Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Appointment Scheduling Access AM001
Department: Medical
Approved by: President/CEO
CMO
Revised:
March 14, 2011
Purpose: Provide guidance in scheduling appointments for new and established patients in the
electronic appointment scheduler. To maintain adequate scheduling slots and improve flow
and access to care. Myrtle Hilliard Davis Comprehensive Health Centers, Inc. will make every
effort to schedule patients’ appointment according to desired preference.
New Patient /Established Appointment: Query Intergy for birth date and social security to
check for previous visit in the Intergy System. Scroll down list to see if patient has been seen at
MHDCHC in the past. If the name appears in the roster with the same demographic
information, schedule patient using the same account number.
Policy: Any patients who make appointments who have not been registered will complete a
Quick registration per telephone. The information is needed:
1.
2.
3.
4.
5.
6.
First and last name (ask patient to spell name)
Current Telephone
Date of Birth
Social Security Number
What type of service needed
What day and time preferred
Established Patient must provide at least 2 types of information to schedule an appointment
1. First and last name (ask patient to spell name)
2. Social Security Number
3. Date of Birth
4. What type of service requested
5. What day and time preferred
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Requesting the address and phone number will facilitate contact for appointment reminder
services and mailing services if needed.
After registration is completed proceed to the Intergy Appointment scheduling. The following
steps will allow an appointment to be scheduled.
1.
2.
3.
4.
5.
6.
Click Select Patient Icon located to your left.
Enter patient date of birth, Name or Social Security number
Highlight the correct patient and click OK button
Patient name will appear under SELECT PATIENT ICON with existing appointments
Click on patient name to assure demographics are correctly entered
Select a patient preferred provider or assign to the rotating provider according to
availability.
7. Click on CALENDAR at top left of screen you may use arrows to go forward with dates.
8. Find available date by clicking on calendar or use SEARCH button bottom left to locate
put in date range for appointment.
9. Select date by either method highlight the date and click, screen opens to that date
10. Click on time slight desired screen will change to Make Appointment Screen use reason
code drop box and click appropriate reason or use free text to indicated reason.
11. Verify telephone number again and click SAVE to set appointment.
12. Patient should be given instruction to bring picture Identification, check stub or award
letter for disability/social security, insurance cards and something mailed to the current
address used when appointment scheduled.
13. Patient should arrive 30 minutes to 1 hour in advance to complete registration.
Please make every effort to schedule follow up appointments with same provider as
assigned. Give patient an appointment card for next visit.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Registration Process Access AR001
Department: Fiscal
Approved by: President/CEO
CFO
Revised:
March 2011
Purpose: To ensure that information obtained is adequate to assure that the health center is
reimbursed for services provided.
Policy: To establish baseline demographics, financial and insurance information in the
electronic health system. The registration process initiates HIPAA Privacy Practice compliance
by having patients sign required documents. The process also includes patient signing the
required Consent for Treatment/Financial Responsibility document.
Procedure:
New Patients and update evaluation:
1. Patient completes a pre-numbered registration form.
2. Once called to the registration area patient must provide the appropriate documents
Current photo I.D. (Driver’s License, Passport, State I.D., Credit card photo)
Proof of residency (piece of dated mail)
Proof of income (check stub, income tax return or unemployment statement)
3. Enter patient demographic and financial information
4. Verify insurance coverage prior to entering information into system
5. Once all information is verified and entered into the system patient signs the following
forms:
a. Consent for Treatment /Financial Responsibility
b. Patient Registration Form
c. Registration Verification Form
d. HIPPA Privacy Notice
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Established Patients: Patients with scheduled appointments are verbally asked for current
demographics (address and phone number) if information has changed, patient will be update
by clinical support staff in the demographics. All financial information changes should be
directed to registration for update. Patients who have not updated their registration
information in the past 12-months will be required to complete the registration process to
update information.
Detailed Registration Processes:
1. When registering patients, registrar should request the following information; a picture
Identification, check stub or award letter for disability/social security, insurance cards
and a mailer to the current address used when appointment scheduled.
2. Using the 3 options to identify patients’(name, DOB, SS#) in the system either locate
the temp registration or current registration information in Intergy ask patient to
verbally give the information and check against what is in system, make any necessary
changes by clicking (M)modify, (C)cancel, (D)dependent, (I)insurance (L)last Diagnosis,
(E)extended, (S)supplemental.
3. Select (M) to change information in the system or add information not obtained during
temp registration. Tab through all fields and update as appropriate which include
marital status, employer or school, dental medical record, insurances, ethnicity and
race, veteran’s status, language and person responsible for billed services. If different
from patient information.
4. Enter emergency contact information in screen provided (name, address, relation to
patient and phone number).
5. Insurance verification is critical to updating or creating a new registration on patient in
the Intergy system. Please follow correct channels to contact and verify private
insurance carriers, enter Medicaid/Medicare number in the State verification system
(EMOMED) to determine if coverage is current or discharged. The same verification
process applies for dental insurance coverage. Be sure to enter name, insurance group
number and person holding insurance policy in system to ease billing process. It is
important that the co-pay status be entered and patient be asked to make co-payments
prior to seeing provider.
6. (S) Supplemental is indicated for sliding scale fee patients. Under (I) document the
number in the household, enter gross income, number of dependents. If patient
presents proof of income the system will calculate the sliding fee percentage and saves
this information in the system.
7. The encounter is printed and the patient is then directed to cashier to make payment as
determined by the system and according to the Federal Poverty Guidelines.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Provider Empanelment Access AM002
Department: MEDICAL
Approved:
President/CEO
CMO
Revised:
March 2011
Purpose:
To ensure all patients are assigned to a provider and establish a Medical Home
by providing continuity of care and visit coordination.
1) Insured patients will be assigned based on the provider assigned as their
primary care provider.
2.) All new patients will be assigned to the provider with the smallest panel with
preference given to new providers.
3.) If a provider’s panel is full new patients are assigned according to availability.
4.) Patient may request a provider of their preference. When appropriate a
patient’s visit should be coordinated with other providers (i.e. ophthalmology,
podiatry) and diagnostic tests (i.e. lab or radiology tests).
5.) Patients assigned through the Community Referral Coordinator Program
at area hospital emergency rooms are assigned to the next available provider or
to their PCP if they are an established patient.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Same day/ Next day Appointment Scheduling Access AM003
Department:
MEDICAL
Approved by: President/CEO
CMO
Revised Date: March 2011
Purpose: MHDCHC will provide access to meet the needs of the patient with Same Day/Next
Day appointments. The appointment scheduling template facilitates scheduling to
accommodate same day and next day appointments.
Policy: Support staff will add patients to appointment schedule as per patient request with
emphasis on urgent/emergent appointment access. When scheduling appointments, every
attempt should be made to accommodate patients need in a timely manner.
Procedure:
1. Patient requesting an urgent/emergent appointment or appointment for an acute
medical issue shall be given a same day/next day appointment.
2. Support staff to open the Appointment Scheduler that contains 2 extra slots per
appointment time slots between 8am-12pm daily, with Same Day and Next Day
appointments reason codes.
3. Support staff to add patient to the appropriate appointment slot in schedule template.
4. Support staff will only use one of the two extra appointment slots in the schedule
template allowing open access. (i.e. scheduled chronic condition plus same day
appointment in the same time slot)
5. Support staff to inform provider of urgent/emergent appointment added to schedule.
The availability of same day and next day appointments will allow MHDCHC to accommodate
patients attempting to access health care for acute medical conditions.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Walk-In Appointment Access AM003a
Department:
MEDICAL
Approved by: President/CEO
CMO
Revised Date: March 2011
Purpose: MHDCHC will provide access to meet the needs of the patient with walk-in
appointments. The appointment scheduling template allows for the addition of walk-in
patients.
Policy: Patients walking into MHDCHC for acute care are assigned to the designated walk-in
provider or added to available slots on the appointment schedule template (i.e. same day
appointment). In the event all provider schedule templates are at capacity, walk-in patients are
triaged by the Clinic Manager and Site Coordinators or professional nurses.
Procedure:
1. Walk-in patient presents to cashier or registration.
2. Patients are issued an encounter to see the designated walk-in provider or added to
available appointment slots on the provider schedule template (i.e. same day
appointment).
3. In the event all provider schedule templates are at capacity, walk-in patients are triaged
by the Clinic Manager and Site Coordinators or professional nurses.
4. Patients with no acute medical condition are given the option to wait for a provider or
make a next day appointment.
5. Patients that elect to wait for the providers who are at capacity are informed of possible
long wait time and added to schedule.
6. Providers are informed of patients added to schedule template.
The availability of walk-in appointments will allow MHDCHC to accommodate patients
attempting to access health care for acute medical conditions.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Triage Policy Access AM004
Department: MEDICAL
Approved by: President/CEO
CMO
Revised:
March 2011
Purpose: To provide patients access to have same day medical advice and see if concern
warrants immediate or urgent medical care.
Policy: Patients seeking medical service who may be in distress upon arrival to facility will be
assessed by the clinic manager/site coordinator or professional nurses. The clinic manager/site
coordinator or professional nurse will greet the patient and ask reason for the visit. The clinic
manager/site coordinator or professional nurse will determine if patient will be seen same day
or given appointment for the earliest availability of service. The clinic manager/site coordinator
or professional will determine the service area in which the patient will receive care.
Definition of Terms
Emergent- patient in unstable condition and require immediate medical attention to module
for vital signs and assessment. Walk-in appointment scheduled (See chief complaints by body
regions/organs/systems)
Urgent- patient in stable condition requires vital signs assessment schedule as same day
appointment. (See chief complaints by body regions/organs/systems)
Appointment - patient assessed and given future appointment maybe Next day or according to
provider availability.
Attached is a list of STAT situation that require immediate intervention and a Chief Complaints
by body regions/Organ Systems.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
STAT TRIAGE SITUATIONS
ALLERGIC REACTION- difficulty swallowing/throat swelling, shortness of breath/chest tightness
CARDIAC- any chest pain
GASTROINTESTINAL-vomiting (Blood, food, liquids), bloody stools (bright red or tar colored)
FEVER-infant less than 3 moths temp > 100.4 Fahrenheit
NEUROLOGIC-sudden loss of balance, severe headache, droopiness of face on one side, or
inability to move one side, unsteadiness, unable to speak, loss of control of movements,
seizures or inability to swallow.
PREGNANCY- abdominal pain, bleeding lack of fetal movement, leaking fluid or severe
headaches and visual (eye) disturbances
POISONING- any awareness of suspected poisoning or ingestion
PULMONARY- shortness of breath, wheezing or coughing up blood and chest pain when
breathing
TRAUMA-large amount of bleeding from wound, laceration or head injury
VITAL SIGNS- self monitored V.S. with high numbers BP above14O/90, respiration greater than
50 in children and 40 in adults, heart rate greater than 120.
MENTAL HEALTH-mention of suicide, threatening harm to others, crying or hearing voices
SEXUAL ASSAULT-report of sexual assault
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Chief Complaint
Category/Action
HEAD
Headache-acute (24 hours or less) (check BP)
Urgent
Headache- chronic
ASAP
Headache-associated with blurred vision (check BP)
Urgent
Headache-associated high blood pressure (check BP)
See HEART (BP up)
Headache-associated with vomiting (check BP)
Urgent
Head injury
Urgent
Head injury-associated with decrease consciousness
Emergent
Head sore-ringworm
ASAP
Head sore-associated with exclusion from school
Urgent
EYES
Blurred vision-acute (check BP)
Urgent
Blurred vision-chronic
ASAP
Decrease vision-acute (check BP)
Urgent
Decrease vision-chronic
Appointment
Double vision-chronic
ASAP
Double vision-acute (check BP)
Urgent
Eye discharge
Urgent
Eye injury
Urgent
Eye injury-associated with active bleeding
Emergent
Eye pain
Urgent
Pink eye
ASAP
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Pink eye-associated with exclusion from school
Urgent
Chief Complaint
Category/Action
EARS
Decreased hearing
Appointment
Decreased hearing- associated with trauma
ASAP
Earache
Urgent
Earache- associated with discharge
Urgent
Ear discharge with pain
ASAP
Ear wax
Appointment
Infected external ear
Urgent
Post-auricular fissure-infected
Urgent
Ringing in ears-acute (check BP)
Urgent
Ringing in ears-chronic
Appointment
NOSE
Inability to smell
Appointment
Nose bleed
ASAP
Nose bleed-actively bleeding
Emergent
Nose injury-acute
Urgent
Nose injury – greater than 1week
ASAP/Appointment
Runny nose- associated with fever (check Temp)
Urgent/ASAP
Runny nose-chronic
ASAP/Appointment
Stuffy nose- associated with fever (check Temp)
Urgent/ASAP
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Stuffy nose-chronic
ASAP/Appointment
Chief Complaint
Categories/Action
MOUTH
Fever Blister
Urgent/ASAP
Mouth injury-acute
Urgent
Sores in mouth
ASAP
Sores in mouth associated with fever (Check temp)
Urgent
Sores in mouth-associated with decreased oral intake
Urgent
Thrush
ASAPT
Tooth abscess
ASAP
Tooth pain
ASAP
THROAT
Difficulty swallowing-acute (check temp)
Urgent
Difficulty swallowing-chronic
ASAP
Hoarse voice –acute (check temp)
Urgent
Hoarse voice-chronic
Appointment
Tonsils enlarged-acute (check temp)
Urgent
Tonsils enlarged-chronic
Appointment
Tonsils enlarged chronic- associated with hx difficulty breathing
ASAP
NECK
Neck injury-acute
Emergent
Neck injury-chronic (check BP)
Urgent/ASAP
Neck mass
ASAP
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Stiff Neck
Chief Complaints
Urgent/ASAP
Categories/Actions
CHEST
Chest pain-acute
Emergent
Chest pain-chronic (check BP)
Urgent
Rib injury
Urgent
Rib injury-associated with shortness of breath
Emergent
BREAST
Breast mass
ASAP
Breast pain
Urgent
Breast pain-associated with lactation
ASAP
Nipple discharge
ASAP
LUNGS
Coughing
Urgent/ASAP
Coughing associated with fever (check temp)
Urgent
Coughing associated with hemoptysis (blood in sputum)
Urgent
Difficulty breathing-acute
Emergent
Difficulty breathing-chronic
ASAP
Shortness of breath-acute
Emergent
Short of breath-chronic
ASAP
Wheezing
Emergent
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Chief Complaints
Categories/Actions
HEART
Chest pain-acute
Emergent
Chest chronic (Check Bp)
Urgent/ASAP
High Blood Pressure (check BP)
Urgent
greater than 160/100
Emergent
less than160/100 needs meds refill
ASAP
wants BP check
Appointment
Palpitations (check BP)
Urgent
Rapid pulse
ASAP
ABDOMEN
Abdominal mass
ASAP
Abdominal mass –associated delayed menses
ASAP
Abdominal-acute
Urgent
Abdominal pain-chronic
ASAP
Colic
Appointment
Constipation
ASAP
Diarrhea
Urgent/ASAP
Diarrhea- child (check temp)
Urgent/ASAP
Diarrhea- child associated lethargy
Emergent
Vomiting
ASAP
Vomiting-active
Urgent
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Chief Complaints
Categories/Actions
Vomiting-associated with head trauma (check BP)
Emergent
Vomiting-child associated with ingestion
Emergent
RECTAL
Constipation
ASAP
Diarrhea
Urgent/ASAP
Diarrhea-child (check temp)
Urgent/ASAP
Diarrhea –child associated with lethargy
Emergent
Hemorrhoids
Appointment
Increased flatus-gas
Appointment
Rectal bleeding
Urgent
Rectal pain
Urgent
Rectal trauma
Urgent
Rectal trauma associated with rape
Emergent
GENITAL/URINARY
Blood in urine
Urgent
Delayed menses missed period
Appointment
Diaper rash
ASAP/Appointment
Diaper rash-associated with diarrhea (check temp)
ASAP/Urgent
Dysuria-painful urination
ASAP/Urgent
Penile discharge
ASAP/Urgent
Penile trauma
Urgent
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Rape
Emergent
Chief Complaints
Categories/Actions
Scrotal mass
ASAP
Scrotal mass associated with pain
Emergent
Scrotal pain
Emergent
Vaginal Bleeding-not associated with menses
Urgent
Vaginal bleeding prenatal patient
Emergent
Vaginal itching
ASAP
Vaginal trauma not rape
Urgent
EXTREMITIES
Hot joints
Urgent
Numbness (check BP)
Urgent
Pain-acute
Urgent
Pain acute associated with chest pain
Emergent
Pain chronic
Appointment
Swollen joint associated with trauma
ASAP
Tingling in extremities (check BP)
ASAP/Urgent
Trauma
Urgent
SKIN
Chickenpox
Contact Provider
Discoloration
Appointment
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Itching
Appointment
Mole
Appointment
Rash
Appointment
CHIEF COMPLAINTS
Categories/Actions
Rash-associated with exclusion from school
ASAP/Urgent
Sore
Appointment
CNS
Decreased consciousness
Emergent
Dizziness (check BP)
Urgent
Double vision (check BP)
Urgent
Headache (See head)
Numbness (check BP)
Urgent/ASAP
Seizure
Emergent
Tingling in extremities (check BP)
ASAP/Urgent
Unresponsive person
Call Code Blue
MISCELLANEOUS
Fever- Check Temperature
Axillary greater than 101.6 oral greater than 103.6
Emergent
Axillary greater than 98.6 or greater than 99.6
Urgent
History of fever in the last 24 hours
Urgent/ASAP
WIC
Appointment
Physical Exam (P.E.)
Appointment
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
P.E. DFS
Urgent
P.E.-associated with exclusion from school
ASAP
CHECK UP
Shots- (childhood immunizations)
Appointment
CHIEF COMPLAINTS
Categories/Actions
Shots- (childhood immunization) high risk infant program
ASAP/Urgent
Shots-tetanus-associated with injury
Urgent
Shots-tetanus-job/school
Appointment
Shots-Hepatitis A immunization- job related
Appointment
Pregnancy test
ASAP/Appointment
Medication refills
ASAP
Check blood pressure at intake refer to BP guide for change of action/category
Check temperature at intake refer to temperature guide for change of action/category.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Triage Policy Access AM004
Department: MEDICAL
Approved by: President/CEO
CMO
Revised:
March 2011
Purpose: To provide patients access to have same day medical advice and see if concern
warrants immediate or urgent medical care.
Policy: Patients seeking medical service who may be in distress when calling the facility will be
assessed by the clinic manager/site coordinator or professional nurses. The clinic manager/site
coordinator or designee will greet the patient and ask reason for the visit. The clinic
manager/site coordinator or designee will determine if patient will be seen same day or given
appointment for the earliest availability of service. The clinic manager/site coordinator or
designee will determine the service area in which the patient will receive care.
Procedures:








Operator will transfer phone calls to clinic manager/site coordinator from patients
seeking telephone medical advice/care. If patient describes symptoms or diagnoses
listed on STAT triage list the operator will page Clinic Manager/site coordinator or
designee to pick up call
The nurse will access the computer to determine appointment availability at the start of
clinic day
The nurse will inform staff of additional patients scheduled in EHR by tasking or
telephone.
The patient with an urgent situation will be scheduled for a same day appointment.
If nurse unable to meet the needs of caller and PCP unavailable, the Chief Medical Officer
will be contacted.
Calls requesting results of lab test, medication refills are forwarded to the Chief Medical
Officer.
Calls requesting Certificate of Attendance or work excuses should be forwarded to Health
Information Management.
If an emergency situation will advised to seek 911 emergency services.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
STAT TRIAGE SITUATIONS
ALLERGIC REACTION- difficulty swallowing/throat swelling, shortness of breath/chest tightness
CARDIAC- any chest pain
GASTROINTESTINAL-vomiting (Blood, food, liquids), bloody stools (bright red or tar colored)
FEVER-infant less than 3 moths temp > 100.4 Fahrenheit
NEUROLOGIC-sudden loss of balance, severe headache, droopiness of face on one side, or
inability to move one side, unsteadiness, unable to speak, loss of control of movements,
seizures or inability to swallow.
PREGNANCY- abdominal pain, bleeding lack of fetal movement, leaking fluid or severe
headaches and visual (eye) disturbances
POISONING- any awareness of suspected poisoning or ingestion
PULMONARY- shortness of breath, wheezing or coughing up blood and chest pain when
breathing
TRAUMA-large amount of bleeding from wound, laceration or head injury
VITAL SIGNS- self monitored V.S. with high numbers BP above14O/90, respiration greater than
50 in children and 40 in adults, heart rate greater than 120.
MENTAL HEALTH-mention of suicide, threatening harm to others, crying or hearing voices
SEXUAL ASSAULT-report of sexual assault
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
Policy:
Hours of Operation and After Hours Medical/Dental Coverage Care Instructions
AM005
Department: MEDICAL
Approved by: Board of Directors
President/CEO
CMO
Revised:
March 2011
Purpose: To provide clinical support 24 hours a day, 7 days a week with On Call providers
available by pager or cell phone after hours between 5:00pm-8:00am, to ensure that services
are available and accessible during the hours when the health centers are closed in accordance
with (section 330 (k) (3)(A)of the PHS Act.)
Procedure:
1) Patients have access to health care services during Board approved hours of operation
Monday-Friday from 8:00 a.m. - 5:00 p.m. at all three sites with extended hours at Myrtle
Hilliard Davis Comprehensive Health Center 1 on Wednesday from 5:00 p.m. – 8:00 p.m.,
Homer G. Phillips on Thursday from 5:00 p.m. - 8:00 p.m. and Florence Hill Health Center on
Monday from 5:00 p.m. – 8:00 p.m.
2) When a patient calls the health center after hours there is a message stating that if this is an
emergency or life threatening issue hang up and call 911. The message then instructs
patients to call the exchange at 314-995-2122 to speak to a provider.
3) Patients needing assistance after health center hours will call the Exchange number at
(314) 995-2122. The Exchange will page or call the provider’s cell phone as per MHDCHC’s
monthly On Call schedule in Adult Medicine, Women’s Health, Pediatrics and Dental.
4) The On Call provider will answer the page ASAP (within 15 minutes).
5) The provider will call the patient seeking after hour medical attention and treat
appropriately.
6) If the On Call provider does not respond to the exchange’s page or answer cell phone the
exchange will then contact the Chief Medical officer.
7) The Chief Medical Officer will then call the patient seeking after hour medical attention and
treat appropriately. The Chief Medical Officer will then investigate why the provider did
not respond and make appropriate adjustments.
8) Any medical treatment done while On Call should be documented in electronic health
record.
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Myrtle Hilliard Davis Comprehensive Health Centers, Inc.
9) During office hours 8am to 5pm Monday through Friday the exchange will forward any calls
to the provider’s office location.
10) The support staff will task patient telephone calls to providers in the electronic health
record and verbally inform them. The provider will answer urgent telephone calls
immediately and other telephone calls before the end of day (morning call before lunch and
afternoon calls before 5pm).
11) The exchange telephone number shall be posted on the main entrance at the three health
center sites, printed on provider appointment cards, and included on the service brochures.
12) The communications company will provide a daily activity record of calls received which will
be used by administration to track and monitor effectiveness of the process.
NOTE: all provider contracts mandate participation in the after -hours-on-call rotation.
Pagers are provided by the health center.
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