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Table of Contents Section 1: Understanding what Terms, Guidelines, Provisions, Conditions, and Consequences Patients Agree to Follow pgs. 4-9Section 2: Assisting Providerspgs. 10-24A.????? Protocol: Orientation of New Medical Provider pgs. 10-16B. Use of Abbreviations When Communicating Medical Information pgs. 17-20Appropriate Medical Notations and Approved medical Abbreviationspg. 18Risks of MisinterpretationPgs. 18-20C.???? Protocol: Assisting Providers with Examinationpgs. 21-22D.????? Protocol: Joint Injection/Aspiration of Joint pgs. 22-23E.???? Protocol : Papanicolau Testpg. 23F.???? ?Protocol: Wet preppg. 24Section 3- Emergencypgs. 24-42A.????? Protocol: Finger Stick, Accident, Incident Immediate action and Reportpgs. 24B.????? Protocol: Chest Painpg. 25C.????? Protocol: Electrocardiographs (EKG) pgs. 25-7D.???? Protocol: 911 Call – Medical pg. 27E.????? Protocol: CPR Training and Certificationpgs. 27-8F.??????Protocol: AED Monitor Training and maintenancepgs. 28-9G.???? Protocol: Use of Adult Ambu Bagpgs. 29-30H.???? Protocol: Immunizations: Emergency Plan for Adverse Reactionspg. 30I.?????? Protocol: Vaccinationspg. 30Standing Orders for Flu Vaccinepgs. 31-5Standing Orders for TDAPpgs. 36-40J.???????Protocol: Oxygen Administrationpg. 41K.????? Protocol: Handling Seizurespg. 41L.??????Protocol: Syncopepg. 42Section 4- Lab Protocolpgs. 43-50Addressing Critical Values pg. 43Responding to Critical Values during Closed timespg. 43-45 Critical Values Chart – most recent must be available at all timespg. 45-46Protocol: New Patient Lab Orderspg. 47D Protocol: Blood Glucose Monitorpg. 48Protocol: Addressing Hyper/ Hypoglycemic Indexpg 48Protocol: GC/ Chlamydia DNA Probepg. 49Protocol: Hemoccult Test for Fecal Occult BloodPg. 50H. Protocol: UrinalysisPg.50Section 5- Medicationspgs. 51-66Pharmacy Operating Policypg. 51Protocol: Dispensing of MedicationsPg. 51-52Protocol: Instructing Patients on How to Dispose of Medicationspg. 52-53Protocol: Counseling Patients on Medication Intake and Side-Effectspg. 53Protocol: DEA Controlled and Pain Drug Dispensing Policypg. 54Protocol: Dental Clinic Patientspg. 54Protocol: Medications RefillsPg. 55Formulary pg. 55Medication Refill Standing Orderspg. 56-64UTI Standing Orderspg.65-66Section 6- TriageA.?????Protocol: Universal/Standard PrecautionPg. 67-68B.??? ?Privacy of Patient Medical Information Requests for Medical recordspg. 69C.???? Access to Medical Recordspgs. 69-71D.??? ?Front Pre-visit Preparationpg. 72E.?????Patient Accountability Policypg. 72F.????? Cleaning of Exam Roomspg. 72G.??? ? Digital Temple Thermometerpg. 73H.???? Shortness of Breathpg. 73I.???????Pulse Oxpg. 73-74J.?????? Referral for Sleep Studiespg. 74K.????? Donation of CPAP Machinespg. 74L.?????? Chart Post Audit pg. 74M.? Infectious Waste Management Protocolpg. 75Section 7 - Supporting ProgramsPgs. 76-77A.????? BCNpg. 76-77B.????? Colon Cancer preventionpg. 77Section 8- SecurityPgs. 78-82A.????? Protocol: Handling Violence or Disorderly Conductpg. 78B.????? Protocol: Responding to an Active Shooter(Code Silver) pgs. 78-81C.????? Protocol: Treatment of Intoxicated Patients? Pg.82Section 1: Understanding what Terms, Guidelines, Provisions, Conditions, and Consequences Patients Agree to FollowUpon Becoming a Patient or recertifying Patients sign the following Summary: Patient Terms of Agreement (November 2016 update)Guidelines, Provisions, Conditions and ConsequencesESTABLISHED FOR PATIENTS RECEIVING MEDICAL CARE, DENTAL CARE & Prescription Assistance AT OR FROM ANDERSON FREE CLINIC (AFC)It is the patient’s responsibility to initiate the process of re-screening for eligibility prior to the expiration date aboveProviding false or incomplete information will be grounds for dismissal from the AFCFailure to report an increase in income or a change in insurance status will result in dismissal from AFC immediately.Unacceptable behaviors - Engaging in any of the following unacceptable behaviors will result in immediate, permanent dismissal from Free Clinic services. Verbally threatening employees, volunteers, or other Free Clinic patientsExhibiting rude or threatening behavior or engaging in any act of violence while on Free Clinic propertyBringing weapons of any kind onto Free Clinic propertyUsing or possessing illegal drugs on Free Clinic propertyBehaving in a discriminatory manner toward health-care providers, other volunteers and staff because of race, color, gender, ethnicity, national origin, religious affiliation, or sexual orientation.Demonstrating careless behaviors and disrespect to our efforts in maintaining the interior and exterior areas of the Clinic as a clean and healthy environment (i.e., smoking on the property, littering in the gardens and parking lot),4) The following actions may result in temporary suspension or permanent dismissal from Free Clinic services: Exhibiting rude or discriminatory behavior or profane languageArriving at the Free Clinic intoxicated.Providing false information regarding previous or current medical careFailing to adhere to the agreed-upon treatment plan Contacting the volunteer physicians at their private-practice officesRequesting prescriptions for controlled substancesAsking volunteer physicians to fill out Disability paperwork or other paperwork certifiying medical conditionsEngaging in disruptive or disrespectful behavior during a referral appointment or otherwise violating the Free Clinic Physician Referral PolicyProviding false information regarding income, insurance status, or residencyFailing to recertify with the Intake Coordinator & Patient Advocate on an annual basis or as requested5) The following actions will cause patients to be unable to receive some or all prescribed medication or services:: Missing deadlines to sign paperwork, set by the Patient Assistance Program (PAP) CoordinatorFailing to provide the information/documentation requested by the PAP Coordinator and required by the pharmaceutical companiesFail to always give to our staff the most current phone number and addressFor Non-English-speaking patients: bring someone fluent in both languages to your appointment IF ASKED. It is not always possible for AFC to have a translator available on any given day. There are Consequences If I CHOOSE TO show up late, CANCEL or “No Show” for Dental and/or Medical services:ARRIVING ON TIME - If arriving more than 15 minutes late for an appointment may cause you to lose that appointment. That appointment may be rescheduled for another day and time but will be counted as a “no show”,A CANCELLED VISIT will only be rescheduled one more time, and AFC has the right to refuse to reschedule repeated cancellations, regardless of the reason I had to cancel.MISSED DENTAL APPOINTMENTSAll patients who miss ONE dental appointment will only be eligible to return for dental care after 12 months from the date of the missed appointment. MISSED MEDICAL APPOINTMENTS A patient will be considered a “no show” at the Free Clinic if a call has not been received 24 hours in advance canceling an appointment. Any message must be left on (864) 512-7804. This number goes to a phone with a call time-stamped feature. Patient leaving before being seen also counts as a “no show” NEW PATIENTS:New patients - who do not show up on their first MEDICAL OR DENTAL appointment without calling to cancel an appointment will be placed back on a waiting listNew patients who are referred in from the hospital and do not show up for their first medical/dental appointment will be placed back onto the list to be called.EXISTING PATIENTS (THOSE WHO HAVE BEEN SEEN BY AN AFC PROVIDER): The first “no show” of an existing patient for a MEDICAL appointment will be noted on their chartThe second MEDICAL “no show” of an existing patient in a twelve-month period will result in suspension of medical appointment privileges for one year from the date of the second no- show. Patients can attempt a walk in visit, with no guarantee that a provider has an opening.Patients will still be able to use the pharmacy as long as they have refills.RECURRING NO-SHOWS AFTER 12 MONTHSAfter one-year with only walk in visits allowed, 12 months’ patient can begin making appointments, but there will be no warning thereafter, and patient privileges will be suspended after one (1) no-show, regardless if that was a dental or medical care. NO WALK INN WILL BE ALLOWED. Patients will need to recertify after 12 months of the date of this recurring NO SHOWOther reasons for no-shows Showing up to a visit without my medication in original vials and without tests requested to be completed before that visit for that visit will be considered a "No Show"Labs and Orders:If the doctor orders labs and/or tests:You must complete those as directed by the provider. Patients are given one of two options as to when labs must be done: The lab sheet will either have a very specific date to have labs done, or it will say to complete labs no later than one week prior to the next visit. Even if you call, if your appointment is canceled or rescheduled because of tests you did not get done in time, we will not refill prescriptions until your rescheduled office visit. Anderson Free Clinic Physician/Dentist Referral PolicyAppointments will be made by the Free Clinic staff and you will be notified by of the date and time We CANNOT guarantee an appointment. Some physicians volunteer their time at their own practices to help Free Clinic patients who need care from a specialist, as per our referrals. Patients who miss referral appointments with no cancellation calls may not get that appointment rescheduled.Medications prescribed by the referral provider can be filled at the Free Clinic pharmacy if we carry that medication or can obtain it. If not, it is the patient’s responsibility to obtain the medication.EligibilityYou MUST have your certification current at the Free Clinic to be eligible for a referral visit.You must be seen at the Free Clinic for your primary medical or dental care to be eligible for referrals.You will need a copy of the completed Free Clinic Referral Form to take with you to your appointment.You do not have authorization to bring along (or mail) and ask referral doctors to complete questionnaires about your health condition. Violation will result in termination of your rights to receive treatment at AFCUnder no circumstance are you allowed to contact the physician’s office directly to make the first appointment. It may take from several weeks up to several months to get an appointment.If we are unable to contact you, the referral appointment will be canceled. It is YOUR responsibility to let the Free Clinic know of any change in your address or phone number. It is YOUR responsibility to call the referral doctor’s office if you need to cancel or reschedule an appointment. Appointments missed without YOU notifying the doctor’s office may NOT be rescheduled.Additional responsibilities may apply depending on the referral office. We have agreed to follow their individual guidelines and these may vary from office to office.PaymentsIt is the decision of each individual referral doctor whether there will be any cost for the appointment. We will do our best to make you aware of any cost, but it is YOUR responsibility to verify that with the referral doctor’s office. Please be aware that the referral only covers the cost of the doctor’s fees. Any procedures or surgery done at the hospital will be YOUR responsibility. Patient should call the AnMed Business office to determine if you qualify for their AnMed Medical Assistance Program also known as AMAP. Labs and Tests CoverageIf a test ordered by a provider AT THE FREE CLINIC OR AT THEIR OFFICE costs more than $1500, YOU will be responsible for anything over that amount. AMAP AssistanceYou should call the AnMed Health business office to determine if you qualify for their assistance. Please call one of the following according to the first letter of your last name: A-G Travis Campbell 512-8225H-O Ann Wightman 512-2756P-Z Heather Pigman 512-2245Pharmacy Refills: The Free Clinic pharmacy requires two business days for refills and three days to get new prescriptions ready. The pharmacy does not stock any controlled medications. Patients are not allowed to request the providers to write controlled medication for an outside pharmacy. Doing so may result in temporary suspension or permanent dismissal from Free Clinic services The pharmacy obtains medications two ways: We buy them, or they are ordered by the pharmacy staff from the drug company. We expect patients to watch for notes stapled or inside your “medicine bag”, if staff need to order any of your medications, a note will be placed in your bag for you to come in to sign for your medications. Some drug companies require recent income, taxes, SNAP info. before the medicines are shipped. The note in your bag tells you when to come in, who to see and what medication is being ordered. No documents equals no MedicationIf you have no refills left on your prescriptions, or if it was written a year or more ago, the pharmacy cannot give you a refill. You must see a medical provider to get new ones written.Refills are provided only at provider discretion and subject to current medical information available to them, including requested labs and tests. DO NOT wait until you are out of refills. It might take over 48 hrs. to get a refill written. Your lack of planning ahead does not establish a reason for priority refill at our pharmacy.The pharmacy hours are: Tuesday through Friday 9 am to 1 pm Closed on MondayFees:A $2 dispensing fee applies to each prescription that is filled at the Free Clinic, due at pick up.Despite the donations we receive, the cost to the Free Clinic to serve ONE patient for one year is approximately $500. That cost continues to rise. At the same time, grants and financial donations have decreased. The Free Clinic does not receive any federal government funding. In order to continue to offer the best healthcare possible to a largest number of patients, the Anderson Free Clinic Board of Directors voted to charge a Certification Fee to all patients. Patients are charged an annual $15 certification fee which will be valid for 12 months. The following applies to current and new patients at our Anderson and Honea Path ClinicsFor current patients,The $15 annual certification fee will be due at your next recertification date and paid to the Intake Coordinator. Mail in re-certifications will be accepted if accompanied by a money order or check for the $15 fee (no cash) made out to Anderson Free Clinic along with all documents that apply to youDrop off re-certifications can be paid w/ cash (ask for receipt) or check made out to Anderson Free Clinic.No certifications will be done without the fee. New patients must pay the fee upon meeting for the final screening with the Certification Volunteer (for Honea Path) or the intake Coordinator (for Anderson patients). Hospital discharges must pay the fee at the first doctor’s visit (pay at check in). Medical Information Release (HIPAA Release):Medical information release includes the diagnosis, records, and examination rendered to the patient.The release of information will remain in effect until terminated by the patient in writing.The Free Clinic uses pictures or videos of patients for purposes of publication in newspapers, magazines or other printed media; radio, television, online or other promotion; and social media, such as Facebook. The form below will request your Consent and Waiver of LiabilityThe administration of Anderson Free Clinic believes that the most comprehensive care can be afforded to its patients by the sharing of patient information between staff and providers of different areas of services within the Clinic, various physician’s offices, and Human Services agencies. The form below will request your permission for release Anderson Free ClinicUNDERSTANDING OF Guidelines, Provisions, Conditions and Consequences rights that I am forfeiting In exchange for receiving free care for the most part by those receiving uncompensated health care services, I waive my right to take legal action against any and all medical providers or ancillary personnel at this clinic or to otherwise seek a monetary recovery from Anderson Free Clinic and/or its employees and health care volunteers for any alleged professional acts of negligence, except for acts or omissions that are deemed to be grossly negligent or are considered willful and malicious, regardless of where such services are performed. Please initial: _______I acknowledge that I have been provided the opportunity to ask questions or request further information from the Anderson Free Clinic regarding the above and I fully understand and accept the rights that I am forfeiting by accepting or refusing to comply within this provision. Please initial: _______My signature below is my indication that I understand, accept and will comply with all the guidelines, provisions & conditions established for patient of the Anderson Free Clinic in Anderson or Honea Path and documented on the previous pages of Guidelines, Provisions, Conditions and Consequences for RECEIVING MEDICAL CARE, DENTAL CARE, and Prescription Assistance AT ANDERSON FREE CLINIC______________________________________________________________________Patient Signature DateCONSENT FOR CARE: STATE OF SOUTH CAROLINA ACKNOWLEDGEMENT OF MEDICAL SERVICES WITHOUT COMPENSATION I am asking for care at this facility. I understand that once becoming a patient of the Anderson Free Clinic I will receive services by one or more medical practitioners working?without financial compensation and in good faith. I agree to receive medical services voluntarily and without compensation, expectation, or promise thereof; these medical services will be rendered by medical providers volunteering their service associated with Anderson Free Clinic. I agree to permit the medical provider and other caregivers associated with Anderson Free Clinic to treat me in ways they judge beneficial to me. I understand that this care may include tests, examinations, medical and/or surgical treatment. No one has given me any guarantee how these examinations and treatment will affect my condition or me. This acknowledgement or agreement has been made prior to the rendering of medical services by the medical provider. ______________________________________________________________________Patient Signature DateRELEASE OF INFORMATION AND LIMITED POWER OF ATTORNEY FOR INDIGENT PATIENT CARE PROGRAM MEDICATION To expedite the request of medication in a time efficient manner, I authorize the Free Clinic to provide my financial information (size of household, income, social security number, etc.) to prescription manufacturer and I give limited power of attorney to the Anderson Free Clinic to assign a staff to sign on my behalf on these forms and provide such companies. I ALSO UNDERSTAND THAT I HAVE THE RIGHT TO REFUSE TO PROVIDE ANY INFORMATION UPON REQUEST, BUT IN SO DOING I UNDERSTAND THAT THIS MAY ALSO LIMIT THE RESOURCES/SERVICES AVAILABLE TO ME.______________________________________________________________________Patient Signature Date PHOTO RELEASE/ Consent and Waiver of Liability: I hereby authorize and consent to the interviews/photography/recording activities taken while I am a patient of the Free Clinic. I also defend, indemnity, and hold Anderson Free Clinic and its agents and representatives harmless from any consequence arising from my participation in the interview/photography/recording activity. It is my responsibility to alert those involved with production of photos and videos that I did not sign this consent and waiver. I assume full responsibility for any subsequent publication or broadcasting of any portion of the interview/photography/recording activity described above ______________________________________________________________________ Patient Signature Date MEDICAL INFORMATION RELEASE TO INDIVIDUALS REGARDING MY HEALTHUpon signature below I:Authorize AFC to leave messages or speak with Name: ____________________________ Relationship: _________________________ regarding appointments, diagnosis, records, and/or examination rendered to me while I am an established patient of the Free Clinic. _____________________________________________________________________ Patient Signature DateDo not authorize AFC to speak with anyone else regarding appointments, diagnosis, records, and/or examination rendered to me while I am an established patient of the free clinic. ______________________________________________________________________ Patient Signature DateAUTHORIZATION FOR RELEASE-RETRIEVAL OF INFORMATION (pharmaceutical, agencies, and various referral physicians)I authorize the Anderson Free Clinic to share biographical, including facts related to my health, and financial information with other agencies, pharmaceutical companies and various referral physicians to better find and secure the appropriate care and/or treatment.______________________________________________________________________Patient Signature DateI, _____________________________________ DOB _____________________ have read Patient Terms of Agreement: Guidelines, Provisions, Conditions and Consequences given to me to read (reduced copy on the back). I understand that my eligibility for Anderson Free Clinic services expire on / / 201_____, unless I renew my certification before that day. I am aware that no medical care, dental appointments or medication refills will be made beyond the expiration date. Eligibility is also dependent on patient behavior as explained under the previous 3 pages of the Patient Terms of AgreementSection 2: Assisting ProvidersApproved ByDateBarb BaptistaReviewed/Revised ByDate??????A. Protocol: Orientation of New Medical Provider Purpose: To give providers appropriate provisions and resources available for the practice of medicine at the Anderson Free ClinicOrientation of New Medical Provider VolunteersWe appreciate your time! Ask 1) number of patients provider prefers and 2) specific requests or preferences for nursing assistance. Medications:Anderson Free Clinic Formulary is basic, but adequately treats the majority of patients’ illnesses/diagnoses. If absolutely necessary or you do not feel comfortable in using what is available through our Formulary, you may ask for a specific prescription and our pharmacist at the Anderson Free Clinic will buy it or, if affordable, apply for a prescription-assistance program if available.No prescriptions for controlled meds. See physician reference book.Write no more than 3 prescriptions per page, per Welvista protocol.Give enough refills to last at least until the next scheduled visit.Prescriptions are placed in the box at the provider station and pharmacy staff will pick them up. Only prescriptions filled at outside pharmacy will be given to the patient. Prescription Pick-up requires 2 work days.Patients are required to bring medication bottles to every visitNurses will review medications during triage and make notes or additions/corrections on EMR.Nurses will point out medications that need refills.Providers will see need for refill Formularies are in Physician Reference BookPharmacy HoursAnderson: Tuesday-Friday from 9am-1pmHonea Path – a volunteer pharmacist is on site the night of the Clinic and the Friday after clinics from 10-12 noon to dispense medication prescribed by volunteer physicians and filled in Anderson.Miscellaneous:Ordering canes, crutches, boots, wheelchairs and other auxiliary devicesBathrooms/Coffee Room (Anderson)Which room(s) they will be using and how patients will be put backPatient Education Materials – where they are locatedPhysician computer/Portal Access – show where located (Anderson Only)If you can’t find it or have a question, please ask.Patients are asked to contribute, but no one will be denied the opportunity to be seen or receive medications due to their inability to payThings to remember:No prescriptions should be written for controlled meds. Explain guidelines for Welvista and PAPLabs: Please order only what is needed. Labs are written off – We don’t want to take advantage of hospital generosityRadiology: Hospital writes off $1500.00 per day. Anything above that amount will be pt’s responsibility. Staff will explain this to patient at checkout.Referrals: Explain Referral Guidelines. We strive to manage all problems at the clinic firstAlternative services: Acupuncture, Cranial Sacral Massage. Any new additions.AFC has a Dental Department - Encourage patient to see AFC dentist at least once a year. Make Dental referral in chart note and on a note for patient to take to the front for an appointment.WE welcome your ideas!EHR: Use Google Chrome as the browser for Practice Fusion. The Free Clinic has primarily transitioned to EHR – Practice Fusion (PF.) All documents, including labs, x-rays, medical records, consults, etc., will only be available through the timeline. For other patients, historical information previous to the documents in the timeline will be available in the paper charts by request.Before seeing patients, please check the menu to the left for pending tasks and messages. STARTING A NOTE:Open encounter already started for that patient. All providers, make sure that your name is on the encounter - found at the top of the encounter.Under the encounter (upper left) please review the time line, and then under documents pending for lab or test results, and other documents. (top left)All new meds need to be added to the medication list. D/C all meds being stopped in the medication list.Proceed to notePRESCRIPTIONS: NO E-PRESCRIBING Check AFC paper formulary Record prescribed meds in patient chart under Plan. Write paper script and deposit in acrylic box on counter. NOTE: AFC does not carry controlled substances. Prescription pads have a “Not valid for controlled substances” notation at the bottom of the script.No prescriptions should be written for controlled meds. Write only 3 prescriptions per page on a script padGive enough refills to last at least until next scheduled visitPharmacy Medication Profile -Nurses will review during triage and make additions/corrections in PF Patient ProfileMedication Profile - Provider should review and, if necessary, update this in PF during patient visitFormularies available near computers and at Physician’s deskIf prescribing medications not on our formulary – document “fill outside AFC” in planOnly give to patient RXs that will be filled outside AFC. Others should be placed in pink, square boxHOW TO ORDER A LAB:Go to Actions Drop-down menu in top right cornerGo To “Add lab order”Vendor – “Other”Add tests from drop down menu. Save.Add diagnoses. SaveAdd provider if not already populatedPrint labs from PF, give to patient to take to the front to be stampedHOW TO ORDER IMAGING:Go to Actions Drop-down menu in top right cornerGo To “Add imaging order”Vendor – “Other”Add a study from drop down menuAdd dx from drop down menu. Save.Add provider if not already populatedPrint imaging order from PF, give to patient to take to the front to be stamped.REFERRAL PROCESS Select “Add Referral” in Practice Fusion, under “ACTIONS” tab while in the patient encounter. Select “Referrals, Barbara” as the provider, under “My Connections.” Under “Referral for” add the specialty, diagnoses, and any history that you may feel pertinent to process the referral in the space provided.Click the “send” button on the bottom right side. This will send medication list, diagnoses, and allergies by internal fax to the referral department to begin processing. *Note* You may also click on “add attachments” to attach any labs, radiology, or office visits along with the above. RTC: Write on lab or on paper provided and give to patient. Front will make appointment.FINISH NOTE: SIGN ENCOUNTER. Medical Students: Do not sign the encounter- the preceptors will review your note within 24 hours and sign.SUPERBILLS: Create for each patient using correct codes and save. Please chart CPT and diagnosis code. We track VALUE OF SERVICES and conditions being treated for grants FILENAME \p \* MERGEFORMAT I:\Volunteer Management\Job Descriptions and Training Checklist\Orientation information - Medical Provider\Orientation of New Medical Provider Volunteers 2016 update.docGuidelines for Patient Referrals to Outside SpecialistsGeneral Guidelines:Need physician orderDictation should document need for referral including appropriate physical exam/findingsPlease try to manage problem with AFC resources before referringReferral resources are not always availableSpecific Guidelines:SpecialtyCommentsAlternative Therapies (In-Clinic)AcupunctureChiropractorCranial-Axial MassageCardiologyPt will be scheduled to see Dr. Barnes, Dr. Morse or Dr. Turner prior to outside referralPt may have to set up payment planPlease have appropriate tests completed prior to referralDermatology Anmed Family Medicine DermatologistRefer for dx and tx of skin conditions that have not responded to tx at AFCBiopsy suspicious lesionsRemoval of warts and other benign lesions Known skin cancer or lesions too large for Family Medicine clinicEndocrinologyNone availableENTSerious problems that cannot be handled at AFCGIColonoscopy/EndoscopyEnd Stage Liver Failure on a limited basis after record review by specialistNO HEPATITIS CNone available for screening if pt has fam hxSymptomatic patients – limited availability depending on circumstancesGYNScreeningGYN problemsDepends on age of pt and availability of fundingAnMed Health Gyn Clinic (Dr. Jennings)Dr. Herbert has monthly clinicPt may be scheduled to see Dr. Herbert prior to outside referralNephrologyPt will be scheduled to see Dr. Turner prior to outside referral if he is availablePt will have to set up payment plan at Nephrology office (minimum $5/week)NeurologyOnly Neurological Testing Available – no consulting AnMed Health Neurologic Consultant will see patients if they feel it is neededMay require MRI prior to referralMust have well documented neurological need including appropriate neurological examThere is usually a waiting listEMG/NCS have to be scheduled through AnMed Scheduling **If pt has pacemaker can do NCS but not EMG – cardiologist needs to OK**If pt has internal defibrillator cannot have NCS or EMG**If pt on Coumadin may need to be off med prior to procedure. Specialist to decide. (Cardiologist) need last Pt/INR**If pt has neurotransmitter cannot have NCS or EMGNeurosurgeryMRI within last 12 monthsMust have well documented surgical need including appropriate neurological examOncology/HematologyScheduled through cancer clinic onlyOphthalmologyMedicus:Diabetic eye examsNon-diabetic exams on limited basisNo standard ocular examsNo contact lens fittingAcute serious problemsGlaucomaMay have to wait for appointment for up to a yearClinics such as Eye-Mart and Family Vision:ScreeningDiagnosisOptometryDiabetic eye examsEyeglass RX will be filled at Lens CraftersNo standard ocular examsNon-diabetic patients will be referred for help from A.I.M./Lion’s clubOrthopaedicsAnmed Family Medicine Sports Medicine ClinicOrthopaedic Surgery**NO CHRONIC BACK PAIN**Evaluation and treatment for for non-surgical problems that cannot be treated at AFCEvaluation for need for surgical intervention and recommendation for surgical referral except in cases of acute injury/fractureJoint InjectionsIf pt was seen in ER and referred to surgeon then AFC cannot make referral. Pt will have to set up a payment plan with surgeon’s office.Pain ManagementPt will have to set up payment planPhysical TherapyPatients have to go on indigent pt waiting list and do not always get appointmentsPodiatryRefer to on-site nurse for footcare for:Trim Nails Pain CornsAssess skin Assess sensitivity Foot exams for diabetics with problems that cannot be managed at the AFCIngrown toenails that require removalPulmonologyHave appropriate tests completed if possible prior to referralSleep StudiesReferred to Anmed Sleep LabMust have an Epworth score of at least 10SurgeryMust have well documented surgical needsHave appropriate tests completed if possible prior to referralUrologyWell documented problem that has not responded to treatment at AFCHave appropriate tests completed if possible prior to referral FILENAME \p \* MERGEFORMAT I:\Referrals\Guidelines\Guidelines for Patient Referrals to Outside Specialists.docInstructions given to patients regarding referralsEligibilityYou MUST be currently certified as a Free Clinic patient to be eligible for a referralYou must be seen at the Free Clinic for your primary medical care. Patients who have a private doctor outside the clinic are not eligible for referrals.There must be an order for the referral from a volunteer doctor at the Free ClinicYou will need a copy of the Free Clinic Referral Form to take with you to your appointmentAppointmentsAppointments will be made by the Free Clinic staff and you will be notified of the date and time. Under no circumstance are you allowed to contact the physician’s office directly to make the first appointment.It may take from several weeks up to several months to get an appointmentIf we are unable to contact you the referral appointment will be canceled.It is YOUR responsibility to let the Free Clinic know of any change in your address or phone number. It is YOUR responsibility to call the referral doctor’s office if you need to cancel or reschedule an appointment. Appointments missed without YOU notifying the doctor’s office will NOT be rescheduled.PaymentIt is the decision of each individual referral doctor whether there will be any cost for the appointment. We will do our best to make you aware of any cost, but it is YOUR responsibility to verify that with the referral doctor’s office.Please be aware that the referral only covers the cost of the doctor’s fees. Any procedures or surgery done at the hospital will be YOUR responsibility. You should call the AnMed Business office to determine if you qualify for their AnMed Medical Assistance Program also known as AMAP.If a test costs more than $1500, YOU will be responsible for anything over that amount. You should call the AnMed Health business office to determine if you qualify for their assistance.Please call one of the following according to the first letter of your last name:A-G -Tanya Witcher- 864-512-2163 H-O- Ann Wightman- 864-512-2756P-Z- Heather Pigman- 864-512-2245Medications prescribed by the referral physician may be filled at the Free Clinic pharmacy IF they are on the Free Clinic Formulary.Additional responsibilities may apply depending on the referral office. We have agreed to follow their individual guidelines and these may vary from office to officeApproved ByDate?Paul Wagner ?Reviewed/Revised ByDate????????Protocol: Use of abbreviations when communicating medical information.Purpose: Encourage practice of professional documentation that includes safe and effective use of abbreviations when communicating written orders, computer-generated labels, medication administration records, storage bin/shelf labels, reprinted protocols, medical information, orders and memorandums. Avoid ambiguous information and miscommunication between support-personnel, prescribers and pharmacists- in the form of misunderstood and/or illegible abbreviations.Provide our workforce with a list of approved abbreviations.Introduce health-care students to risk-reducing protocols in health care, such as avoidance of ambiguous abbreviations which have led to errors and serious patient harm.Rationale: Medication errors stem from a variety of causes, including Abbreviations and other shorthand notations on prescriptions and orders, increasing the risk of medication errors. The majority of errors and subsequent harms are caused by relatively few abbreviations or notations; in addition, decimal errors (e.g., no leading zero or a trailing zero) are also troublesome.PROCEDURESStaff and volunteers at the Anderson Free Clinic should NEVER use those when communicating medical information. This includes internal communications, telephone/verbal prescriptions, computer-generated labels, labels for drug storage bins, medication administration records, as well as pharmacy and prescriber computer order-entry screens.SHORT LIST*The following is a list of approved medical abbreviations. In general, the use of abbreviations at AFC should be limited to this list. A&O x 3 - alert and oriented to person, place and timeA&O x 4 - alert and oriented to person, place, time and eventA-FIB - atrial fibrillationAAA - abdominal aortic aneurysmABC - airway, breathing, circulationABD - abdomen (abdominal)ACLS - advanced cardiac life supportAKA - above the knee amputationALS - advanced life supportAMA - against medical adviceAMS - altered mental statusAMT - amountAPPROX - approximatelyASA - aspirinASSOC - associatedBG - blood glucoseBILAT - bilateralBKA - below the knee amputationBLS - basic life supportBM - bowel movementBP - blood pressureBS - breath soundsBVM - bag-valve-maskC-SECTION - caesarean sectionC-SPINE - cervical spineC/O - complaint of (complains of)CA - cancerCABG - coronary artery bypass graftCAD - coronary artery diseaseCATH - catheterCC - chief complaintCEPH - cephalicCHF - congestive heart failureCNS - central nervous systemCOPD - chronic obstructive pulmonary diseaseCP - chest painCPR - cardiopulmonary resuscitationCSF - cerebrospinal fluidCT - cat scanCVA - cerebrovascular accident (stroke)Appendix G 2009Approved Medical AbbreviationsD5W - 5% dextrose in waterDKA - diabetic ketoacidosisDNR - do not resuscitateDOA - dead on arrivalDT - delirium tremensDx - diagnosisECG - electrocardiogramEEG - electroencephelogramET - endotrachealETOH - ethanol (alcohol)ETT - endotracheal tubeEXT - external (extension)FB - foreign bodyFLEX - flexionFx - fractureg - gram(s)GI - gastrointestinalGSW - gunshot woundgtts - dropsGU - gastrourinaryGYN - gynecology (gynecological)H/A - headacheHEENT - head, eyes, ears, nose, throatHR - heart rate (hour)HTN - hypertensionHx - historyICP - intracranial pressureICU - intensive care unitIM - intramuscularIV - intravenousJVD - jugular vein distensionkg - kilogramKVO - keep vein openL-SPINE - lumbar spineL/S-SPINE - lumbosacral spineL&D - labor and deliveryLAT - laterallb - poundLLQ - left lower quadrantLMP - last menstrual periodLOC - level of consciousness (loss of consciousness)LR - lactated ringersLUQ - left upper quadrantMAST - military anti-shock trousersmcg - microgram(s)MED - medicinemg - milligram(s)MI - myocardial infarction (heart attack)min - minimum / minuteMS - mental statusMS - mental status changeMSO4 - morphineMVC - motor vehicle crashN/V - nausea/vomitingN/V/D - nausea/vomiting/diarrheaNAD - no apparent distressNC - nasal cannulaNEB - nebulizerNKDA - no known drug allergiesNRB - non-rebreatherNS - normal salineNSR - normal sinus rhythmOB/GYN - obstetrics/gynecologyPALP - palpationPAC - premature atrial contractionPE - pulmonary embolusPEARL - pupils equal and reactive to lightPMHx - past medical historyPO - orallyPRB - partial rebreatherPRN - as neededPT - patientPVC - premature ventricular contractionAppendix G 2009Approved Medical AbbreviationsRLQ - right lower quadrantRUQ - right upper quadrantRx - medicineRXN - reactionS/P - status postSOB - shortness of breathSQ - subcutaneousST - sinus tachycardiaSVT - supraventricular tachycardiaSx - symptomSZ - seizureT-SPINE - thoracic spineT - temperatureTIA - transient ischemic attackTKO - to keep open (refers to IV’s - same as KVO)Tx - treatmentUOA - upon our arrivalURI - upper respiratory infectionUTI - urinary tract infectionVF - ventricular fibrillationVS - vital signsVT - ventricular tachycardiaWAP - wandering atrial pacemakerWNL - within normal limitsYO (YOA) - years old (years of age)M or ♂ - maleF or ♀ - female+ - positive - - negative? - questionableΨ - psychiatric ~ - approximately> - greater than< - less than = - equalAppendix G 2009Approved Medical Abbreviations↑ - upper (increased)a - beforep - afterc - withs - without? - changeL - leftR - right↓ - lower (decreased)1° - primary2° - secondaryKnow the risks and use corrected way to abbreviate !Approved ByDate??Reviewed/Revised ByDateDr.?Stuart M. Barnes6-19-13?????B. Protocol: Assisting Providers with Examination Purpose1. To prepare the patient for a complete physical examination.2. To promote patient’s physical and psychological comfort. 3. See Protocol: Universal/Standard Precaution in Triage SectionGeneral InstructionsUse personal protective equipment (PPE) for procedure to be performed.A female nurse or medical assistant must be in continual attendance for a pelvic examination of any female patient. Specimen containers are sealed until first used. Slides are not used due to the fact that we don’t have a microscope that is sufficient. It has been used, but was very hard for the provider to see.Specimens are to be sent to the lab as soon as possible after collection. Clean all equipment used during the examination and return to designated areas.Exam room should be left clean and ready for immediate use.Equipment: Physical examination Drape sheet/patient gownTongue depressorsLamp or flashlightPercussion hammerSphygmomanometer and stethoscopeOphthalmoscope-otoscopeCotton ballsHemoccult cards are kept in the rooms [3-pk available] SlidesMicroscopeHemoccult cards in rooms - 3-pk Pt. to bring back Pelvic examination and Pap SmearGlovesWater-soluble lubricantDraping sheet/patient gownLamp or light sourceThin prep, cervical brush, cervical spatulaTissues*Note* Glass slides and microscope are available for viewing wet prepsProcedure:Physical ExaminationExplain procedureWash hands Have patient remove all clothing and don hospital gownDrape the patient so that only necessary exposure is permitted. Assist the patient to the positions desired for examination of the following areas: Head, face, throat and neck- sitting positionAbdomen- horizontal positionChest- sitting positionExtremities- sitting position and/or horizontal positionRectal- dorsal recumbent or Sims lateral positionVaginal- lithotomy position Assist the physician with the examination of the female patientHave patient get dressed and wait for further instructionsWash handsClean room.Pelvic Examination/Vaginal or Pap Smear Explain procedure to patientHave patient void prior to examHave patient remove clothing from the waist downWash handsAssist patient into the dorsal position with knees flexed and draped. Assist patient to place feet in stirrups after provider arrives.Put on gloves.Place speculum in water basin.Open Thin Prep bottle.Stir cervical brush/spatula in thin prep solution 9 times.Replace cap on thin prep bottle.Upon completion of examination, offer tissues to patient for cleansing perineal area.Write patient name and date of birth on thin prep bottle.Remove gloves.Clean room.Wash hands.C. Protocol: Joint Injection/Aspiration of Joint Purpose: To ensure that adequate support and all supplies necessary for joint injection or aspiration are available for providers.Equipment: Joint injection/aspiration trayProcedure: Obtain written consent from patient (located in tray).Expose joint for injection. MD to locate and mark site to be injected/aspirated.Cleanse site using Provo iodine prep stick in circular motion, starting from inner and moving outward. Repeat with a second Provo iodine prep stick. Draw up 1 mL Celestone with 4 mL Lidocaine in a 5-mL syringe, then discard needle and replace with a 23 G 1”-1?” needle. Spray the injection site with Ethyl Chloride spray until a nickel-size area of white occurs. The provider will inject the Celestone/Lidocaine mixture into the joint.Provide the provider with gauze to massage the area of injection.Cleanse the Provo iodine off with an alcohol pad, wipe dry and apply a Band-Aid. Clinical Services Coordinator - restock trayINVENTORY FOR JOINT-INJECTION TRAYEthyl Chloride Spray- 1Multi-dose vial Lidocaine- 2Provo-iodine prep sticks- 20Alcohol prep pad- 20Band-Aids- 10Gauze pads- 2x2 or 3x3- 1010-mL syringe for joint-aspiration – 220-mL syringe for joint-aspiration – 216G and 18G 1?“ needle for joint aspiration- 4 each5-mL syringe for joint-injection23G to 25G- 1?“ needle for joint-injectionBetamethasone Sodium Phosphate & Betamethasone Acetate 6mg/mL (Celestone) –(2 ) 5-mL multi-dose vialsApproved ByDate?DMP?2-15-11Reviewed/Revised ByDate?RTW6/1/13??????? Sterile gloves- sizes 6? , 7, 7? , 8-- 1 pair of eachBlank copies of consent forms- 10D. Protocol : Papanicolau TestPurpose: To ensure the readiness of the room and the patient.Equipment: Disposable vaginal speculumGlovesSpatula and brushLong cotton-tipped applicatorThin prepLight sourceDrapeLubricating gelWater in basinProcedure:Document LMP, last PAP date and last breast examHave patient disrobe, provide patient with appropriate drapeNotify provider when patient is readyApproved ByDate?RTW6-19-13Reviewed/Revised ByDate??????E. Protocol: Wet prepPurpose: To prepare slide for microscopic examination. Equipment:Microscope slide and coverCotton-tipped applicatorVaginal speculum and light sourceSurgical lubricantNormal SalinePotassium HydroxideProcedure:Prepare patient exam drape for vaginal exam.Insert light into vaginal speculum and apply lubricant to speculum; give to provider.Give provider cotton-tipped applicator.Apply sample from vaginal speculum to slide/slides.Add one drop of Normal Saline to one slide, apply cover.Add one drop of Potassium Hydroxide to one slide, apply cover.Provider to examine under microscope.Approved ByDate??Reviewed/Revised ByDate????????SECTION 3: EMERGENCYA. Protocol: Finger Stick, Accident, Incident Immediate Action and ReportProcedures:Accidents involving finger sticks or other possible transmission of blood from one person to another must be immediately reported to the area supervisor. Both parties need to obtain a lab requisition for finger stick protocol and report to the emergency room within the hour for testing. An incident report must also be filled out about any accident at the Free Clinic.Lab work must include Hepatitis C, Hepatitis B (surface antigen) and HIV.All staff and volunteers must have read and must understand this protocol before commencing their jobs.Name: ____________________________________________Date: _____________________________Approved ByDate??Reviewed/Revised ByDate????????B. Protocol: Chest PainPurpose: To identify and determine possible cause of chest pain.Procedure: Identify patient complaining of chest pain.Obtain vital signs.Notify provider, if present, of patient complaining of chest pain.If ordered get EKG.If no provider present, send patient to the emergency room or activate 911.Approved ByDate??Reviewed/Revised ByDate??????C. Protocol: Electrocardiographs (EKG)Purpose: To accurately obtain an EKG tracing of the patient heart after receiving an order for EKG. The recordings are used to diagnose the condition of the heart muscle and its nerve system. Procedure:Clean skin with alcohol or acetone and let dry completely.Apply sensors before entering patient information. This allows time for the sensors to adhere and improves conductivity. Follow the Directions on EKG machine.For patients with a lot of hair, the following techniques may improve contact.Use the thumb and forefinger to spread the hair before applying the sensor to the skin.Abrade the skin slightly with a dry, heavy gauze or similar alternative.If the sensor does not adhere well, it may be necessary to shave the site. Connect the cables to the sensor pads, using the lead placement chart, Figure 5-2.From Standby mode, press power to power up screen.Follow directions and enter patient demographic.Press ECG to acquire an Auto ECG report.Maintenance and TroubleshootingRefer to manual kept on cart. CleaningAt the beginning of each stand and during the stand as necessary, the unit may be cleaned with a clean, soft cloth and a solution consisting of mild dishwashing detergent diluted in water. (Before starting, turn the unit off.) However, avoid coming into contact with open vents, plugs and jacks of any kind, the keyboard and the writer. Thoroughly wipe the exterior of the unit and dry it with a clean, soft cloth or paper towel. After each use, the Dal-Square should be cleaned off with alcohol and gauze. 3. The ends of the banana plugs should be rubbed with alcohol and gauze to clean them and to remove any tarnish. 4. At the beginning of each stand, the ECG/x-ray table should be wiped with a clean, soft cloth and a mild dishwashing solution. Dry the table with a clean, soft cloth. Maintenance At the beginning of each stand, inspect all cords on the unit for fraying or other damage. Inspect all plugs and connectors for bent prongs or pins. Verify that all cords and connectors are securely slated. Needed repairs or replacements should be reported to the Office Manager.Maintenance Checklist DailyCleaning Clean off dust with dry cloth and replace dust cover Visual checks Check that battery charge indicator, power indicator and patient cable connector indicators are working Function checks Check the calibration of machine before use using 1mV pulse Check the baseline of the ECG recording is steady Check the printing is clear Weekly Cleaning: Clean the printing head Visual checks: Check all cables are not bent, knotted or damaged Replace any damaged electrical plugs, sockets or cables Check all knobs, switches and indicators are tightly fitted Function checks Check the calibration of recordings with ECG simulator Check battery power can operate the equipment.Approved ByDate?Rita Williams, APRN ?6/10/13Reviewed/Revised ByDate????????D. Protocol: 911 Call - MedicalProcedure:Identify person in distressGet help - Notify provider - As many medical assistants as possible report to area of emergency.Notify front desk to call 911.Give person's name if known.State medical problem - unconscious, breathing, not breathing.CAB’s of CPRWhen 911 arrives, report and relinquish care.Front desk to provide a copy of the demographic sheet and the medication list.Approved ByDate??Reviewed/Revised ByDate????????E. Protocol: CPR Training and CertificationPurpose: To provide emergency care for the patient in Respiratory/Cardiac arrest Staff who must maintain CPR certification:Lead Patient ServicesNurse PractitionerClinical Services CoordinatorBesides being certified, staff and key volunteers must know Frequently asked questions about new CPR guidelinesWhat are the most recent CPR recommendations for bystanders?Based on 2015: Bystanders should first call 911. Untrained bystanders should perform Hands-Only — or compression-only — CPR, which remains an effective tool in saving lives from cardiac arrest. However, the new guidelines recommend that if a bystander is trained in CPR and can perform breaths, he or she should add breaths in a cycle of 30 compressions and two breaths.What other key updates have been made to the CPR & emergency cardiovascular care guidelines?Based on 2015: The chest compression rate and depth have been updated. In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120 compressions per minute to a depth of at least 2 inches for an average adult, while avoiding excessive chest compression depths of greater than 2.4 inches.There is also now an emphasis on the use of mobile technologies by bystanders to aid in calling 911 sooner and receiving dispatch-assisted CPR instructions. Mobile technology and social media applications that notify rescuers of a nearby cardiac arrest may increase the rate of bystander-initiated CPR. Bystanders should use mobile phones to immediately call 911, placing the phones on speaker so the dispatcher can help bystanders check for breathing, get the precise location and provide instructions for performing CPR.Why are there new limits for depth and rate of chest compressions?The upper limits of recommended compression rate and depth are based on preliminary data that suggest excessive compression rate and depth adversely affect outcomes.What are the key recommendations for children?For infants and children, the guidelines reaffirm the C-A-B (compressions, airway, breathing) sequence and that compressions and ventilation are needed for pediatric cardiac arrest. Compressions should be done at a rate of 100 to 120 compressions per minute at a depth of about 1.5 inches for infants, about 2 inches for children and at least 2 inches but no greater than 2.4 inches for adolescents.Approved ByDate??Reviewed/Revised ByDate???????? If rescuers are unwilling or unable to deliver breaths, they should perform compression-only CPR.F. Protocol: AED Monitor Training and MaintenancePurpose: To provide emergency care for the patient in Respiratory/Cardiac arrest as outlined by the American Heart Association, using the Automatic Defibrillator Procedure:Training of all staff must be conducted once a year, scheduled by Office ManagerKnowledge of procedures must be assessed through a post training testProcedures are as follow: Assess the patient, activate 911Use the unit only if all of the following patient signs are present.UnconsciousnessAbsence of breathingAbsence of pulseAttach electrodes as shown on the electrode package.Open the package containing the defibrillations pads and cable.Peel off the backing from the electrode pad labeled RA. Place this pad just below the patient’s right collar bone.Peel off the backing from the electrode pad labeled LL. Place this pad over the ribs on the patient’s left side below the breast.Plug the pad connector into the AED unit.Check the battery level icon near the handle.Turn unit on and follow voice prompts from unit.Start the AED unitPush the round green ON/OFF button located in the center of the unit.Listen to voice prompts.If prompted press the red triangle SHOCK button.MaintenanceA weekly check of the battery life icon on the unit will be made and recorded.A new battery will be ordered if necessary.Reference: Defibtech DDU-100 Semi-Automatic External Defibrillator User’s ManualApproved ByDate??Reviewed/Revised ByDate????????G. Protocol: Use of Adult Ambu BagLocated with AED Unit Purpose: To provide oxygen in an emergency situation to a patient.Procedure: Connect the oxygen tubing to a regulated oxygen source.Adjust the gas flow so that the reservoir expands completely during inspiration and nearly collapse as the squeeze bag fills during exhalation.Connect the resuscitation mask to the patient connector, place mask over patient's mouth and nose, ensuring a tight fit.Follow accepted American Heart Life support press and squeeze bag to deliver a breath. Observe the chest rise to confirm inspiration.Release pressure on the bag to allow exhalation. Observe the chest fall to confirm exhalation.During ventilation, check for:Signs of cyanosisAdequacy of ventilationAirway pressureProper function of all valuesProper function of reservoir and oxygen tubingShould the non-rebreathing valve become contaminated with vomitus, blood or secretions during ventilation disconnect the device from the patient and clear the non-rebreathing valve as follows.Rapidly compress the squeeze bag to deliver several sharp breaths through the non-rebreathing valve to expel the contaminate. If the contaminate does not clear,Rinse the non-rebreathing valve in water and then rapidly compress the squeeze bag to deliver several sharp breaths through. the non-rebreathing valve to expel the contaminate. If the contaminate still does not clearDiscard the resuscitator.Approved ByDate??Reviewed/Revised ByDate?6-19-13??????Maintenance: For single patient use. Not intended for reprocessingReference: Product user guide.H. Protocol: Immunizations: Emergency Plan for Adverse ReactionsProcedures: If an immediate adverse reaction occurs after the administration of vaccines, the following plan will be implemented.Have physician complete an immediate assessment.Administer Epinephrine 1:1000 as directed by physician using the following guidelines: Less than 15 Kg (6.8 lbs)—0.15 cc subcu 15 Kg to 50 Kg (6.9-22.7 lbs) – 0.3 cc subcu Greater than 50 Kg (22.8 lbs) – 0.5 cc subcu Follow procedure covered in the policy for Adverse Drug Reactions using the vaccine Adverse Event Reporting Form. Approved ByDate?SB12-14-13?Reviewed/Revised ByDate????????I. Protocol: VaccinationsPurpose: Clinical personnel to administer flu vaccineGuidelines: The following patients/volunteers may Receive the Flu Vaccine without seeing a Provider:Established Clinic patient Have been seen within the last yearDo not have an elevated temperature or an infectionDeny allergy to eggs/latexReside in the Recommended Group for receiving the vaccineApproved ByDate?DMP2-15-11?Reviewed/Revised ByDate?SMB?6-19-13?????? J. Protocol: Oxygen AdministrationPurpose: To provide supplemental Oxygen to treat or prevent hypoxemia and ensure proper use of oxygen equipment. Guidelines: It will be the responsibility of the clinical Staff to administer Oxygen therapy per order of health-care provider or in emergency situations until the health-care provider arrives and/or an order can be obtained. Equipment: Oxygen tankFlowmeterTubing and mask/cannulaPulse oximeter Procedure: 1. Obtain order from provider. 2. Explain procedure to patient. 3. Check pulse Ox prior to starting oxygen and again after oxygen has been started for 5 minutes. 4. Place oxygen on patient using nasal cannula or mask, depending on order. 5. Dial the flow meter to the ordered liters/minute flow. 6. Observe patient and follow further provider guidelines.Note: In an emergency situation, set flowmeter at 2L/min and administer Oxygen to patient via mask/cannula until the health-care provider gives further orders.Approved ByDate?RTW6/10?30?/13?Reviewed/Revised ByDate????????K. Protocol: Handling SeizuresPurpose: To ensure the safety of the individual having a seizure. PROCEDURE:Once patient is identified as having a seizure, determine that CPR does not need to be started.Make sure patient has patent airway.Call for help. Activate EMS.Get vital signs.Time the length of the seizure.Describe the type of seizure (i.e. fall, stare, jerking)Was the patient incontinent of bladder/bowel?Postictal state--- state of consciousness after seizure (coherent, confused, sleepy)If provider present, notify provider and director. Do not move patient. If patient awakens, ask patient to remain still. Have someone from front desk make a copy of patient demographic sheet and medication list for EMS.Approved ByDate?RTW6-10-13?Reviewed/Revised ByDate????????L. Protocol: SyncopePurpose: To ensure the safety of the individualhaving a syncope episode.Procedure: Once patient is identified as having a syncopal episode, determine that CPR does not need to be started. Make sure patient has patent airway. Call for help. Activate EMS.Get vital signs.If provider is present, notify provider and director.Do not move patient. If patient awakens, ask patient to remain still.Have someone from front desk copy patient demographic sheet and medication list for EMS. Approved ByDateSBarnes?8-21-13?Reviewed/Revised ByDate???Section 4: Lab ProtocolAddressing Critical ValuesProtocol: Urgent or Critical Lab ValuesDuring Clinic hoursPROCEDURE: In the event the Staff Nurse Practitioner or a volunteer physician are not at the Clinic to take care of an urgent/critical lab, report or other concern by the staff, the following provider should be contacted in the order listed: Medical Services ManagerMedical Director ATS Resident After-hours Critical Results Management AnMed Health Family Medicine care coordinated with Anderson Free Clinic Protocol: The critical value is confirmed by Lab Services according to a test-specific protocol. During Anderson Free Clinic after hours the test result will be immediately reported to Family Medicine Resident on call. Resident will interpret test results and follow up with patientsResident complete documentation of care. Form is available on X Drive: Anderson Free Clinic/Free Clinic critical lab values follow-up…/After Hours Care for Critical Values Fax completed and signed documentation to Anderson Free Clinic to 716-1218 (electronic fax #)After-hours Critical Results Management An AnMed Health Family Medicine care coordination with Anderson Free Clinic is in place.Protocol: 1) The critical value is confirmed by Lab Services according to a test-specific protocol. 2) During Anderson Free Clinic after hours, the test result will be immediately reported to the Family Medicine Resident on call. The resident will interpret test results and follow up with patients. 3) Resident completes documentation of care. Form is available on X Drive: Anderson Free Clinic/Free Clinic critical lab values follow-up…/After Hours Care for Critical Values. 4) Fax completed and signed documentation along with labs to Anderson Free Clinic fax # 716-1218. Patient Name: ______________________________________________ Patient DOB: _______________ Date of Service: ______________ Physician Name: _________________________________ (Please Print) Pager# _____________ Physician Signature: _________________________________ Date: ______________________ Test names, values, and interpretations for laboratory results: Interpretation associated with them: Follow up: Contact with patient at Phone #: Orders for diagnostic tests: Other: Fax completed and signed documentation along with labs to Anderson Free Clinic fax number 716-1218Approved ByDate?SB12-14-13?Reviewed/Revised ByDate?Dr. SB/ Teri Lawson???Protocol: New-Patient Lab OrdersPurpose: To provide baseline lab values on all patients.Procedure: All PatientsCBC with DiffCMPLipid PanelTSHUA with reflex cultureIf patient is Diabetic, addHgbA1CUrine Microalbumin 3. Other: Hep C - born between 1945 and 1965 and other risk factorsPatients are asked to complete the short Questions after eligibility for services is determinedIn preparation for a productive first medical visit at the Anderson Free Clinic, you will be asked to complete labs before the visit. Please answer the questions below so that we can determine what tests are needed. Some questions are very personal, but they are important for your overall health. Questions are asked regardless of age, gender or marital statusNAME :?AGE?FOLD WHEN DONE ANSWERING ALL QUESTIONSYESNOI DON’T KNOW OR NOT SUREDo you have Diabetes????Do you have High Cholesterol????Were you born between 1945 and 1965????Are you currently injecting drugs????Have you ever injected drugs, including only once or a few times, many years ago????Have you had persistently abnormal liver tests????Do you have HIV infection????Have you ever received a transfusion of blood or blood components, or had an organ transplant before July 1992????Were you born of a Hepatitis C Virus -positive women???Recipients of transplanted tissue (e.g., corneal, musculoskeletal, skin, ova, sperm)???Have you ever used Intranasal cocaine and other non-injecting illegal drug????Do you have/had tattooing or body piercing????Have you had sex with more than one person????Do you & your partner(s) use any protection against STDs, such as condoms????Have you ever been diagnosed with a sexually-transmitted disease????Have you had sex with a person(s) who you know/suspect are Hepatitis C -positive ???Approved ByDate?SB7-17-13?Reviewed/Revised ByDate????????Protocol: Blood Glucose MonitorPurpose: To correctly obtain a blood glucose reading of a patient and interpret the results.PROCEDURE: Identify patient needing blood glucose check.Select finger to be used to obtain drop of blood.Clean the patient’s finger with alcohol and wipe dry with cotton.Activate blood glucose monitor and insert strip matching monitor. Stick patient finger with a lancet.Apply blood to glucose strip and read results when ready.Document results on patient chart.Blood Sugar Higher Than 500 If provider present, notify provider of results.If no Provider present, send the patient to the emergency room.If ordered, give patient regular insulin and water to drink.Blood Sugars Lower Than 70 Refer to Hyperglycemia/Hypoglycemia Procedure steps to be taken. Protocol: Addressing Hyper/Hypoglycemic Index Approved ByDate?SB?10-8-14Reviewed/Revised ByDateHyperglycemia [ Blood Sugar >500] Send patient to ERHypoglycemia [Blood Sugar <70] Do the following:Procedure: HypoglycemicAdminister Glucose tablets: Give 1, Wait 15 minutes. Check Blood Sugar. If still <80, give a 2nd tablet. Wait 15 minutes. Check Blood Sugar. If still <80, give a 3rd tablet and recheck Blood Sugar. Check patient’s Blood Pressure, Pulse, Respiration and Level of Consciousness. Document all of the above. Procedure: HyperglycemicRefer patient to ER with a blood glucose level of 500+.Approved ByDate?RTW6-10-13?Reviewed/Revised ByDateSMB??6-19-13??????Protocol: GC/Chlamydia DNA ProbePurpose: To obtain GC/Chlamydia probe to test for STD.Equipment: GC/Chlamydia test kit. Procedure: Get test kit, making sure that the kit has not expired.Assist provider in obtaining specimen using the thin blue cotton-tipped swab.The swab must remain in the cervical os or penis for 10 seconds.Open vial in kit and place swab in vial.Break swab at indented area ?-way down swab.Throw remainder of stick away.Close swab into vial.Label the specimen with the patient name and date of birth. Place numbered sticker from lab requisition on specimen. Place specimen inside biohazard bag.Fill out requisition with the patient name, date of birth, social security number, phone number, order date. Ordering provider name/AFC. Keep pink copy of requisition to place in the patient’s chart, stapled to the pink copy of the encounter form. Place lab requisition in separate pocket of biohazard bag from specimen. Place specimen in area for courier to pick up. Call courier for pick-up of specimen.Protocol: Hemoccult Test for Fecal Occult BloodPurpose: To obtain a fecal sample in order to test forApproved ByDate?DMP?13/3/10Reviewed/Revised ByDate?DMP2-15-11??RTW?6-10-13???? the presence of occult blood.General Instructions: Use appropriated universal precautions to include gloves, gown or eyewear as indicated.Keep developer stored out of reach of children, in a cool environment.Do not use slides or developer after expiration date, or if slides have a blue tint before use.Equipment:For obtaining specimen in the office: Hemoccult slidesDeveloperGloves/lubricantFor home collection: Three slides for three separate stool samples (take-home kit)Instructions on how to collect specimens and dietary guidelines prior to collectionProcedure:Office:Place patient in Sims position on exam table.Assist physician with rectal exam and collection of specimen on slide. Drop developer and observe for blue color, indicating blood in stool.Show results to physician.Discard into biohazard waste container.Home: Patient will follow directions as given for collection and when completed, return to the office lab for testing.Chart: Results will be documented in provider’s note or, if patient takes home tests, the nurse will have documentation of the returning samples. The lab results will be placed in the record. Approved ByDate?RTW?6-17-13Reviewed/Revised ByDate????Protocol: UrinalysisPurpose: To obtain accurate test results using urine dip test strip.Procedure:Please refer to the box and bottle label for specific reagent areas on the product you are using. Confirm that the product is within the expiration date shown on the label.Collect fresh, well-mixed, uncentrifuged urine specimen in a clean, dry container. Mix well immediately before testing. Remove one strip from the bottle and replace the cap immediately.Inspect the strip. If reagent areas are discolored, do not use the strip.Dip the test strip into the urine up to the last test pad for no more than one second (See Diagram A). Read the test results carefully at 60 seconds in a good light and with the test area held near the appropriate color chart on the bottle label. Changes in color that appear only along the edges of the test pads for after more than 2 minutes have passed are of no diagnostic significance (see Diagram C). When reading instrumentally, carefully follow the directions given in the appropriate instrument operating manual. Handling procedures:Do not remove strip from the bottle before it is to be used for testing. Do not touch the test pads on the strip. After removing the test strip, immediately replace the cap completely. Do not remove the desiccant from the bottleSection 5: MedicationsANDERSON FREE CLINIC pHARMACY OPERATION POLICY (Pharmacy management system, role of pharmacists and technicians)PURPOSEMedication ManagementOBJECTIVESAnderson Free Clinic pharmacy’s practice reflects an evolving paradigm from one in which the pharmacist primarily supervises medication distribution and cou nsels patients, to a more expanded and team-based clinical role providing medication therapy management, health improvement, and disease prevention services.Procedure:If the free clinic is dispensing medications (other than samples), the free clinic holds a pharmacy license and complies with all applicable federal and state laws and rules. (See South Carolina Board of Pharmacy for more information ) If the free clinic dispenses medication samples, the free clinic complies with all applicable federal and state laws and rules. (21 United States Code (“USC”) Section 353 et seq., 21 USC Section 203 et seq., ORC section 3719.81 et seq.)The free clinic has a written policy regarding the elimination of dangerous abbreviations when writing prescriptions.The free clinic ensures that a copy or copies of pharmaceutical reference books are available (such as the Physicians Desk Reference (“PDR”)) through either print or electronic means, for all staff and volunteers to access when writing prescriptions.FYI: Patients sign our “Patient care Terms” document agreeing “To respect the volunteer physicians’ time and their volunteer agreement with the Free Clinic”…The Agreement further states: Patients may not ask for prescriptions for controlled substances, and it is the policy of the Free Clinic that volunteer physicians may not write prescriptions for these medications. These substances includes but are not limited to Lortab, Vicodin, and Valium.Violating that agreement may result in temporary suspension or permanent dismissal from Free Clinic services.Approved ByDate?Paul Wagner ?Reviewed/Revised ByDate????????Protocol: DISPENSING OF MEDICINE Purpose: Medications are dispensed in a manner compliant with all state and federal pharmacy laws, and with respect to every patients’ rights under HIPPA, as well as their safety. Procedure:The Free Clinic dispenses medications, including samples, and the Clinic holds a pharmacy license and complies with all applicable federal and state regulations. The Free Clinic has a written policy regarding the elimination of dangerous abbreviations when writing prescriptions. The Free Clinic ensures that a copy or copies of pharmaceutical reference books are available [such as the Physicians Desk Reference (“PDR”)] through either print or electronic means, for all staff and volunteers to access when writing prescriptions.Patients sign our “Patients’ Understanding of Terms” document, agreeing “…to respect the volunteer physicians’ time and their volunteer agreement with the Free Clinic…” The Agreement further states, “...Patients may not ask for prescriptions for controlled substances. It is the policy of the Free Clinic that volunteer physicians may not write prescriptions for these medications. Violating this agreement may result in temporary suspension or permanent dismissal from the Free Clinic.” All prescriptions are entered into QS/1 under the “AFC” (Anderson Free Clinic) price plan, which always bills out at $0.00. Patients are responsible for a $2.00 per prescription dispensing fee. The Free Clinic has a “credit period of two months or $40 per patient. If a patient is unable to pay the dispensing fee that is logged in an IOU system, after the two months or IOU has reached the limit of $40, any medications the Clinic has purchased may be withheld. Medication from Drug Company’s Assistant Programs (PAP) will still be supplied. Patient meet with staff for review of personal expensesPrescription pick-up is 2 work days. If it is a new medication, dispensation will take 3 work days.Providers will see the list of medications under “Chief Complaint.”See 21 United States Code (“USC”) Section 353 et seq., 21 USC Section 203 et seq., ORC Section 3719.81 et seq.) Approved ByDate?Paul Wagner ?Reviewed/Revised ByDate????????Protocol: Instructing patients on how to dispose of medications Purpose: Have a positive impact in safeguarding lives and protecting the environment by disposing of unused medicines properlyProcedures: During Triage and at Pharmacy when asked, provide patients appropriate information on disposalDO NOT FLUSH unused medications and DO NOT POUR them down a sink or drain. Keep the medicine in its original container. The caps are typically child proof. Cover or Remove and destroy ALL identifying information (prescription label) from all medication containers before recycling them or throwing them away. Cover patient’s name and the content information clearly visible, with a permanent marker or pour medication into a sealable plastic bag. 2. Modify the medicines to discourage consumption. For solids, such as pills or capsules, add a small amount of water to the bottle to at least partially dissolve them. For liquid medicines, add enough table salt, flour or powdered spice (such as turmeric or mustard) to make a pungent, unsightly mixture that discourages anyone from taking it.Add kitty litter, sawdust, coffee grounds (or any material that mixes with the medication and makes it less appealing for pets and children to eat) to the plastic bag.3. Seal and conceal. Tape the container’s lid shut with packing or duct tape. Place it in a bag or container such as an empty yogurt or margarine tub to ensure that the contents cannot be seen. 4. Safe disposal of unused and expired medications in household trash:Do not place it in the recycling bin. 5. When discarding unused medications, ensure you protect children and pets from potentially negative effects.6. Consult pharmacist with any specific questions. Approved ByDate?Paul Wagner ?Reviewed/Revised ByDate????????Protocol: Counseling Patients on Medication intake and side effectsPurpose: Counseling of patients filling prescription is an essential aspect of pharmaceutical care. The use of a protocol summarizing all relevant counseling aspects can be a useful tool to standardize pharmaceutical care and to promote implementation.Aspects to include in counseling are: IndicationDose and timing of intake. Mechanism of action What to do if a dose is missed Side effects Lifestyle advice Potential drug–drug (including nonprescription), drug–food, and drug–disease interactions or contraindicationsThe medication’s relationships to radiologic and laboratory procedures (e.g., timing of doses and potential interferences with interpretation of results) Prescription refill authorizations and the process for obtaining refills. Proper storage of the medicationProper disposal of contaminated or discontinued medications and used administration devicesWho has a role in counseling patients on medication intake and side effects?Providers can print medication inserts, which contain the information listed above.Approved ByDate?SB12-4-13?Reviewed/Revised ByDateProtocol: DEA – CONTROLLED AND PAIN DRUG DISPENSING POLICYPurpose: To ensure that all providers follow the recommendation of the board-adopted June 1, 2010 policy concerning controlled substances.Procedure: Providers at the Free Clinic will no longer be able to write prescriptions for controlled medications (those requiring a DEA number) on Free Clinic prescription pads. Exception made for chronic, stable Phenobarbital or clonazepam for treatment of seizure disorder if originally prescribed by a neurologist.Pain medication available in our Pharmacy will include acetaminophen, ibuprofen, Amitriptyline and certain SSRIs. Gabapentin will be available for treatment of diabetic neuropathy. (Note: Naproxen is available on the $4 formulary at Wal-Mart). Tramadol: New prescriptions for Tramadol will not be written.Patients currently taking Tramadol will be tapered off per protocol and no further prescriptions will be written.[The above procedure is a direct quote from the policy put forth from the board on June 1, 2010Approved ByDate?SB12-4-13?Reviewed/Revised ByDateProtocol: Dental Clinic PatientsPurpose: To ensure Dental Clinic patients being seen by the Dental Assistant that may need medication are seen by a medical provider when dentist is not present.Procedure: Dental Assistant to identify patient in Dental Clinic that needs medication such as antibiotic, ibuprofen or acetaminophen. Dental Assistant to ask front desk to have patient worked in to be seen by medical provider for evaluation of tooth/teeth involved. Dental Assistant to brief provider as to problem.The front desk is to pull the patient chart and print an encounter form.The Triage Nurse is to be notified to triage the patient.Once the patient has been seen, return to Dental desk for follow-up appointment.Patient then to check out at the front desk of the Clinic.Approved ByDate?RTW?6-10-13Reviewed/Revised ByDate????????Protocol: Medication RefillsPurpose: To ensure patients are able to get medication refills if the Clinic has to reschedule the patient’s appointment due to a provider cancellation. Procedure:Patient calls requesting medication refills due to provider cancellation.. Check EMR and verify patient’s appointment.Review medication list on QS1.Verify which medications need to be refilled.Send a message through EMR and have a provider write for enough medications to last until scheduled appointment. A patient recently seen in the last 3-6 months- does not need a visit to get medication unless documented by a provider that the patient needs to return for a medical visit. If the patient was a “NO SHOW” for an appointment, NO medication refills are to be given to the patient. An appointment should be made for the patient, at which time (s)he will receive medication refills. *NOTE* All refill requests can take up to 1 week to be sent to Anderson Free Clinic Pharmacy due to large amount of requests. FORMULARYFormulary and Communicating Changes on Medication availabilityFormulary can be found at exam rooms and Doctor’s StationsWhen changes occur on med-availability, the Pharmacist or Pharmacy Coordinator will submit to Medical Clinic notices that must be posted by Clinical Services Coordinator AND updates must be given orally as well to providerApproved ByDate??Reviewed/Revised ByDate???????? SECTION 6: TriageA. Protocol: Universal/Standard PrecautionUniversal/standard precautions will be observed by considering all blood and body fluids as potentially infectious. New elements of standard precautions include Respiratory Hygiene/Cough Etiquette and Safe Injection Practices. Procedure: Hand WashingAll staff must observe good personal hygiene, which includes hand washing. Staff should wash hands before and after each patient contact; before donning and after removing gloves or other personal protective equipment; before preparing and after administering medications or injections; after handling objects contaminated with blood or other potentially infectious materials; after using the toilet, blowing your nose, or covering a sneeze or cough; and before eating, drinking, or handling food. Procedure: Use of Gloves/Barrier PrecautionsGloves shall be worn when it can be reasonably anticipated the healthcare worker may have hand contact with blood, semen, vaginal secretions, urine, feces, saliva, sputum, vomitus, or any bodily substance. Note: Throughout the manual, unless otherwise specified, the term “gloves” will refer to Disposable latex examination gloves or suitable equivalent such as vinyl gloves or glove liners used underneath the latex gloves, if the employee is allergic to latex. Employees who are allergic to latex should not wear latex gloves or inhale powder from latex gloves worn by other staff. Procedure Gloves shall be used for all procedures where exposure to blood or body substances is expected, including patient care, cleaning equipment and environmental surfaces directly contaminated with such substances, or during any vascular access procedure. It is recommended that gloves be worn on both handsIf cross-contamination of surfaces and equipment is anticipated, one hand should remain ungloved and not be used to perform the exam. Change gloves between patient contacts. Gloves should not be washed or disinfected for continued used. Gloves should not be reused. If the gloves become torn or punctured, discard them and put on a new pair.If breaks in the skin are present on the hands, additional coverings may be worn under the gloves.For environmental cleaning purposes, heavier reusable household gloves may be used. They can be washed with soap and water after use and hung to dry. Discard the household gloves if they are cracked, peeling, torn or punctured, or show other signs of deterioration.Key PointsDisposable gloves will be made available for all staff to wear when contact with body substances is expected.Vascular access procedures include such things as finger- or heel- sticks.When both hands are gloved, be careful not to contaminate equipment and surfaces while performing patient exams.Employees should evaluate their working situations to determine appropriate glove use.Washing gloves with soap may cause “wicking” (i.e., the enhanced penetration of fluids through undetected holes in the gloves). Disinfecting agents will lead to glove deterioration. Gloves should be checked for tears and should not replace hand-washing.Glove-liners, bandages, gauze or finger cots can help minimize hand irritations.Lightweight examination gloves do not hold up under prolonged exposure to disinfection procedures. Note: The use of gloves is not intended to replace good hand-washing practices; rather, it is meant to support and supplement hand washing.Procedures & Expected Glove UseMandatoryDrawing bloodDoing finger- or heel-sticksSpinning blood in centrifugesTesting urine with dipsticksDoing Pap smears and testing for sexually transmitted diseasesPelvic and/or rectal examsChanging diapersDoing an oral examHandling/preparing lab specimensOptionalGiving injectionsDoing physical exams on childrenNot RequiredTaking temperaturesTaking blood pressureTaking heights, weightsDoing breast examsUSE OF ADDITIONAL PERSONAL PROTECTIVE EQUIPMENTAdditional forms of barrier protection such as goggles, masks and gowns are necessary if splattering of blood or other body fluids is anticipated. Patients with signs or symptoms or infectious tuberculosis disease should wear a surgical or procedure mask; healthcare workers, visitors, and others entering the room of a suspected or confirmed infectious TB disease patient should wear, at minimum, N95 disposable respirators that are user-seal checked. PROVISION OF PERSONAL PROTECTIVE EQUIPMENTThe employer shall provide, at no cost to the employee, necessary protective personal protective equipment and clean or replace such items as needed.B. Protocol: Privacy of Patient Medical InformationPurpose: To ensure that HIPPA guidelines are followed.Reviewed/Revised ByDate?SB12-4-13???????Procedure: Record Request Patients may request a copy of their records in writing.Patients have the right to request an appointment, lab and test results by phone, regular mail and e-mail.Patients may list in chart other individuals to whom information such as messages may be given, or who staff may speak with about the patient.Patient information given out to unapproved individuals may result in the termination of the employee or the volunteer. Approved ByDateSBarnes1-15-14C. Protocol: Access to Medical RecordsProcedure: All Clinic staff will have access to patient medical records as related to individual needs of patients. Volunteer staff will have access to patient medical records, as related to Adding appointment dates to incoming labs, consults, etc.Scanning labs, consults, etc.Post-auditsNeither staff nor volunteer will access patient medical records for the purpose of obtaining information for use outside of the Clinic or to disseminate this information to persons other than the patient or those listed in the rmation given out improperly may result in termination of staff or volunteer.All recorded requests from outside providers and/or agencies will have a signed release by the patient. Procedure: Expediting Medical Records RequestsThe task of processing Medical records should only be handled by trained staff or volunteers trained and approved for such responsibility by Intake Coordinator or Executive DirectorMake sure a signed “CONSENT OF CARE AND RELEASE_RETRIAVAL OF INFORMATION” Form is signed and in Patients ChartMake sure requests are being processed in the order they were received. The date request was received should be stamped or written on the top right corner of request sheetVerify if patient signed authorization to release records. Records may not be released without written authorization. If patient is deceased, court documentation indicating the executor of Patient’s will is typically the documentation necessary. Exceptions are handled only by Executive Director.Locate patient chart. Request for records of Honea Path patients are processed in Honea Path. If you cannot find patients records see Sandra or Barbara Maxwell. Places to look – HP patient list. Check patient chart for Date of Birth (DOB) or Social Security Number (SSN) to confirm that the correct chart has been pulled. (Patients occasionally have same first and last name.)Check the period of time that records are being requested. Fax or copy only those records in the requested time frame. Records from referral visits can be sent. Records that are in patients chart belong to us. For Voc Rehab and DSS requests charge $15.00, sign on line above provider. They will not pay more than the flat fee. Some DSS offices have specific request / i.e Invoice page must be page 1Do not invoice for record search. If records are not found , send cover sheet only stating the facts, such as:“No records were found for ________.” “________________ has not been seen during the period you requested”For attorneys, Insurance companies, and research companies complete work sheet on fax cover sheet to determine fee. The invoice will walk you thought determining the fee, that is based on number of pagesFor patient self-requests Front Office staff or volunteer will:Ask patient if he/she has been seen during that period and if this is the first request (to make sure we have records to process)Due to the volume of patient request that were not picked up, patient must pay $15 before we process the request On a plank Invoice: Complete top. Mark Paid in front of the $15. Staple invoice to Medical Record Request and signed release. Patient must be informed that requests will be processed in the order they are receivedMake copy of invoice to patient if requested.Give check or cash to Executive Director, in an envelope w/ patient name/ date Person processing the request Complete invoice to document the balance patient owes – to be paid when picking up the records. Highlight balance. Place record in envelope with Invoice stapled outsideHospitals or doctor’s office are not invoicedRecord the processing of the Medical Records in Patient EMR or on Paper chart if that patient is inactiveExample: Date, faxed (or mailed) medical records from 1/2010 to present to Voc Rehab (or wherever you sent it) and write your initials (very important !!!!)If Paper Chart: Punch holes in request and cover sheet/invoice and place in patients chart under problem list.Record what you did in the computer. There is an Excel document to log Medical records processed along with payment received.If Paper Chart: Return patient record to where you found it immediately after processing and documenting the Medical RecordsThere is a folder with invoices paid. Find patient name and matching request. Enter Check amounts and dates received.However, if you are not trained ON HOW TO LOG, write what you did on a piece of paper, WITH A NOTE to Lee Richardson or Jake (our Chief Medical Records Request Expeditors)ALWAYS: Make entries of requests made on Computer, including those that were dates when there were not visits or records.Anderson Free ClinicContact: (864) 226-1294 FAX: 261- 4543Honea Path Free ClinicContact Phone and Fax: (864) 369-9493 REQUEST FOR MEDICAL RECORDS This authorizes the physicians, hospitals, or attendants at ______________________________ Doctor, Clinic or Hospitalto furnish full and complete medical reports, for the period of ______ to _______. hereby requested by the undersigned, to the party identified below □ Anderson Free Clinic 414 N. Fant St. P.O. Box 728 Anderson, SC 29622□ Honea Path Free Clinic 34 N. Main St. Honea Path, SC 29654 □ Doctor/Facility or Office_______________________Name of facility/Doctor ______________________________Street______________________________City ST ZIP_____________ ______________Ph Number Fax Number□ Myself Method: □ Will pick up □ Mail to following address:____________________________Street____________________________City ST ZIP________________________This authorization includes (please initial only what is necessary, please)___ Nurses notes ___ X-ray film *Note: Fees may apply if not a doctor or Medical Facility Name of Patient: ________________________________________ SSN: __________________ Date of Birth: ______________ Comments: ________________________________________ _______________________________ Signature of patient or guardian / Date requested Witness (Staff/Volunteer) Please Print Approved ByDate?Rita Williams?6-10-13Reviewed/Revised ByDate????D. Protocol: Front Pre-visit PreparationProcess:Print daily patient list.Check labs, etc. in Practice Fusion under timeline.Call Lab/Rad if missing in PF.Check demographics & cert dates in PF.Highlight Lab/Rad Box if not done & Notes if not done. Write what Lab/Rad missing in Notes section. Approved ByDate?Reviewed/Revised ByDate?D. Protocol: Patient AccountabilityPatients with appointments are seen only if: We have the results of all labs and tests requested by the doctor at the previous visit. All medications are brought along and are in their original bottles, including meds prescribed by doctors outside the Free Clinic or not dispensed at the Free Clinic, including over-the-counter medications. If patient appointment is cancelled or rescheduled because of test not being done by patient or not being done in time for us to have results at the Free Clinic, providers will not refill prescriptions until patient’s rescheduled visit.Approved ByDate? RW1-15-14?Reviewed/Revised ByDate??E. Protocol: Cleaning of Exam Rooms Purpose: To reduce the risk of spread of infection, parasite, transmission, and/or contagious skin infections.Procedure: Gloves must be worn for the cleaning of al exam rooms.Tear off table paper and dispose in trash container between each patient visit. Exam paper soaked with blood or body fluid should be placed in biohazard trash. Wipe table with 10:1 bleach solution at the end of the day and pull paper over table.Wipe stethoscope and cuff, inside and outside, with 10:1 bleach solution at end of day. Allow cuff to dry. The countertop should be cleaned at the end of each day using a 10:1 bleach solution and whenever any liquid, blood or body fluid is noted on countertop between patient visits. The sink should be cleaned at the end of the day using a 10:1 bleach solution. New 10:1 bleach solution should be made each day.Sharps, biohazard containers and trash are discussed under another procedure. F. Protocol: Digital ThermometerPurpose: To obtain body temperature reading for physical assessment.Approved ByDateRTW?6-17-13Reviewed/Revised ByDate????????Equipment: Instant Temple ThermometerProcedure:Press OK and push blue ON/OFF button. When you hear two beeps, place on temple. Use on clean, dry skin. Wipe away any perspiration prior to use. Make sure patient and thermometer do not move while measurement is in progress. [Correct temple-placement and good contact with the body ensure reliable results.]When done, the thermometer will beep.Cleanse with a cotton ball soaked with alcohol.G. Shortness of BreathApproved ByDate? SB?12-4-13Reviewed/Revised ByDate????????Purpose: To identify and take action for patients showing symptoms of shortness of breath.Procedure: Take patient’s respiratory rate.Document on patient’s chart.For Respirations Greater Than 30: Notify the provider if patient is breathing 30 times or more per minute, orIf patient complains of inability to get a good breath.Check patient’s pulse ox and record in chart. If less than 90%, notify provider immediately and administer oxygen per hypoxia protocol.For Respirations less than 8 per minute: Notify providerActivate 911 if ordered or if not provider is presentH. Protocol: Pulse OxApproved ByDate? RTW6-12-13?Reviewed/Revised ByDate?SB7-3-13???????Purpose: To determine level of capillary oxygen level of patient complaining of shortness of breath or difficulty breathing. Results to be used to determine need for emergency medical procedure.Procedure:Count patient respirations for one minute.Listen to patient’s lungs. Place finger probe over end of patient’s finger and wait for automatic digital readout.Record findings in patient’s chart and notify the provider of the reading.Maintenance:Check pulse monthly to be sure that display comes on with use, and record in log. Know the location of Log!I. Protocol: Referral for Sleep Studies Must have a physician’s order.May or may not have an Epworth score of 10 or greater.The following information must be completed and faxed to 512-4904: AnMed Health physician order formSleep Assessment Form including height and weightAnderson Free Clinic Referral FormOffice Visit dictationScan document into patient chart under Referrals. Place patient’s name on Sleep Study Referral List (kept in notebook at front desk).J. Protocol: Donation of CPAP/BiPAP machinesDonor should be given a receiptOnce we have several, either we will take the machines to the Sleep Center Sleep Center will e-notify the Free Clinic Clinical Coordinator each time a machine is given out to a Free Clinic patientApproved ByDate?Reviewed/Revised ByDate????????K. Protocol: Chart Post-AuditPurpose: To ensure that all documented recommendations for the patient in the Plan are executed as appropriate. Procedure:Read the S.O.A.P. note in its entirety.Make any and all changes that have been documented within the visit, including any medications that have been changedFor any referral, verify referral was initiated under timeline and referrals. Once this is done, verify that the referral department received information.Fax Encounter sheet, with Referral request for EMG/NCT or Sleep Studies.Place all documents to be scanned in the “To Be Scanned” basket. Approved ByDate? RTW6-15-13?Reviewed/Revised ByDate???????? L. Protocol: Infectious Waste Management UNIVERSAL PRECAUTIONS WILL BE USED AT ALL TIMES WHEN HANDLING INFECTIOUS WASTEProcedure: All infectious waste will be placed in containers which are labeled with the Biohazard symbol and are lined with the red Biohazard bags.Biohazard containers will be placed in all treatment rooms, the lab, and the patient triage room.Infectious waste will be removed from all Biohazard containers at least weekly or as needed when containers are full.The collected biohazard bags will be placed in the large biohazard trash cans located in the locked storage closet located on the ground floor. The trash cans will be lined with red biohazard bags and the lids will remain closed at all times.A Regulated Waste Tracking label will be completed by AnMed employee and signed by an employee of the Anderson Free Clinic. The Infectious Wwaste storage closet will remain locked at all times and will be clearly marked with a universal biohazard symbol sign.Every Friday morning, the Infectious Waste cans will be picked up and weighed by an employee of AnMed Health. A Regulated Medical Waste Tracking Form will be completed by an AnMed employee and signed by an employee of the Anderson Free Clinic.The Pink Copy (copy 3) of the signed form will be placed in the Infectious Waste notebook, located in the Dictation Room file cabinet. The other two copies of the form will accompany the biohazard trashcans to the AnMed Health main campus. The Infectious Waste trash cans will be transported by truck to the AnMed Health incinerator and the waste will be disposed of according to AnMed Health Infectious Waste policies. Section 8: Supporting ProgramsBest Chance Network?(BCN) – a South Carolina's Breast and Cervical Cancer Early Detection ProgramThe Best Chance Network (BCN) program provides free breast and cervical cancer screening for South Carolina women who meet program eligibility requirements. Our goal is?to reduce deaths from breast and cervical cancer by providing underserved women in South Carolina access to breast and cervical screening and other BCN services. According to national and state statistics, South Carolina has one of the highest rates of uninsured women in the nation.Who May Qualify for Free Cancer Screenings:?A woman who:Lives in South Carolina30 to 64 years oldDoes not have health insurance or is underinsured (meaning her insurance only covers hospital care)Has deductibles of $1,000 or higherHas insurance that does not cover diagnostic servicesMeets income eligibility guidelines Best Chance NetworkFollows Income Eligibility Guidelines 6/30/16 – 6/29/17Household SizeAnnual Income1$23,760.002$32,040.003$40,320.00Each Additional Member Aprox. $8,320.00What Services BCN Provide:The following services are available for eligible women in South Carolina:Screening services:MammogramsClinical breast examsPap testsPelvic exams Women between the ages of 40 and 64 who qualify for BCN services may also qualify for the?WISEWOMAN Program?services.BCN is primarily funded by the Centers for Disease Control and Prevention (CDC), the Prevention and Public Health Funds and state funds allocated by the South Carolina Legislature. South Carolina has been providing services for the Breast and Cervical Early Detection Program (NBCCEDP), of which BCN is a part, since 1991. South Carolina was one of the first NBCCEDP fund recipients.Human papillomavirus testsDiagnostic testing for women with abnormal screening resultsSupport services including patient navigation and referral for treatmentCommunity education on breast and cervical cancerColon Cancer preventionThis?state-wide program?provides screening ?colonoscopy?to the uninsured medically underserved populations of South Carolina.?Qualified individuals are uninsured, live at 150% or below the poverty line, are between the ages of 50-64 (or 45-64 for African Americans), and?meet?eligibility criteria for?the program.?The Colorectal Cancer Prevention Network utilizes a virtual database and enhanced?navigation services to promote compliance and?education to individuals in the program.The Anderson Free Clinic makes referrals for qualifying men and women. See Patient Services Associates for procedures or contactCenter for Colon Cancer Research712 Main Street, Rm 614Jones PSC BldgUniversity of South CarolinaColumbia, SC 29208?Main Office Phone:?803.777.1231 |?Fax:?803.777.1173Kendra McBride ? 803.777.1231 |?EmailAnnie Thibault ? ??803.543.9608 ?|?Email Section 9: SECURITYApproved ByDate?BBuF?5-30-13Reviewed/Revised ByDate???????? Protocols must be in place to ensure the safety of the staff and Patients of the Anderson Free Clinic.Protocol: Handling violence or disorderly? such?as?the?use?of?vulgar?and?obscene?languageIdentify the person/s creating problem.Call Security or ask for Security to be called. The number is 864-512-1250 or 864-512-1554.Remove any patients from the area if concerned that the situation could escalate.Document that Security was called and place in patient chart if known. If serious, a “No Trespass” order can be issued against the individual.If the situation escalates, call 911 for the police. Protocol: RESPONDING TO AN ACTIVE SHOOTER (Code Silver)Purpose: To best prepare working personnel for an active shooter situation, to effectively respond and help minimize the loss of life.Procedures:Staff and Volunteers Training conducted annually – scheduled by Office ManagerKnow important number to callEmergency Services: 911Anderson County Sheriff’s Office: receptionist (864)260-4400 Administration (864)260-4421Anderson Police Department: (864)231-2277Anderson Fire Department: Fire Station 1- (S. McDuffie St.) (864)231-2259 Fire Station 1- (N. Main St.) (864)231-2261AnMed Health hospital: (864)512-1000Anderson FBI Field Office: Columbia- (803)551-4200 ; Charlotte- (704)672-6100 ; Atlanta- (404)679-9000Anderson Free Clinic Address: 414 N. Fant St., Anderson, SC 29621Anderson Free Clinic Phone Number: (864)512-7801Executive Director Cell: 706-525-9644Have in place an Emergency Action Plan (EAP)Conduct training exercises. Together, the EAP and training services will prepare your staffMaintain updated Emergency Action Plan (EAP) for Active Shootingwith input from several stakeholders, owners/ including local law-enforcement and emergency responders. An effective EAP includes:A preferred method for reporting fires and other emergenciesAn evacuation procedureEmergency escape procedures and route assignments (i.e., floor plans, safe areas)Contact information for, and responsibilities of, individuals to be contacted under the EAPInformation concerning local area hospitals (i.e., name, telephone number, and distance from youer location)An emergency notification system to alert various parties of an emergency, including individuals at remote locations within premises, local law-enforcements & local area hospitals3. Conduct Training ExercisesThe most effective way to train your staff to respond to an active shooter situation is to conduct mock active shooter training exercises. Local law-enforcement is an excellent resource in designing training exercises. Recognizing the sound of gunshotsReacting quickly when gunshots are heard and/or when a shooting is witnessed: Evacuating the areaHiding outActing against the shooter as a last resortCalling 911Reacting when law-enforcement arrivesAdopting the survival mindset during times of crisisOffice manager responsibilities:Institute access controls (i.e., keys, security system pass codes)Distribute critical items to appropriate managers/employees, including:Floor plansKeysFacility personnel lists and telephone numbersCoordinate with AnMed security department to ensure the physical security of the locationAssemble crisis kits containing:RadiosFloor plansStaff roster, and staff emergency contact numbersFirst aid kitsFlashlightsPlace removable floor plans near entrances and exits for emergency respondersActivate the emergency notification system when an emergency situation occurs4.Know the Plan:Evacuate If there is an accessible escape path, attempt to evacuate the premises. Be sure to:Have an escape route and plan in mindEvacuate regardless of whether others agree to followLeave your belongings behindHelp others escape, if possiblePrevent individuals from entering an area where the active shooter may beKeep your hands visibleFollow the instructions of any police officersDo not attempt to move wounded peopleCall 911 when you are safe Hide OutIf evacuation is not possible, find a place to hide where the active shooter is less likely to find you. Your hiding place should:Not trap you or restrict your options for movementBe out of the active shooter’s viewProvide protection if shots are fired at your direction (i.e. an office with a closed and locked door)If in an exam room, move the examination table toward the door, long- ways, and stay behind it To prevent an active shooter from entering your hiding place,Lock the doorSilence your cell phone and/or pagerTurn off any source of noise (i.e. radios, televisions)Hide behind large items (i.e. cabinets, desks)Remain quietIf evacuation and hiding are not possible:Remain calmDial 911, if possible, to alert police to the active shooter’s locationIf you cannot speak, leave the line open and allow the dispatcher to listen D) Take action against the active shooterAs a last resort, and only when your life is in imminent danger, attempt to disrupt and/or incapacitate the active shooter by:Acting as aggressively as possible against him/herThrowing items and improvising weaponsYellingCommitting to your actions E) Respond to Law Enforcement upon arrivalLaw enforcement’s purpose is to stop the active shooter as soon as possible. Officers will proceed directly to the area in which the last shots were heard.Officers usually arrive in teams of 4Officers may wear regular patrol uniforms or external bulletproof vests, Kevlar helmets, and other tactical equipmentOfficers may be armed with rifles, shotguns, handgunsOfficers may use pepper spray or tear gas to control the situationOfficers may shout commands, and may push individuals to the ground for their safetyHow to React When Law-Enforcement Arrives:Remain calm and follow officers’ instructionsPut down any items in your hands (i.e. bags, jackets)Immediately raise hands and spread fingersKeep hands visible at all timesAvoid making quick movements toward officers such as holding on to them for safetyAvoid pointing, screaming, and/or yellingDo not stop to ask officers for help or direction when evacuating--- just proceed in the direction from which officers are entering the premisesInformation to provide to law-enforcement or 911 operator:Location of the active shooterNumber of shooters, if more than 1Physical description of shooter(s)Number and type of weapons held by the shooter(s)Number of potential victims at the locationThe first officers to arrive to the scene will not stop to help injured persons. Expect rescue teams comprised of additional officers and emergency medical personnel to follow the initial officers. These rescue teams will treat and remove any injured persons. They may also call upon able-bodied individuals to assist in removing the wounded from the premises. Once you have reached a safe location or an assembly point, you will likely be held in that area by law- enforcement until the situation is under control, until all witnesses have been identified and questioned. Do not leave until law-enforcement authorities have instructed you to do so.F) MANAGING THE CONSEQUENCES OF AN ACTIVE-SHOOTER SITUATIONAfter the active shooter has been incapacitated and is no longer a threat, The Executive Director or Office Manager should engage in post-event assessments and activities, including:An accounting of all individuals at a designated assembly point to determine who, if anyone, is missing and potentially injuredDetermining a method for notifying families of individuals affected by the active shooter, including notification of any casualtiesAssessing the psychological state of individuals at the scene, and referring them to health-care specialists accordinglyIdentifying and filling any critical personnel or operations gaps left in the organization as a result of the active shooterLESSONS LEARNEDTo facilitate effective planning for future emergencies, it is important to analyze the recent active-shooter situation and create an after-action report. The analysis and reporting contained in this report is useful for:Serving as documentation for response activitiesIdentifying successes and failures that occurred during the eventProviding an analysis of the effectiveness of the existing EAPDescribing and defining a plan for making improvements to the EAPApproved By BBuFDate 5-14-13??(Effective Date)Reviewed/Revised ByDate????????C. Protocol: Treatment of Intoxicated Patients Purpose: To provide a protocol for the treatment of Intoxicated persons who present themselves to the dental or medical clinic for an appointment or walk-in care. Procedures: Intoxicated individuals will not be treated at the Free Clinic. This policy is necessary for the following reasons:Intoxicated patients are often unable to remember or to follow medical/dental instructions.Intoxicated patients are more likely to become nauseated during or after dental treatment.Intoxicated patients cannot give adequate medical histories.Intoxicated patients cannot be given appropriate pain medications due to the possible interactions between the pain medication and the intoxicating substance.Intoxicated patients can become abusive, unmanageable and violent while receiving treatment.Procedure: If a patient, in the judgment of the treating provider, is under the influence of alcohol or other intoxicating substances, he/she will be asked to leave the Clinic and return when sober for care. Staff and/or volunteer may not at any point confront the patient and position self to and unsafe interaction with patient. Patient state is documentedAnMed Security or, if deemed necessary, 911 will be called to remove the intoxicated patient if he/she should become belligerent or abusive. D. Protocol: Storing and Ordering Supplies Inventory check once a month (includes Emergency Box & all used meds by Clinical Services Coordinator or it can be designated to trained individual or group Supplies ordered as needed, but exercising anticipation of needsRequests made in writing to Office Manager ................
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