Checklist of Primary Care Practitioner privileges in ambulatory care for use with any applicants or new hires.
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- 45_DelienationofPrivilegesinAmbulatoryCare.pdf (215.72 KB)
This form should be filled out annually by any clinical subcontractors. It outlines licensing, appointment certification and credentialing for any clinical staff that provides services under the subcontract.
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- 49_MedicalClinicalStaffReportForm.pdf (121.6 KB)
Clinical Assistant privileging request form for lab procedures related to In-House Lab Tests and Microscope Use.
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Clinical Assistant privileging request form related to nursing abilities, patient well-being, and IVs.
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This document outlines the process a health center goes through to appoint a new clinician to staff.
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- 42_ClinicalHiringFlowChart.pdf (198.17 KB)
Sample written policy for clinician appeals and hearings related to privileging and appointment.
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- 74_appealandhearingprocess.pdf (186.82 KB)
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Medication refills may be approved by an RN with co-signature of licensed provider, according to the following guidelines.
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- 3B.1.09 Medication Refills.doc (41.5 KB)
Sample policy for dispensing pre-packaged and sample pharmaceuticals.
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- proceduredispensingmeds.doc (21 KB)
Sample policy describing the overall procedure for dispensing medication.
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- Pharmdispensation.doc (24.5 KB)
Sample policy describing the mechanisms to procure patient medications.
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- PharmaceuticalPolicy.doc (25.5 KB)
Sample health center pharmaceutical policy and procedure manual (10 pages).
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- PhamacyPP.pdf (26.67 KB)
Sample policy outlining the documentation of medication refill requests.
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- medicationrefill.doc (22.5 KB)
Written protocol outlining the process for handling prescription requests in the clinic.
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- PrescriptionRequestProtocol.doc (32.06 KB)
CSHS providers will provide to all patients who have undergone diagnostic studies their results in a timely manner.
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Sample procedure for copying OB records for Certified Nurse Midwives. The procedure includes copying OB records and closing OB files.
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- MAINTENANCEOFOBRECORDS.doc (24 KB)
Sample clinic policy to assure accurate and detailed record of all PPD testing in the clinic.
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- PPDAdminRecord.pdf (451.48 KB)
A sample job description for a registered nurse/case manager.
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- 65_RegisteredNurseCaseManager.pdf (374.43 KB)
Very comprehensive Medical Records Technician job description and performance evaluation.
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- 413_MedRecordsTechnician_0.doc (331.5 KB)
Job description for a Medical Records Technician.
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- 414_MedRecTechnician2.doc (34.5 KB)
Job description for a Medical Records Coordinator
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- 416_MedRecCoordinator.doc (29.5 KB)
Job description for a medical records clerk.
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- 412_MedRecClerk3.doc (26.5 KB)
A 2-page medical records clerk job description.
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- 408_MedicalRecordsClerk.doc (36 KB)
Full-time Medical Records Clerk II job description.
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- 410_MedRecClerkIIFT.doc (33 KB)
Position description for a Medical Records Clerk II.
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- 407_ClerkII_MedRec.doc (30.5 KB)
Job description for a part-time medical records clerk I.
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- 409_MedRecClerkIPT.doc (31 KB)
Job description for a Lead Medical Records Clerk to, nder limited supervision, perform medical records activities including filing, pulling and delivering medical records to the proper location and handle the information confidentially.
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- 417_LeadMedRecClerkFT.doc (33.5 KB)
Job description for a Health Information Manager who can plan and coordinate all services provided by the Health Information Department including the Medical Records department.
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- 418_HealthInfoManager.doc (30 KB)
Job description/evaluation form
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- 398_health_edu_descrip_eval.doc (97.5 KB)