions:


1.         = coordinating intra-organizational units involved in release of information activities,

   &n= bsp;            = ;            &n= bsp;       2.         = coordinating intradepartmental functions.

3.         = applying the detailed provisions of specific laws and regulations.

   &n= bsp;            = ;            &n= bsp;       4.         = honoring the patient's right to authorize such release of             =             &nb= sp;            =         &= nbsp;   information.

5.         = applying routine administrative processes to all requests and accounting for excepti= ons to routine processing.

   &n= bsp;            = ;            &n= bsp;       6.         = safeguarding the process through the application of quality             = ;            &n= bsp;            = ;               &= nbsp;   controls.


   &n= bsp;            = ;            &n= bsp;       RELEASE OF INFORMATION


Requests for information= from patient records shall be processed in a timely, consistent manner as set fo= rth in these policies.


   &n= bsp;            = ;            &n= bsp;       Priorities and Time Frames


   &n= bsp;            = ;            &n= bsp;       The following priorities and time frames shall apply to release of         &= nbsp;           &nbs= p;            &= nbsp;          &= nbsp;   information requests processed by the office manager.


1.         = Emergency requests involving immediate emergency care of patient: immediate processin= g.

2.         = Priority requests pertaining to current care of patient: within one working day.

3.         = Patient request for access to own record: within one working day of record completi= on.

   &n= bsp;            = ;            &n= bsp;       4.         = Subpoenas and depositions: as required.

   &n= bsp;            = ;            &n= bsp;       5.         = All other requests: within five working days.


The Office Manager as we= ll as the appropriate health care practitioner(s) of the facility shall be notifi= ed when any of the following occurs:

1.         = Information is requested from the medical record by the patient or representative.

2.         = Patient or representative requests direct access to the complete medical record.

   &n= bsp;            = ;            &n= bsp;       3.         = Legal action is initiated.


   &n= bsp;            = ;            &n= bsp;       Release of information Log

A log shall be maintaine= d to track the step-by-step process toward completion of each request for releas= e of information.  This log shall be reviewed and updated regularly in order to give proper priority to requests= and foster early intervention in problem situations.  Information shall include the foll= owing:


   &n= bsp;            = ;            &n= bsp;       1.         = date request received

   &n= bsp;            = ;            &n= bsp;       2.         = name of patient

   &n= bsp;            = ;            &n= bsp;       3.         = name of person making request

   &n= bsp;            = ;            &n= bsp;       4.         = information released

   &n= bsp;            = ;            &n= bsp;       5.         = date released

   &n= bsp;            = ;            &n= bsp;       6.         = fee charged


   &n= bsp;            = ;            &n= bsp;       RELEASE OF INFORMATION PROCESS


   &n= bsp;            = ;            &n= bsp;       Release of information personnel at Name of RHC        =             &nb= sp;            =           =             &nb= sp;            shall carry out the following functions:

   &n= bsp;            = ;            &n= bsp;       { = ;         Receive requests, and determine their legitimacy.

{ = ;         Review requests, and determine that authorization requirements have been met. 

{ = ;         Initiate the necessary reply to those making requests if information will not be sen= t or if authorization is needed.

   &n= bsp;            = ;            &n= bsp;       { = ;         Determine billable or non-billable status of requests.

   &n= bsp;            = ;            &n= bsp;       { = ;         Designate priority assignments to requests.

{ = ;         Maintain the tracking log, and process inquiries concerning the status of requests.<= span style=3D'mso-spacerun:yes'> 

   &n= bsp;            = ;            &n= bsp;       { = ;         Select the material to be released.


   &n= bsp;            = ;       



   &n= bsp;            = ;            &n= bsp;       Capacity to Authorize Release of Information


Adult patients:      &nb= sp;        The patient or a duly authorized representative (e.g. lawyer); proof of authori= zed representation required.

Decea= sed patient:      &nbs= p;  Next of kin as stated on the admission face sheet (relationship to be stated an authorization) or executor of estate.


   &n= bsp;            = ;            &n= bsp;       Content and Format of Authorization


Written authorization sh= ould contain detailed, specific information directing the release of information.  Authorizations s= hall specifically include the following:


   &n= bsp;            = ;            &n= bsp;       { = ;         name and address of the facility

   &n= bsp;            = ;            &n= bsp;       { = ;         name of the patient

{ = ;         person or organization/company to whom the information is to be released

   &n= bsp;            = ;            &n= bsp;       { = ;         purpose of the disclosure (e.g., support information for an             =             &nb= sp;            =                 &= nbsp;   insurance claim) signature of the patient or duly authorized             =             &nb= sp;            =             &nb= sp;      representative

{ = ;         date signed (date cannot precede the time period of the treatment dates for which information is to be released; date shall be reasonably current, e.g., sign= ed within the last 90 days.)


{ = ;         information= to be released (e.g., episode of care covered, treatment and/or procedu= re, specific test results, summary of most recent      hospitalization summary of all inpatient and outpatient care.



        &= nbsp;           &nbs= p;            &= nbsp;  The signature of a witness to the patient’s signature is optional but         &= nbsp;           &nbs= p;            &= nbsp;                   &= nbsp;   encouraged.


        &= nbsp;           &nbs= p;            &= nbsp;  To assist in obtaining the necessary information, an approved         &= nbsp;           &nbs= p;            &= nbsp;              &= nbsp;   authorization form shall be used as far as possible.&nbs= p; Letters, alternate    = ;            &n= bsp;            = ;         &= nbsp;   forms, and "blanket requests" for any and all information shall be honor= ed         &= nbsp;                    &= nbsp;           &nbs= p;   provided the required elements are included.  The facility shall correspond &nb= sp;               &= nbsp;           &nbs= p;            &= nbsp;  with the person making the request to obtain a listing of specific         &= nbsp;           &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;  information desired.


        &= nbsp;           &nbs= p;            &= nbsp; 


        &= nbsp;           &nbs= p;            &= nbsp;  Updating Authorizations


Update authorizations shall be obtained from patients who are continuing in treatm= ent and for whom release of information is required for ongoing billing purpose= s.


        &= nbsp;           &nbs= p;            &= nbsp;  Revocation of Authorization


A patient may revoke an authorization by providing a written statement to the facility.  This revocation sha= ll become effective when it is received by the facility.  If information associated with the billing process cannot be    = ;  released to third-party payers as a result of the revocation, a letter shall be sent= to the patient stating that he or she shall assume the responsibility of paying the bill directly.


        &= nbsp;           &nbs= p;            &= nbsp;  Refusal to Honor Authorization

        &= nbsp;  

Authorization shall not be honored in situations where there is reasonable doubt or quest= ion as to the following:


        &= nbsp;           &nbs= p;            &= nbsp;  { = ;         identity of the person presenting the authorization

        &= nbsp;           &= nbsp;           &nbs= p;   { = ;         status of the individual as the duly appointed representative of a minor, deceased= , or incompetent patient

        &= nbsp;           &nbs= p;            &= nbsp;  { = ;         legal age or status as an emancipated minor

        &= nbsp;           &nbs= p;            &= nbsp;  { = ;         Patient capacity to understand the meaning of the authorization

        &= nbsp;           &nbs= p;            &= nbsp;  { = ;         authenticity of the patient signature

        &= nbsp;           &nbs= p;            &= nbsp;  { = ;         current validity of authorization


Your Medical Director shall make determinations regarding validity of the          = authorization in cases where there is a question regarding appropriateness.


            =             &nb= sp;    Consent to Treat Minors


Minor= s:        &= nbsp;    Parent or next of kin or legally appointed guardian; proof of relationship require= d.


Emancipated Minors as de= fined by state law. (e.g., is 18 years old is a high school graduate, is/has been married, is/has been pregnant, or is/has been treated for reportable disease and information to be released relates to episode of care):  Same as adult patient.


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Healthcare Business Specialists

Visit our web site at www.ruralheal= thclinic.com for seminars



PAGE=   1


           &= nbsp;           &nbs= p;            &= nbsp;        Telephone:          =    (800) 768-0278

             &= nbsp;           &nbs= p;                 Email:        =           marklynn@bellsouth.net

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