STATEMENT OF PURPOSE
The Family Health Center of Genesys East Flint Campus provides quality health care for a number of people in the Flint Metropolitan Area. The East Flint Campus Family Practice Residency Program provides an opportunity for resident physicians to develop skills and acquire experience in continuing, comprehensive, longitudinal ambulatory care. The Center also supports on-going research concerning that care.
We welcome you to our health care team, and hope you will find our time together to be personally and professionally satisfying.
Ken Yokosawa, M.D / John Georgakopolous, D.O.
Co-Directors, Family Practice Residency Program
Guozhen Liu, M.D.
Medical Director,
GRMC-FHC
Our mission is to provide quality primary care medicine to our community to improve the health of our patients and their families. Our guide in this mission will be the Genesys values of Service of the Poor, Reverence, Integrity, Wisdom, Creativity and Dedication.
In addition, the Family Practice Residency Program provides an opportunity for resident physicians to develop skills and acquire experience in continuing, comprehensive, longitudinal ambulatory care. Our mission includes training resident physicians to provide the highest quality care in a patient, family and wellness oriented health system.
GRMC-FHC Vision Statement
Within the Genesys Health Care System, the
We will accomplish this by adhering to and exceeding the vision of the Genesys system. First, by focusing on the health and well being of our patients and their families, and secondly, by producing highly qualified and sought after family practice physicians.
The goals of the
By the end of the residency, the residents as a result of their ambulatory experience will be able to:
ADMISSION OF PATIENT TO HOSPITAL AND RESPONSIBILITY
The physician must consult Faculty prior to deciding to admit a patient to the hospital. Admission is requested on the Encounter Form physician notes section.
The physician requesting the admission is responsible for all admitting orders, admitting note, dictation of history and physical, consultation request. If the admitting physician is not the physician of record the admitting physician will notify the physician of record who is responsible for daily rounds while patient is hospitalized. Treatment and management will be reviewed with the rounding Faculty physician. Discharge planning and the dictated discharge summary is the responsibility of the physician of record. Any dictation for an admitted patient must be done through the hospital medical records system.
AMBULATORY SURGERY SCHEDULING
When considering admission of a patient to the hospital for ambulatory surgery, the physician must obtain confirmation of physical findings by a faculty physician. After discussion of the case and agreement to proceed, the physician must enter "schedule for Ambulatory Surgery - (procedure name) - (preferred date)" onto the physician notes section of the Encounter Form.
No
The referral nurse will arrange for completion of a consent form and scheduling of the procedure.
It is the Resident physician’s responsibility to have a relevant history and physical and pre-op orders completed and sent to Ambulatory Surgery prior to the scheduled procedure.
Admission of pregnant patients for delivery is accomplished by a separate mechanism, initiated by the patient herself.
COMPLETION OF FORMS
Resident physicians are expected to fill out work physicals, insurance forms, sick leave papers, etc., for their patients. These forms are also to be placed in the xerox box when completed.
Examples of a work excuse and a work restriction notice required by some employers follow:
• "No lifting, bending or twisting X 7 days for medical reasons."
• "No work X 10 days for medical reasons."
A diagnosis cannot be given without written consent from the patient
CONFIDENTIAL INFORMATION
Hospital Policy states:
Employees must not release confidential information to which they may have access, except to authorized personnel.
Confidential information includes any and all information about a patient such as name, phone number, address, treatment, diagnosis, lab reports, or appointment times. This information can be given only if a release is signed by the patient.
Examples would be:
1. Patient names should never be mentioned outside the work area.
2. If an employer calls desiring any information on office appointments, attendance, or diagnosis, there must be a written release.
Insurance companies can receive information only if there is a release signed by the patient or guardian.
For advice regarding institutional policy in these matters, contact the Risk Management Office.
CONTINUITY OF CARE
Departing residents must reassign their most complex patients to other members of their team before leaving. They must notify the new physician of this transfer. All other patients will be randomly reassigned to in-coming residents. A patient list and instructions for reassignment of patients will be made available approximately six weeks before the physician’s expected date of departure.
It is the resident physician’s responsibility to see that orderly transfer of patient care is accomplished.
Dictation
1. All physicians must dictate progress notes on every patient seen, and on the same day.
2. Please send the chart with the cassette to the transcriptionist every day. Place the charts and attached cassettes in the dictation basket in the business office. This includes progress notes and letters.
3. Always record on Side A of the cassette first. When Side A of the cassette is full, use Side B.
4. Begin by stating your name and the date of dictation. The date should be the date the patient was seen.
5. State and spell the patient’s name: last name, first name, middle initial or middle name, if known, and the patient’s chart number.
6. DICTATE IN THIS ORDER:
a. Problem: "XXXXXXX"
S: Subjective Complaints
O: Objective Findings
A: Assessment or Diagnosis
P: Plan
1. Diagnostic Tests
2. Therapy
3. Education
4. Follow-up
b. If there is more than one problem, follow SOAP FORMAT for each problem.
7. SPEAK SLOWLY, CLEARLY, AND DIRECTLY INTO THE RECORDER.
8. If you change your mind while dictating, you can back up the tape to where you want to make the changes and record right over it. Also say "correction" if you have made an error.
9. PLEASE SPELL OUT UNUSUAL WORDS, PROCEDURES, OR NEW DRUGS.
10. Avoid shuffling papers and background noise while dictating.
11. At the end of your dictation for the day, please say, "END OF DICTATION".
12. Attach a daily list and the cassette tape to your charts with a rubber band and place on the Dictation Shelf.
13. Problems encountered with dictation will be initially brought to the attention of the resident; if unresolved, then the problems will be reported to the Manager of the
14. No dictation is needed for
15. Please separate your dictated charts from your
16. At the end of the daily sessions, please request from the nursing station all charts for patients who did not show. Please review the chart and, if indicated, send a letter for follow-up and/or contact the patient by phone and document action taken. If no action is necessary, please co-sign the DNS (Did Not Show).
DRESS CODE POLICY
The
Remember that many first impressions are made about a person on the basis of his/her personal appearance. The Hospital dress code policy was established to help you put your best foot forward and to increase patient and public confidence in you as an efficient, professional employee of this Hospital.
1. Ties (male physicians).
2. The only acceptable tennis shoes are LEATHER.
EQUIPMENT AND SUPPLIES
To request maintenance and replacement of
As you are aware, medical equipment and supplies are extremely expensive. The financial ability of this program to operate depends upon our conservative use of such equipment and supplies. Please do not waste, over-use or take equipment or supplies from the
1. The assigned physician is responsible for seeing that a complete data base and Problem List is on the chart within the first two or three visits, then yearly.
2. The Problem List must be completed and the "Drug List" must be up-to-date.
3. Dictated progress notes using SOAP format must be complete, up-to-date, and signed.
4. All pediatric charts must contain growth charts that are up-to-date.
5. All obstetrical visits must be recorded on the official Family Health Center OB Form. (See Policies and Procedures Manual for the Management of Pregnancy.)
6. The record must contain a copy of all forms filled out, or letters sent regarding the patient.
7. All laboratory data must be countersigned by the Resident before the chart is filed.
8. Ordered procedures, consults, or labs should be dictated in the plan so confirmation of completion or results can be verified.
FAMILY HEALTH CENTER RECORD
The components for the medical records are the encounter form, problem list, medication list, demographic form, progress notes, laboratory documentation, flow charts, and health maintenance. Each time a patient is seen, a defined sequence of events should occur:
1. Review problem and medication lists.
2. Read latest relevant progress note.
3. Check health maintenance record for data (front cover).
4. Office visit.
5. Complete encounter (and consultation) form.
6. Dictate progress notes, including medications, dose, and number of refills.
7. Update problem and medication lists.
8. Complete health maintenance record and flow chart, if indicated.
NO INFORMATION CAN BE RELEASED WITHOUT A WRITTEN CONSENT FROM THE PATIENT. When filling our work physicals, insurance forms, sick leave papers, etc., check to see that the patient has signed a release of information form. Remember that when writing or telephoning a patient, that you may not reveal the nature of your call to anyone but the patient.
REMEMBER, MEDICAL RECORDS ARE CONFIDENTIAL!
**All written forms, letters or documentation must also be copied before the patient leaves the
NOTE: CHARTS ARE NOT TO BE REMOVED FROM THE
GUIDELINES FOR COMPLETING THE ENCOUNTER FORM
The Encounter Form is one way in which the physician communicates with the clinical staff and the business office. It is the billing mechanism, as well as, the method of initiating referrals.
SECTION A is completed by the computer.
SECTION B is completed by the business staff. Please note the type of insurance which covers your patient.
SECTION C is completed based on whether preventive care or medical treatment is provided, determined by evaluating the three components of an office visit: the history, the examination, and the medical decision-making required in the course of the visit. Only the physician can accurately indicate the complexity of the decision-making process, the number of potential diagnoses considered, and the medical severity of the differential diagnosis. For that reason, it is mandatory that the physician mark the encounter form before the patient leaves the office.
Medical Treatment Codes
Also called evaluation and management codes (E/M), medical treatment codes are determined by evaluating the three components of an office visit: the history, the examination, and the medical decision-making required in the course of the visit.
HISTORY - There are four types of histories.
1. Problem-focused
2. Expanded problem-focused
3. Detailed
4. Comprehensive
The history includes these elements: chief complaint; history of present illness; review of systems; and past, family, and social history.
EXAMINATION - There are four types of examinations.
1. Problem-focused - limited exam of affected body area or organ system.
2. Expanded problem-focused - limited exam of affected area or organ system and symptomatic or related organ systems.
3. Detailed - extended exam of affected area and symptomatic or related organ systems.
4. Comprehensive - a general multi-system exam or complete exam of a single organ system.
MEDICAL DECISION-MAKING - There are four types of medical decision-making.
1. Straight forward
2. Low complexity
3. Moderate complexity
Each has to meet two of the three elements shown below:
|
|
Number of Diagnoses or Management Options |
Amount or Complexity of Data to be Reviewed |
Risk of Complications, Morbidity, Mortality |
|
Straight Forward |
minimal |
minimal or none |
minimal |
|
Low Complexity |
limited |
limited |
low |
|
Moderate Complexity |
multiple |
moderate |
high |
4. High complexity
Number of Diagnoses or Management Options
• Document an assessment, clinical impression, or diagnosis for each encounter.
• If there is an established diagnosis, state whether the problem is:
a. Improved, controlled, resolving, or resolved; or
b. Inadequately controlled, worsening, or failing to change.
• If there is no established diagnosis, document a differential diagnosis or state the diagnosis as symptoms.
• Document the initiation of treatment and changes in treatment, including patient and nursing instructions, therapies, and medications.
• Document where referrals are sent and sources of consultations.
Amount and Complexity of Data to be Reviewed
Document these points:
• tests ordered or performed during the E/M encounter
• test reviewed, either by a progress note (such as "WBC’s elevated") or by initialing and dating the test report.
• the decision to get old records or obtain additional history from the family or caretaker.
• relevant findings from old records or family. If the review turns up no relevant findings, say so. A notation of "old records reviewed" or "additional history obtained from family" without elaboration is insufficient.
• the results of discussions with other physicians about tests.
• the visualization and independent review of any image, tracing, or specimen that another physician has interpreted.
Risk of Complications, Morbidity, and Mortality
Document these points:
• co-morbidities and other factors that increase the risk of complications.
• procedures ordered during the E/M encounter.
• invasive diagnostic procedures performed during the E/M encounter.
• the decision to refer or perform an invasive diagnostic procedure on an urgent basis.
Remember, however, at all times proper documentation in the medical record is critical to limit audit liability and defend yourself from a carrier’s quality assurance review.
Preventive Medicine
For all health maintenance visits the codes used are based on whether the patient is a new or established patient and that patient’s age. A patient is considered a new patient if he or she has not received any professional services at the
SECTION D is completed by the physician and should specifically communicate any test and/or procedures with detailed information. For surgical procedures, specify size in cm, number of sutures, and if a biopsy was taken.
SECTION E is the diagnosis area. List the primary diagnosis first, then list any others pertaining to this visit. Never use "Rule out ..." as a diagnosis. Use symptoms as opposed to "Rule out ...".
SECTION F is intended to itemize injections, laboratory studies, and procedures for billing purposes.
SECTION G denotes the expected return visit. If you are not the assigned resident, please specify which physician the patient will see for the return visit. If it is necessary for the patient to return on a specific day, please indicate; otherwise, indicate a range of time appropriate for return
GUIDELINES FOR THE
1. All physicians are expected to be prompt. Office hours begin at 8:30 a.m. and 1:00 p.m. sharp. Resident physicians are expected to remain at the
2. Gauge your time in seeing patients. They should be seen for the original problem, and then for other problems and minor surgery as time will allow. You may schedule patients for extensive examinations or procedures at a later date. Please note appropriate time on the encounter form required for that extensive visit.
3. CHARTS ARE NOT ALLOWED TO LEAVE THE
4. The patient’s medical record MUST BE COMPLETED EACH DAY PRIOR TO THE RESIDENT LEAVING THE
5. All procedures and treatments must be recorded on the Encounter Form for proper billing and curricular credit. Please document in detail on the encounter form the specifics of the procedure. For example: A 1 ½ cm laceration of the hand. Close with three interrupted sutures of 4-0 Nylon.
6. RESIDENT/PRECEPTOR ENCOUNTER - All patient charts must be precepted on the day of the visit.
7. Any patient to be scheduled for surgery and/or admission to the Hospital must first be checked by the preceptor. Each patient referral must be presented to and approved by the preceptor that day. Prior to a patient being seen by a consultant, it is expected that the resident discuss the case directly with the consultant and/or send a written letter.
8. All physicians are required to check their own messages and mailbox daily.
9. All interactions and advice to patients must be documented in the medical record.
10. When seeing a new patient, identify yourself clearly to him/her and please give the patient your business card. Business cards are available in your team office. Explain that you will be his/her physician, responsible for their health care, including referral to specialists when indicated. The patient should know that if he/she becomes ill on a day that you are not in the office, arrangements will be made for care by a member of your team. It is the policy that patients are to come to the office rather than going to the Emergency Room. Patients should also be advised that there is a doctor on-call 24 hours a day, should emergencies arise.
11. Residents on vacation or otherwise away from the
12. Examinations of the rectum, breast, pelvis, vagina, uterus, and other pelvic structures must have medical assistant in the room. This includes the osteopathic back examinations in the areas of the pelvis, rectum, vagina, uterus, or breast.
HEALTH CARE TEAMS
Each physician is a member of a health care team which facilitates continuity of care for patients. When a doctor is unavailable and a patient needs to be seen on a call-in or emergency basis, the visit is scheduled with another team member. When a doctor leaves the program, the family is reassigned by him/her to another team member. This group practice model is the most common practice structure used by family medicine residency program graduates. Other team members, faculty, and nursing professionals compliment the resident physician.
Day-to-day assignment of examination and treatment rooms is the responsibility of the Team’s clinical staff and is dictated by anticipated work load factors.
IMMUNIZATIONS
Pediatric patients are not to receive any type of immunization, injection, etc., without first being checked by a physician.
The immunization authorization information must be completed and is a permanent part of the chart.
LABORATORY
The laboratory in the
LABORATORY REPORTS
Lab reports that are returned to the
Abnormal reports are screened by the preceptor to decide if the report warrants immediate attention. If immediate attention is needed, the resident or his/her team member will be notified. If immediate attention is not required, the report and the chart will be placed in the resident’s box for daily review.
All labs will be permanently affixed in the medical record after it is signed by the resident.
LETTERS TO ATTORNEYS
The Genesys Regional Medical Center Director, Family Practice Residency Program will take care of all letters sent by attorneys requesting information on our
Put the forms in the Xerox box in the business office and arrangements will be made to deliver these charts to the appropriate personnel.
OFFICE ASSIGNMENTS
Resident physicians are divided into three teams. Each team is headed by a Faculty member and a medical assistant. Each team has its own team office, near the examination, consultation and treatment rooms. Most routine administrative functions occur in the team office, including dictation, use of the telephone, and completion of forms, references and records. Team offices are not to be used for patient care. Examination rooms are to be used for patient education and counseling. Special procedure rooms are designed to accommodate complex or time-consuming treatment interventions and can be reserved for colposcopy and sigmoidoscopy procedures.
EQUIPMENT
|
EKG Machines Autoclave Flexible Sigmoidoscope with Video Ring Cutter Wood’s and Bishop Lamps Foley Catheter Cast Material, including Fiberglass Splinting Materials Hyfrecator Liquid Nitrogen Cryo Surgery Equipment Microscope |
Tympanometry / Audiogram Centrifuge Peak Flow Meter Proctoscope Colposcope Small Volume Nebulizer Oxygen OB-Doppler Word Catheter LEEP Infrared coagulator Ellman Surgitron unit |
PROCEDURES
|
Resting EKG* Sigmoidoscopy (Flexible)++ Urinary Bladder Catheterization* Application and Removal of Plaster Splints Aspiration-Injection of Closed Spaces Vision Screening* Audiometry /Tympanometry* Ear Irrigation Wound Care |
Minor Surgery Liquid Nitrogen for Wart Removal Bichloracetic Acid for Wart Removal Small Volume Nebulizer Treatment Colposcopy++ Suture Removal Cryosurgery++ Endometrial Biopsy++ Hemorrhoid Banding LEEP Procedure++ |
|
- Please refer to the Procedure Book for further information on each procedure. |
|
*Routinely administered by Medical Assistant personnel.
++Prescheduling required.
Due to different requirements by the various third party insurers, all blood tests and other procedures must be listed on the Encounter Form to be arranged by the Medical Assistant personnel.
PATIENT SCHEDULES
New Patients:
The policy of the
New Patient Orientation:
All new patients will be scheduled for a new patient orientation appointment to introduce them to the FHC and the policies. This is not a clinical visit.
Appointments:
Patient office visits are by appointment. Some limited provision is made for persons with urgent problems requiring immediate attention (u-providers). Since office hours are assigned by rotation schedules, a minimum of changes helps facilitate orderly scheduling of office visits. Every effort is made to assign family members to the same physician, and residents should encourage family members to see the same doctor, but continuity of care may take precedence.
Work-In Policy (u-provider):
Work-in patients are scheduled to present to the
The patients are assigned to physicians according to the following order of precedence:
1. Primary physician - if an opening is available.
2. Physician in primary doctor’s team group - if no opening with primary physician.
3. First available physician with appointment time unscheduled.
4. Work-In List - daily work-in patients will be equally distributed to the available team members of their assigned physicians. They are to be brief visits where the patient is to be seen for the most acute issue. At that time, these patients are to be rescheduled with their assigned physicians for regular follow-up visits.
Patients seen on a work-in basis are to be referred back to their primary physician for follow-up.
PATIENT SERVICES
Prenatal Assistant Services
We have a full-time Prenatal Assistant, Celene Abraham, working with our pregnant patients at the
Psychological Consultation
The psychology fellows and the Director and Associate Director of Behavioral Science are available for formal and informal consultation regarding patients with problems of a psychological nature. They can provide direct clinical services for and psychological evaluation of your patients. These services are available both in the
Referral forms are available at the MA station and must be completed and put in the Behavioral Science secretary’s mailbox. A copy should be placed in the patient’s medical record.
It is recommended that you discuss the case with the Behavioral Science staff at the time of the referral. You are encouraged, when appropriate, to participate in the interview(s) of your patient.
In addition, an ADHD referral packet has been developed to assist you in the evaluation of ADHD. This is also available at the MA station. You are encouraged to familiarize yourself with this material.
Lifestyle change referrals (smoking cessation, weight reduction, diet modification) referrals can also be made using the special form available at the MA stations.
Pediatric Services
Faculty may be contacted to see patients with you. Specialty clinics are available (cardiology, endocrinology, neurology and gastroenterology) to evaluate pediatric patients as the need arises.
Social Services
Requests for Social Work services should be directed to the Hospital Social Worker. If the need arises for Social Work services, please call the Social Work Secretary at 606-6054. Documentation must be made on all social work referrals. Residents are encouraged to participate in interviews with the social worker when feasible.
PHYSICIAN SCHEDULES
Physician office schedules are determined by the rotation assignment and level of training. Morning hours are from 8:30 a.m. to 12:00 noon and the afternoon hours are from 1:00 p.m. to 5:00 p.m. Physicians are expected to remain in the
On the average, first-year Residents will be scheduled one (1) half days in the office each week, with an average of two to six patients per session. Residents in the second year are assigned three (3) half days, with an average of six to ten patients per session, and Residents in the third year are assigned four (4) half days with an average of six to twelve patients per session.
FAMILY HEALTH CENTER DUTIES TAKE PRECEDENCE OVER ALL OTHER PROGRAM ASSIGNMENTS.
Requests for schedule changes must be presented to the Medical Director as per existing policy. Vacation and leave application must also follow residency program policy.
Physicians may not change or cancel office hours without prior approval of the Medical Director. It is suggested that you add an additional day for your patients’ benefit if you must miss a scheduled day.
Vacations must be scheduled 90 days in advance. See the Vacation Scheduling Calendar for details.
PRESCRIPTION PADS
Prescription pads may be obtained from the medical assistants. Please keep your prescription pad with you at all times while in the
Please document in your dictation all prescriptions and quantities written and the number of refills.
Use a separate prescription for each drug. For potentially abusable drugs, write the number of pills longhand. It is beneficial for the pharmacist if you print your name under the signature.
Prescribing Manual
Most of our patients belong to health plans that specify which medications are covered (or have no prescription drug coverage and pay out of pocket for medications). The list of medications covered by a health plan is called a drug formulary. If you write a prescription that is not on the formulary, the patient will not be able to get the prescription filled. So before you write a prescription, determine what insurance coverage your patient has. (Look for a copy of the insurance card in the back of the chart.) Then follow rule #1: check the formulary before writing the prescription.
Where can you find the formularies? The best source is ePocratesRx, available for FREE download onto your PDA. There is a booklet listing formularies in each team office. Some formularies are on the bulletin board in the preceptors’ office.
Note: some plans require patients to use a mail order pharmacy service once therapy has been optimized. Typically, the patient may obtain new medications or new strengths of a chronic medication for up to 3 months from a local pharmacy. After that, the patient has a financial penalty for not using the mail order pharmacy. Mail order prescriptions must by written for a 3 month supply.
Some commercial HMO’s allow you to prescribe a 60-day supply of maintenance medications. They also allow an 84-day supply of oral contraceptives. Patients prefer this as they have fewer trips to the pharmacy and reduced drug co-payment costs.
Complete a Prior Authorization Form. The form must be faxed to the health plan. (Never give the form to the patient or fax to the pharmacy.)
The health plan will notify you by fax whether the request is approved or denied. Approval codes will also be entered into the computer system accessed by the pharmacy. Advise the patient to check with the pharmacy in 24-48 hours. Depending on the medication, the prior authorization is good for 6 – 12 months.
Recognize this process results in a delay in initiating treatment. If the delay could harm you patient, give several days of samples. Also have a back up plan incase the prior authorization is denied.
Genesee Health Plan is a grant program designed to care for the working poor (earning up to 175% of the poverty level) of the
If you want to prescribe a non-formulary medication for a Genesee Health Plan enrollee, obtain a prior authorization or give samples for 1-2 months therapy. Also, send the patient to Health Access (see below) for assistance in obtaining non-formulary medications. Note: if your patient needs medication urgently (example: ciprofloxin for pyelonephritis), make certain she has 1-2 day supply of medication to initiate treatment while waiting for the prior authorization.
Note: oral contraceptives are not covered by Genesee Health Plan and are not available through Health Access.
Diabetic supplies (glucometers, test strips, lancets) are available through
Durable medical equipment (crutches, wheel chairs, etc) is supplied by H-Care. Give your patient the prescription and have them call one of the H-Care offices to determine if the equipment will be covered. There are three H-Care offices:
Genesee Health Plan pays for office visits, specialist referrals, lab tests, outpatient diagnostic tests (mammograms, x-rays, MRI’s) and prescriptions. It does not pay for emergency room and after hours clinic visits, diabetic education, physical therapy, hospitalization or outpatient surgeries. (Outpatient surgeries may be covered later in 2005.)
Health Access is a grant program funded by the federal government & Ascension Health System to assist patients in getting prescription medications & other services. It is available to all patients, not just Genesee Health Plan enrollees.
Health Access is located at 1428 W. Court Street (
For prescription assistance: send your patient along with a prescription written for 90 days to the Health Access office. The Health Access staff will contact the pharmaceutical company to determine if there is a compassionate drug program that will supply free medication for indigent patients. If there is a program, the Health Access staff will obtain the necessary forms and send them to you for signature. If approved, the medications are usually sent to the
For other services (physical therapy, not covered durable medical equipment), send your patient along with a prescription written on a
Celine is willing to contact Health Access on behalf of your infirm, elderly, confused or special needs patients.
Low cost generic medications are the way to go. Rx Outreach (www.rxoutreach.com or 1`-800-769-3880) is a mail order program available to persons who qualify on the basis of income and the number of persons living in the household. (Persons do not need to be related.) Rx Outreach will mail medications in 90 or 180-day quantities directly to a patient’s home. A 90-day supply of any medication is $18; a 180-day supply costs $30. You write the prescription and give the application to the patient. There are no forms for you to complete. The income requirements are generous. For example, a patient with an income of $47,000 in a household of four would qualify. A copy of the income requirements, application, and list of covered medications are attached.
Note that many of these medications are available at a lower cost through local pharmacies. Advise your patients to call pharmacies to learn the best price. Rite Aid pharmacy tends to be the most expensive. SAM’S Club and Walmart tend to be the least expensive. (A patient does not need to be a SAM’S club member to use the pharmacy.)
Partnership for Prescription Assistance (www.pparx.org or 1-800-477-2669) matches patients with indigent drug programs. The patient initiates contact with the program. Its function is similar to Health Access. Unlike Health Access, they are able to help patients obtain oral contraceptives. (Berlex, manufacturer of Yasmin, does not have an indigent drug program. Ortho-McNeil Pharmaceuticals does.) Qualified patients will be sent applications with a portion for you to complete.
Resist the impulse to rely on samples for your patients’ chronic medications. Why? Because they may not be available when your patient needs a refill. Then you (or your colleague) will be in a bind. Remember, Health Access is a resource for obtaining medications your patient cannot afford or are not covered by a health plan.
Sample medications are best used
When dispensing samples from the Pyxis machine you must always log the medication on the flow sheet in the chart (or place the sticker in the progress note), give the patient the appropriate patient education materials (available in the file cabinet), and document the educational materials were given
Oral Contraceptives
Oral contraceptives are not covered by Genesee Health Plan and some other health plans that pay for prescriptions. Health Access does not assist patients in obtaining “the pill”. Available resources include:
? Partnership for Prescription Assistance (www.pparx.org or 1-888-477-2669)
? Planned Parenthood will dispense oral contraceptives to our patients for $20 per month. Patients are required to bring a copy of their PAP smear results and have a consultation ($25 charge). A patient must have their next gynecologic exam at Planned Parenthood in order to continue to receive oral contraceptives. (If a woman has her PAP smear at Planned Parenthood, she is charged a sliding scale fee for the exam and between $13-15 per month per pill pack.)
? Walmart Pharmacy (on Court Street near
Charting Responsibilities
The
It is expected the flow sheet will be used correctly 80% of the time. This is monitored by the Family Health Center Quality Assurance Committee. If your compliance is less than 80%, you will be assigned to the audit team for the following month. The MA’s will pull the chart but the audit will be done on your own time!
Develop Good Prescribing Habits
How many refills should you give a patient? Typically allow sufficient number of refills to last until the patient is due for the next visit. This saves the patient the need to call for refills and cuts down on the number of phone messages. Tell your patient to call for an appointment when they obtain their last refill.
Some medications are typically refilled for a year. Examples include thyroid replacement for stabilized patients and oral contraceptives. If in doubt, ask when you precept the case.
For patients who routinely “no-show” for appointments, limit the number of refills.
Train you patients to bring all their medications when they come for a visit. Check the medications against the flow sheet. This will help identify medication errors. In addition, inspection of medication vials can provide some idea of whether your patient is taking medications daily as prescribed.
Prescribing medications is a tricky and complicated business. In addition to using sound medical judgment, there is the additional burden of researching whether a medication is covered and what quantity needs to be supplied. You may need to petition a health plan to pay for a non-formulary medication (submit a prior authorization form). The first step for all insured patients is to check the formulary. If you write for a non-formulary medication, it will not be filled by the pharmacy. Your patient’s treatment will be delayed. Additional phone messages (avoidable extra work & hassles) will be generated.
Generic medications should be considered as first line therapies for un-insured patients. They are available at low cost through local pharmacies and mail order programs for patients meeting income guidelines. Resist the impulse to provide samples of expensive medications that your patient cannot afford to buy if samples become unavailable.
Progress Notes
All follow-up visits are dictated by the physician using the SOAP format.
S = Subjective - Includes chief complaint, history of present illness, pertinent past history, family history, current health status, psych/soc history, and review of system symptoms.
O = Objective - Things you observe, physical examination, labs you did in the office.
A = Your Assessment including rule-outs.
P = Plan - 4 pieces
1. Diagnostic needs - to R/O or confirm what you have left on your list.
2. Treatment needs - if you have a diagnosis.
3. Education and counseling needs.
4. Return visit/expected outcomes.
YOUR PLAN MUST ALWAYS ADDRESS YOUR ASSESSMENT!!
Your completed dictation, including all charts, dictated tape and list of patients is placed in the business office box marked Transcription. The transcriptionist types the dictation and places it in the progress notes in the chart. The chart is returned to the physician for signature.
TELEPHONES
The
General Rules:
1. The phones are for the use of in-coming patient calls.
2. With the exception of urgent situations, the
3. At times, physicians will be paged to the phone while seeing patients. The telephone receptionist will screen calls and will relay messages to the doctor concerned over the paging system.
4. Messages for prescriptions, refills, tests, etc., will be taken by a receptionist or MA who will place the message with the chart in the box on the team office door. The most senior member in that team office is responsible to ensure that the patients’ requests are handled appropriately and returned to either the clinical staff or business office. They must be completed before the end of your scheduled session.
TESTS
|
Glucose Screen (Glucometer) |
Pulse Ox |
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Hemocult |
Tympanogram |
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Pregnancy Test |
Cerumen removal |
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TB Skin Test |
Cultures (viral, bacterial [aerobic/anaerobic], fungal) |
|
Urine Dipstick |
RST and Monospot |
|
Wet Prep and KOH prep |
|
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Skin Scraping |
|
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EKG |
|
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PFT |
|
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Audiometry |
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Vision Screening |
|
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Fluorescent Eye Staining |
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