EXAM #2

What are some types of IPV (intimate partner violence)?

1. Physical violence is the intent to do harm or cause disability, injury, or death. Some examples include hitting, pushing, grabbing, biting, punching, slapping, restraining, burning, or using a weapon and one's strength to hurt another person. 2. Sexual violence is forcing another to commit a sex act against his or her will; having sex with someone who is unable to understand, decline participation, or say "no" because he or she is disabled or under the influence of alcohol or drugs; or having abusive sexual contact. Date rape falls under this category. 3. Threats of physical or sexual violence occur when gestures, words, or weapons are used to cause harm, injury, disability, or death. 4. Psychological or emotional violence refers to trauma that includes humiliation, control, and any acts to embarrass or diminish a partner; isolating a partner from family and friends; and denying access to monetary funds or basic resources. Another form of IPV has been added, called stalking. Stalking is the act of following, spying on, making repeated calls or contacts after being asked not to, appearing at one's home or place of employment, and making threats, with or without a weapon.

What is a medical record?

A medical record is established at the first encounter between a provider and a client. It chronicles each interaction thereafter between the client and any member of the clinic's staff. The organization of the medical record will vary depending on the policies of the clinic, whether paper or electronic, but all medical records usually contain the same information, like client demographics, medical history, medical encounters, orders and prescriptions, progress notes, and test results.

What is an example of notifiable or reportable injuries when it comes to public duties of physicians?

A notifiable or reportable injury is identified when it concerns the public welfare and reporting is required to the proper authority; for example, injuries resulting from gun or knife wounds.

The Why in revoking, suspending, limiting licensure?

A physician's license to practice may be revoked or suspended as a result of (1) conviction of a crime, (2) unprofessional conduct, and (3) personal or professional incapacity. Each of these conditions is defined by state statute. Conviction of a crime is a more obvious reason for license revocation than is unprofessional conduct or personal or professional incapacity.

How do you legally discharge/terminate a client?

A point to remember is that some managed care contracts limit a provider's ability to terminate a provider-client relationship. A provider should carefully read the contract to determine whether termination is possible and how to give notice to the managed care plan. If a provider leaves a man- aged care plan for some reason, even though the managed care plan will give notice to its clients, it is a good idea for the provider to send his or her own written communication (i.e., letter) advising clients what arrangements have been made for the continuation of their care. Additionally, a provider may wish to withdraw from a case if a client fails to follow instructions, take the prescribed medications, disclose information pertinent to the care, or return for recom- mended appointments. Almost any nondiscriminatory reason is valid as long as proper written notice is given. To withdraw formally from a case, a provider should notify the client in writing, state the reasons for the dismissal, and indicate a future date when the provider is no longer re- sponsible. Such a letter should be sent by certified mail with restricted delivery only to the person specified and a return receipt requested providing that individual's signature. A copy of the letter and the returned receipt are kept in the client's record. To further protect a provider from abandonment charges, any canceled or missed appointments should be noted in the client's record.

What is a release of information? What are specifics?

A release of information signed by the client gives a provider authority to release certain medical information. Most clinics have created their own release of information form that a client must sign. A release form includes the client's name, date of birth, and other demographic information. It authorizes the provider or clinic (specifically named) to release the medical record to a specific entity, which may be a clinic, provider, lawyer, or other specified individual. The form must iclude a portion that asks specifically if the client wants information to be released concerning the following topics: substance abuse, psychiatric or mental health issues, or HIV/AIDS testing or counseling. The client signs and dates the form that is then signed by a witness and placed into the medical record. To be legal, a clinic should have a form with an original signature; no faxes or e-mailed copies should be accepted. The medical record is then reviewed by the provider, and upon his or her approval, the staff may release only the information specified in the request

Public duties of physicians in regards to abuse

All 50 states and the District of Columbia have laws that mandate the reporting of child abuse and neglect. The report is made to an agency named in the state statute. Certain individuals are required to report suspected abuse and neglect. These mandatory reporters include health professionals, social service personnel, law enforcement personnel, educators, and any professional person working with children. Some states also allow a hospital administrator or a physician to detain a child legally without a guardian's consent in such instances. Individuals making the report are protected from civil and criminal liability if the report is found to be false. Failure to report is a misdemeanor in some states. The function of reporting is to identify incidents of suspected abuse and neglect, not to prove abuse or neglect. The report may be oral, written, or both. Immediate reporting is paramount so that a proper investigation can be initiated.

What is ADA?

Americans With Disabilities Act (ADA) Prohibits discrimination of individuals with physical or mental disabilities from accessing public services and employment.

What are some reasonable accomodations ADA laws give employees?

An employee who has a disability meets all of the qualifications of the job, the employer must make "reasonable" accommodation for the disability. The employer is not required to make an accommodation that imposes "undue hardship" or requires an action with significant difficulty or expense. Reasonable accommodations might include the following: • Handicap parking • Ramps or elevators • Electronic or easily opened doors • Hallways with at least 36 inches of clearance • Accessible bathroom and lunchroom facilities • Reception counters low enough for a wheelchair (34 inches maximum) For example, if the best qualified applicant for receptionist has permanent and serious facial scar- ring, the applicant cannot be denied the position simply because of the fear of negative reactions from others. A medical transcriptionist in a wheelchair should be hired if she or he is the best candidate for the job. In all probability, reasonable accommodation can be made for this individual.

What questions can you ask during an interview?

Ask each candidate the same questions. This is important and makes the comparison of more than one candidate as fair and unbiased as possible. Possible questions that may be asked: A. What are your qualifications? B. Why are you leaving your present position? C. When can you begin work? D. What salary do you expect? E. What do you expect to be doing in 1 year? In 5 years? F. Why do you want to work here? G. Do you foresee any difficulties that may prevent you from doing a good job? H. What prompted you to become an employee in the medical field? I. What is your major strength? J. What is your major weakness?

What questions can you not ask during an interview?

Commons sense techniques to make the interview more effective and satisfy any legal concerns. In the United States it is illegal for an employer to discriminate against a job applicant because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), age, national origin or disability. There are federal and state laws in place to prevent discriminatory employment practices. It is illegal to ask questions about: A. Marital/Family Status B. Age C. Disability Status D. Religion E. Arrest Record

An example of a crime that would result in revocation of a physician's license.

Examples of crimes that would result in revocation would include conviction of child abuse or sexual assault against a client.

An example of unprofessional conduct

Examples of unprofessional conduct include falsifying any records regarding licensing, being dishonest, and impersonating another practitioner. Personal or professional incapacity includes chronic substance abuse, continuing to practice when severe physical limitations prevent adequate care, and practicing outside the scope of training

What are discrimination laws?

Federal law states that an employer of 15 or more people must not discriminate on any form of application for employment. The discrimination includes age, sex, race, creed, marital status, national origin, color, or disabilities (sensory, mental, or physical). Many states have adopted laws that are more strict than federal law. For example, in the State of Washington, an employer of eight or more cannot discriminate. Massachusetts, however, goes several steps beyond the federal guidelines, stating that employers with six or more employees are prohibited from discriminating against employees based on race, color, religious creed, national origin, ancestry, sex, age, criminal record (applications only), handicap (disability), mental illness, retaliation, sexual harassment, sexual orientation, and genetics. In addition, employers in some states have an affirmative responsibility to provide maternity leave to biological and adoptive parents even though it is not mandated by federal law

What is the employment process?

Locating employees, interviewing candidates, selecting emloyees, evaluating employees, employee dismissal, retaining employees,

The Why's of Physician licensing

Many states require a complete and unrestricted license to provide medical services. The Depart- ment of Defense is encouraging states to require full licensure of its military personnel even when they are currently only serving in military medical services. Providers engaging strictly in research and not practicing medicine need not have a license in some states.

Who's the Who when it comes to Licensure of Physicians?

Physicians (doctors of medicine [MDs] and doctors of osteopathic medicine [DOs]

Where can a physician be licensed?

Physicians who choose to practice in more than one state must satisfy the license requirements of each state. This process may require a physician to meet each state's reciprocity requirements. Not all states have reciprocity or endorsement, so rules for each individual state need to be re- searched. Each state also differs on its requirements for non-U.S.-trained and non-U.S.-educated providers. Most of the state regulations include additional education and/or internships. All states require the individual to pass the USMLE before being allowed to practice in the United States.

What are public duties of physicians in regards to reporting?

Physicians, as licensed professionals, and many other health-care professionals have a duty to protect the health of their clients but also have a responsibility to protect the health of the community as a whole. They must follow certain statutory and regulatory requirements.

Why do physicians have to file communicable disease reports?

Physicians, as licensed professionals, and many other health-care professionals have a duty to protect the health of their clients but also have a responsibility to protect the health of the community as a whole. They must follow certain statutory and regulatory requirements.

Example of physician's public duty in regards to reporting

Reports of births, communicable diseases, and abuse are a just a few examples.

What are Medical Practice Acts?

State statutes that define the practice of medicine, describe methods of licensure, and set guidelines for suspension or revocation of a license

Who has ownership of medical records?

The accepted rule is that medical records are the property of the person creating them and entering the data in them. Health-care providers are considered the owners of the medical records they have written. However, clients have access to the information in their medical records. Clients may be ex- pected to make an appointment to obtain that copy and pay reproduction fees. Access should be withheld only when the law prohibits such access or when, in the provider's opinion, great harm would be done to the client. Clients who request that their medical records be transferred to another provider must do so in writing. The original record must be retained in the clinic and the request honored with a photocopy of the complete record or the provider's summary. The continuance of medical records is important in a society that is so mobile. This continuity can be accomplished only with cooperation from providers. The important factor is to release the record promptly so that the client can receive proper care from the new provider.

What are collection guidelines?

The following guidelines are provided to suggest possible procedures for collections in the health- care setting, quite possibly identified in the compliance plan: • Discuss fees with clients the first time they present themselves or call for treatment. A writ- ten payment policy is essential. Explain to consumers their responsibilities in a managed care plan. • Provide clients with a clinic brochure that gives them information about hours, emergency contacts, the providers' services, how billing is managed, and whom to call if there is a ques- tion about a bill. Identify the insurances accepted by the providers. • Provide an opportunity for the client to pay before leaving the clinic. The charge slip or en- counter form is an ideal way for the provider to indicate charges and services as well as the diagnoses. The bill is then presented to the client, who is asked to stop at the bookkeeper's desk on the way out. The bookkeeper can say, "Mrs. Lotta M. Bucks, your charge today is $165. Would you like to pay by cash, check, debit card, or credit card?" Some clinics have been successful in providing clients with a stamped, addressed envelope in which to mail the fee when they return home or are billed at the end of the month. • Have an established practice for mailing statements, and follow that practice. Statements should be itemized, accurate, and easy to understand. Make sure all credits have been posted up to the closing date. Statements should be mailed to arrive the first of the month. State- ments that include envelopes, especially colored ones, are paid faster. • When your collection policy dictates that an unpaid bill should be followed with a letter or a telephone call, do it. Be consistent, pleasant, and firm. The sooner you follow through on a delinquent account, the more likely it will be collected. • Employees responsible for collections should have certain phrases and the wording of possible letters at their fingertips for quick and easy referral. They also need the authority to carry the collection process to its completion. • Suggested procedures for mail or telephone collections include the following: (1) Introduce yourself. (2) Establish that you are speaking to the proper person, if it is a telephone call, or address the letter to the proper person. (3) State the reason for the call or the letter. ("Your account is past due.") (4) Be pleasant, but be firm. ("You are generally prompt with your pay- ments; we wondered if this has been overlooked.") (5) Get a commitment. Make it specific. ("May we expect $150 from you by next Monday?") Then mark that commitment in your tickler file and follow up next Monday if there has been no response. (6) End the contact graciously. Do not get pulled into all the financial problems of the client. (7) Be prepared to offer a payment plan that is suitable to both the client and the clinic. • Have a clearly established practice of when, if ever, to turn the account over to a collection agency or to collect the balance due in small claims court. The Fair Debt Collection Practices Act is a federal law that governs the actions of parties acting as debt collectors for personal debts. The Federal Trade Commission has specific regulations for debt collection. They include the following: • Do not misrepresent who you are or why you are contacting a person. • Do not send postcards; rather, mail a collection letter. • Do not use deception in any form in your contact. • Do not telephone at odd hours or make repeated calls or calls to the debtor's friends, relatives, neighbors, employers, or children. Acceptable hours to call are 8 a.m. to 9 p.m. • Do not use obscene, profane, or abusive language.

The Whats and Whens of physician licensing.

The more common requirements include a 4-year undergraduate degree, graduation from an accredited medical school, completion of an internship, and successful completion of the United States Medical Licensing Examination (USMLE). To be licensed, this process usually involves completing an application, providing proof of required education and training, and paying an application fee.

What is medical record retention?

The question of how long to retain medical records is not easily answered. One guideline indicates that records should be retained until the statute of limitations for acts of medical malpractice has expired so that records are available for any possible litigation. This guideline may require a pedi- atrician to keep the record for as long as 7 to 10 years beyond the age of maturity. Most states have statutes that set retention guidelines for medical records. When a state has no statute regarding retention of medical records, state medical associations and insurance carriers are the best resources for this information. Hospital medical records and provider medical records have different reten- tion time limits. Health-care professionals should know the limits for the state in which they are employed.

Who do ADA laws protect?

The statute applies to all persons with substantial impairment that significantly limits a major function. Hearing, seeing, walking, breathing, performing manual tasks, caring for oneself, learning, and working. It also protects persons with a history of cancer in remission, persons with a history of mental illness, and persons with AIDS or who are HIV positive. Also, ADA covers individuals with a drug addiction who are currently in a drug rehabilitation pro- gram or have successfully completed rehabilitation and have not used drugs illegally for some time.

What are sexual harassment laws?

Title VII of the Civil Rights Act of 1964 protects employees from sexual harassment that may occur on the job. The guidelines from the Office of Equal Employment Opportunities make the employer strictly liable for the acts of supervisory employees as well as for some acts of harassment by coworkers and clients of the company. A written policy on sexual harassment, detailing inappropriate behavior and stating specific steps to be taken to correct an inappropriate situation, should be established. Such a statement can be placed in the policy manual and referred to in personnel policies. The traditional form of harassment is the scenario in which sexual favors are implicit and demanded of an employee by a supervisor in exchange for job advancement. This is known in legal terms as quid pro quo, which means "this for that." For example, the provider says to an employee, "You know, there's a hefty raise for you if you spend the weekend with me on my boat." A second, probably more common form of harassment, a hostile work environment, occurs when the work environment interferes with the employee's work performance. The conduct must be severe or pervasive and may take the form of a series of sexual questions, comments, jokes, inappropriate touching by coworkers, or verbal belittling and teasing. For example, a male MA is always making comments in the front office about "my girls," teasing them about premenstrual syndrome (PMS), and letting them know that they are inferior to men.

What's involved in revoking, suspending, limiting licensure?

Usually charges against physicians are made by the state's licensing board in all three conditions, necessitating the suspension or revocation of a provider's license. In all states, the basic procedure for disciplinary action is similar. Most boards are required to give the physician licensee sufficient notice of the charges and allow the physician legal counsel and a hearing. The board then investigates, prosecutes, makes a judgment, and sentences the physician. Some states have empowered their licensing boards to suspend a license to practice on a temporary basis without a hearing (i.e., due process) when the physician poses an immediate threat.

On what grounds can you decline a job applicant?

Wrong skill set, unsuitable personality, sloppy application, bad fit, not on time, sloppy appearance, lack of passion, poor follow-up questions, not responsive, co-workers don't approve, no references, weak recommendations from references, story doesn't check out, unaffordable salary expectation. There are likely three reasons requiring immediate dismissal of employment: (1) breach of client confidentiality, (2) disregard for client safety, and (3) fraudulent or criminal actions

Do physicians have a duty to immunize children?

Yes. Health-care providers have a duty to the public to immunize children.

What are examples of child abuse?

• Neglect: Failure to provide for basic care, including food, clothing, shelter, or medical atten- tion that endangers the health of the child. • Physical injury: Burns, severe bruising, lacerations, fractures, injuries to internal organs, or serious bodily injury. Injury is often obvious, but many abusers will harm a child in places that are not obvious so that the casual observer will not notice. • Mental injury: Harm to a child's well-being that damages his or her psychological or intellec- tual development. The child may be emotionally withdrawn, depressed, anxious, or aggressive, but injury is not obvious. • Sexual abuse: Using a child to engage in sexual activity of any sort, including rape, molesta- tion, incest, prostitution, or sexual exploitation. Physical evidence may be present. • Sexually explicit conduct: Actual or simulated sexual intercourse with a child (same sex or opposite sex), masturbation, exhibition of genitalia, or sadistic or masochistic abuse; likely is not obvious to health-care professionals. • Child molestation: Oral-genital contact or viewing and fondling of genitals; likely is not obvious to health-care professionals. • Sexual exploitation: Child pornography, child prostitution, or sexual explicit use of child's image in electronic media; likely is not obvious to health-care professionals. • Incest: Sexual relations between children or parents or siblings in the same family; may be recognized by health-care professionals.

What are types of elder abuse?

• Physical abuse: Violence that results in bodily harm or severe mental stress. Assault, beating, whipping, hitting, punching, pushing, shoving, pinching, force-feeding, shaking, or rough handling during caregiving are some of the examples of physical abuse. • Financial abuse: Financial or material exploitation of an elder's resources. The improper use of money, assets, or property is financial abuse. Examples include withdrawing cash from accounts without permission, cashing checks received (e.g., pension and Social Security) and denying those funds to the elder person, forcing an elderly person to alter a will, and forging a senior's signature. • Emotional/psychological abuse: Actions that dehumanize an elderly person, including social isolation, name-calling, harassment, humiliating, insulting, threatening to punish, treating an elderly person like a child, and yelling or screaming. This form of abuse usually accompa- nies one of the other forms. • Sexual abuse: Any sexual contact with an elderly person without his or her permission, in- cluding fondling, touching, kissing; forcing the elder to observe sexual acts, rape, or sodomy; spying on the elder in the bathroom or bedroom; and coerced nudity. • Neglect: Careless lack of attention that results in harm. Neglect may be emotional or physi- cal. Examples include withholding medication or necessary medical attention, personal care, food and water, or any basic necessities of life. Abandonment, lack of assistance with mobil- ity, failure to provide adequate diaper changes, and insufficient help with hygiene or bathing also constitute neglect.