Paul Hom Clinic Protocols

Health Committees

-Hepatitis -Cardiopulmonary -Patient Assistance Program -Covered California -Diabetes -Women's Health -Ophthalmology

What are important purposes of IMI card?

-Identification for finding patient charts -For another medical facility -Record keeping for medications -Emergency contact

Scenario: (You are receptionist) PA hands you chart and says Done Done. How do you finish?

-Log the names of the MD/MS and Room PA -Check to see if patient had lab done or med refill done. (refer to SOAP notes or problem sheet) -Place a X on chart where necessary. -Place an X on the DONE column -Place into box "Done with Labs" or "Done without Labs"

Places to look for chart:

-Main Chart Cabinet -With VN CARES in the back room -Lab call area/crate -Diabetes Box -Hepatitis Box -Committee Co-D's Table -Receptionist -Room 6 -Patient may actually be in a room

How do you verify patient identity when you call them up?

-Name -Date of birth -Phone # -Address

Saturday Clinic Receptionist Arrival Time

7:15 am

Sunday Clinic Receptionist Arrival Time

7:15 am

Saturday Clinic PA Arrival Time

7:35 am

Sunday Clinic PA Arrival Time

7:35 am

What time is morning meetings on Saturday mornings?

9:15 am

Dress Code for Sunday

BUSINESS CASUAL ONLY - button-up, dress pants and shoes for male. - dresses, blouses, knee-length skirts for females

Where does Chart go: After you did a lab call and patient did not pick up?

Back onto the lab call pile

How do you fill out a lab form?f

Fill out: 1. Date/Time collected 2. Patient Information 3. FASTING box 4. MS/RD/MD initials

On Sunday Clinic, who do you tell when you are done with a room?

Floater

What do you put in a new chart?

Left side: Hepatitis Demographics Sheet Pre-filled Hepatitis form Visitor form Information form Consent form CC Yes/No Right side: Problem sheet Master medication

For Med Refills: After filling out "the form", who do you give it to?

MD to review and to give them chart to review. MD hands patient the prescription

For PAP Refills: After filling out "the form", who do you give it to?

PAP Co-D for review

For PAP Refills: What form do you fill?

PAP Questionare

Saturday Speciality Clinics

Week 1: Musculoskeletal Week 2: Psychiatry and Pharmacy Consultation Week 3: None Week 4: Dermatology

PAP Refill Procedure

*Last clinic visit needs to be within the last 6 months* MAKE SURE WITH PAP THAT MEDICATION IS IN 1. Take Vitals 2. Complete PAP Questionnaire, front page, sign "Questionnaire Completed By" 3. Return PAP Questionnaire to PAP Co-Ds 4. Take medication in brown bag and side effects sheet from Co-Ds 5. Find a MD/MS to hand over medication (Have MD/MS and patient sign questionnaire) 6. Return chart to receptionist and say "done done with meds" 7. Patient should leave with PAP medication, IMI, and side effects

Med Refill Procedure

*Last clinic visit needs to be within the past 1 year* 1. Take vitals 2. Fill out prescription form (top part) 3. Find MD and ask them to review the chart 4. Make a copy of the prescription and place under problem sheet 5. Ask PAP for side effects paper 6. Find MD to distribute medication 7. Update IMI and Master Medication Sheet (if needed) 8. Have MD sign bottom of Problem Sheet and return to receptionist and say "done done with med" 8. Patient should leave with side effects, prescription, and IMI card

List all items needed for Urinalysis

-2 bags -3 test tubes (2 are part of the kit, one extra orange test tube) -1 urine cup -1 alcohol wipe -4 lab form -1 Gloves

Scenario: (You are receptionist) A new patient walks in. How do you register them?

-Ask for ID (passport/Driver licenses) -Grab a new chart and IMI card for patient -Highlight name on registration sheet

Patient Chart Left Side

-Blue Diabetes Form -Green Hepatitis Form -Most Recent Lab Results -Visit Form -Information Form -Consent Form -Covered California [Yes/No] Form (copy of insurance card underneath)

Dress Code for Saturday

-Clinic T-Shirt -Jeans (No ripped Jeans or leggings) -Closed-Toe Shoes -Badges -Watch

What kind of lab calls do you do first?

-Consultations -"Needs to start medication right away"

List all materials needed for PAP Smear:

-Cotton swab -Cytobrush -Drape -GC Kit (STD) -Gown -Gloves -Lubricant (GYN specific) -Spatula -Speculum (S,M,L) -Specimen bag -Specimen container -Specimen/lab label (GGG SSSSS CCL D)

List ways you can get a strike

-Dress code violation -Late for clinic -Failure to attend a general meeting -For every social credit you fail to obtain (missing a social) -Using phone at inappropriate time

Scenario: (Patient is getting a lab draw) What is the procedure at the lab draw station?

-Fill out Lab form -Package test tubes & Lab form -Bring over to Lab Check -Print out Lab Labels (by lab checkout PA) -Log it out into Lab Binder -Grab the Patient number of the day clip and clip on the bag. -Place bag into its location -Have blood draw person (MD/MS/RN) sign bottom of Problem Sheet (return to receptionist and say "done done")

For H.Pylori, what do you tell the patient?

-Once you finish your bowel movement, place some of the stool at least to the 60 line of the sample cup. -Write the time/date on the label of the sample cup and place in the biohazard bag -Complete the general lab form by putting the time/date you took your bowel movement. -Place sample into the freezer or with ice. -Return to the clinic within 5 days of bowel movement with ice to drop off.

For PAP Refills: What does patient leave with?

-PAP Medication -IMI Card -Side effects sheet

For Med Refills: What does patient leave with?

-Prescription -IMI Card -Side effects sheet

What 4 boxes do you check for PAP Smear?

-Routine -Cervical -Cytobrush -Spatula

What are reasons to update master medication list?

-Starting new medication -Change in prescription -End medication (add date)

Registration Team: End of Day What do you do?

-Total patients seen by physician -Number of patients seen for that week's specialty -Transfer highlighted (new) patients to "Current Patient Information Database" -Total patients that were insured/uninsured registered for Medi-Cal -Print Registration sheet of the day (Write down the date, highlight new patients of the day, put into "Registration Binder 3.0")

Scenario: (You are PA) You are assigned a new patient, what forms do you fill out with patient?

-VIC (Visit, Information, Consent; first 6 patients, fill out in room, not first 6, fill out outside) -Hepatitis demographic form (put in demographic binder, on top) -Pre-filled hepatitis blood draw form

List all commitments for Translating PA's

-Work in clinic for 2 consecutive quarters -Five Saturdays per quarter (Six Saturdays during the Summer) -All General Meetings (~1 per month) -All required work for your designated committee -1 Social Credit per quarter -One Sunday Clinic per quarter (with our sister clinic, VN CARES). -$15 Clinic Fees -Workshops/Trainings/Events

List all commitments for English PA's

-Work in clinic for 2 consecutive quarters -Four Saturdays per quarter (Five Saturdays during the Summer) -All General Meetings (~1 per month) -All required work for your designated committee (if you choose to participate in an additional committee) -1 Social Credit per quarter -PR Committee work -$15 Quarterly Clinic Fee -Workshops/Trainings/Events

Patient Chart Right Side

-Yellow Medication List -SOAP Notes -Most Recent Problem Sheet (Green blood draw form above it) -Copy of Prescription Form -Copy of Referral Form (if applicable)

What is the consequence of not showing up to clinic

-strike -You need to make up a clinic -No pass on transcript notation

Registration Process

1) Plug in thumb drive and open "Registration Sheet Template" 2)Call Patients up by numerical order 3)Ask patients for IMI card 4)Assistant 1 looks for patient chart 5)Fill out registration sheet 6)Assistant 2 fills out problem sheets while Receptionist fills out registration sheets, CLIP IMI CARD TO PROBLEM SHEET 7)Tell patient we will call them up when we are ready for them 8)Put patient chart in vitals rack for CoDs

On Sunday Clinic, if a patient doesn't show up, what do you do?

1. After 15 minutes, call them to remind them 2. After 30 minutes, call them to remind them again

What do you do when asked to help with MD consultations?

1. After calling patient # of day, verify patient information (name,#, address DOB) 2. Perform Vitals 3. Find table space by Committee Co-Ds for consultation. 4. Find MD to do consultation.

What do you do if patient forgot IMI card?

1. Ask patient for ID 2.Ask when the last time they came into clinic was: look into Registration Binder 2.0 and 3.0, find name and chart # 3. If cannot find their chart, or don't have their ID, notify UG Co-D; Continue registration

What do you do if you're a room/translation PA for the non-first 6 patients?

1. Bring patient in room. 2. Verify information 3. Write name in "Translation PA" line on Problem Sheet 4. Return chart to UG Co-D and say "patient in room" 5. Return to room to wait with patient until MD/MS come in.

How do you call the patient? (If they pick up)

1. Call # on consent form with *67 2. Verify Identity 3. Tell patient what is written on lab results. 4. On CHART, write first name, last initial, date/time, "Patient Picked Up". 5. ON LAB LOGOUT BINDER, write initials, date/time and RD (results delivered) 6. Place chart in diabetes box.

What do you do once MD/MS is done seeing the patient?

1. Clean room (rip off sheet and replace with clean one) 2. Notify UG Co-D that room is clear. 3. Accompany patient for the rest of the visit.

Scenario: (You are PA) You finished with a patient in room, they need to do a blood draw. What do you do?

1. Clean up room (rip sheets off) 2. Direct patient to blood draw station 3. Notify UG Co-D of open room 4. Return to blood draw station

What do YOU (PA) do when you are told you need to do a H.Pylori lab?

1. Complete a lab label with patient information and leave date/time blank 2. Complete the general lab form and leave date/time blank 3. You don't need to fill out MS/MD initials or Fasting 4. Put label on sample cup. 5. Place lab form in the biohazard bag pocket.

Sunday Hepatitis B/C Screening: What forms do you need to fill out with the patient?

1. Demographic form: -Complete the front and back of the form. File the form back into the binder. 2. Pre-filled Hepatitis Blood Draw form: -Ask the MS or the person who draws blood to make sure the lab boxes checked on the lab form are correct. -Fill out the required information

How do we prepare a FIT kit?

1. Fill out lab form with information we would do for a normal blood draw. 2. Write Fecal Immunochemical Test on bottom right corner for "comments" 3. Remind patient to fill out DATE/TIME for lab form and label

How do you prepare a urinalysis for your patient?

1. Grab a urinalysis kit (3 test tubes, 1 alcohol wipe, 1 urine cup, 4 lab form, 1 pair of gloves, 2 bags). 2. Ask MS if clean catch or first catch. (clean catch-mid pee; first catch- start of pee) 3. Tell patient to wipe genital area with alcohol wipe but not flush it 4. Urinate in cup and bring it to sink area 5. With gloves in both hands, remove yellow seal to reveal suction opening. 6. Invert test tubes and they will fill up on their own 7. Double bag urine cup (cup in first bag, put first bag in second bag with test tubes) *triple bag if with blood draw* 8. Log out in lab checkout and lab logout binder. Fill out lab form

For the registration team, what do you do after the PA or MD hands you the patient chart and says, "done done"?

1. Log in names of Vitals PA, Translation PA, MD, and MS. 2. SOAP notes and Problem sheet indicates if labs were done or meds were refilled (mark off with X) 3. Mark off "done" 4. Place chart in either done w/ labs or done w/o labs in shelf next to registration desk

CC checklist

1. Make sure all patients have filled it out 2. When completed give to CC Co-D for review 3. Make copy of checklist and bring to CC Co-and place on left side of patient chart, under consent form 4. Make copy of insurance card and put under insurance checklist

What do you with a patient who has a Green Blood Draw Slip

1. No vitals needed 2. Verify patient information 3. Direct Patient to Blood Draw Station --> Find someone to take blood 4. Write "DONE" across sheet and staple to Problem Sheet of the day. (on top) 6. Give to reception

What do you do after storing time sensitive lab bags

1. Notify MS Co-D 2. Tell UG Co-D 3. Write 4 things on Whiteboard (Chart #, Test name, Time Drawn, Your first name and last initial)

Registration Process:

1. Open "Registration Sheet Template" 2. Call patients up by their number of day 3. Ask for IMI Card 4. Assistant 1 gets Patient Chart 5. Fill out Registration Sheet 6. Assistant 2 fills out Problem Sheet (put IMI Card with Problem Sheet) 7. Place chart into vitals rack (For UG Co-D to review)

What are the lab log-out procedures?

1. PA and MS go to lab log out table 2. PA writes down labs in lab checkout binder 3. Lab log-out team and MS go over patient chart to confirm information on lab form and labels 4. Lab log-out team and MS initial lab logout sheet 5. Remind MS to return chart to reception 6. PA clips patient # of the day to bag and places bag in right place.

What are the lab check-out procedures?

1. PA and MS go to lab log out table 2. PA writes down labs in lab checkout binder 3. Lab log-out team and MS go over patient chart to confirm information on lab form and labels 4. Lab log-out team and MS initial lab logout sheet 5. Remind MS to return chart to reception 6. PA clips patient # of the day to bag and places bag in right place.

What are the temperature sensitive labs?

1. PT/INR *All go in room temperature styrofoam box*

What are the time sensitive labs?

1. PTT 2. ESR 3. Total Iron Serum 4. Transferin *All go in the refrigerator*

Who signs the PAP Questionaire?

1. Patient 2. You (PA) 3. MD/MS 4. PAP Co-D

Scenario: (You are PA) Patient is coming in for lab consultation. What do you do?

1. Perform vitals 2. Look for a table 3. Find preceptor to do consultation

What is the FIT kit procedure for patients?

1. Place the wax paper in the empty toilet. 2. Deposit fecal matter onto the wax paper(Wax paper is flushable) 3. Use the stick in the tube sample and place the tip of the stick in the fecal sample. 4. Place the stick back into the tube sample. 5. Place sample into its envelope 6. Patient mails in the sample WITH the lab form. (the envelope is prepaid and ready to be sent to the lab) → have patient fill out TIME and DATE on lab form and lab label

How do you log out H.Pylori for the first week?

1. Put "H. PYLORI" with a 1 in a circle next to it. 2. Put "Done with no lab"

How do you log out H.Pylori when they drop it off?

1. Put "H. PYLORI" with a 2 in a circle next to it. 2. Put "Done with lab"

What do YOU (PA) do when the patient drops off their H. Pylori?

1. Put on gloves and confirm patient. 2. Attain sample from patient and and place by sink. 3. Confirm both label and form are completed with TIME/DATE with 5 days 4. Notify UG Co-D and MS Co-D of time-sensitive lab. 5. Write on Time-Sensitive board

End of the Day Procedures

1. Take out all trash (back, near women's bathroom) 2. Wipe down all exam rooms with alcohol wipes 3. File patient charts that had no labs 4. Restock supplies, notify UGs if supplies are low 5. Clinic recap before dismissal

What do you do if you're a vitals PA for the non-first 6 patients?

1. Verify patient name, phone #, address, DOB. 2. Do vitals outside of room. 3. Write name in "Vitals PA" line on the Problem Sheet 4. Return patient chart to UG Co-Ds and say "vitals done" 5. Tell patient to return to waiting area

What do you tell the patient when they drop off H. Pylori?

1. Wait in waiting area while PA confirms labels are correct and completed 2. They can leave once lab checkout PA and MS have checked it as well. 3. We will call them back with results

Order of Vitals:

1. Weight (reset to zero) 2. Height (reset to zero in room, to 5ft outside) 3. Temperature 4. Heart Rate 5. Respiration Rate 6. Blood Pressure

What do you do with one of the first 6 in room patients?

1. Write name in "Translation PA" and "Vitals PA" line on problem sheet. 2. Take vitals. (Weight and height done in room. Grab necessary equipment for temperature, heart rate, respiratory rate, and blood pressure) 4. Give chart to UG Co-Ds and say "vitals done" 5. Go back in room and wait with patient for MS & MD to come see patient.

How many Bags and Forms for HPV and PAP Smear co-testing?

2 Lab Forms 1 Bag

For PAP Refills: What do you do before you even start filling out any forms?

Confirm with PAP Co-D to see if we have medication, if Yes, then continue

Where do you bring completed No Covered California Insurance?

Covered California Co-D

Where do you bring completed Yes Covered California Insurance?

Covered California Co-D

Assume you are with first 6 in room patients: Where do you do the vitals?

In a room

What are the time and temperature sensitive labs?

In between ice 1. HBV and HCV Viral Load 2. H. pylori 3. Rheumatoid Factor Styrofoam box 1. Hepatitis C Genotype

List all materials needed for a blood draw:

Inside Basket: -Alcohol wipe -Bandage -Tourniquet -Test tube holder -Needle On Table: -Blue pad -Test tubes -Cotton balls (BBANC TTT)

What do you do during the first week of lab calls when the patient doesn't pick up?

Morning: 1. Put back in lab table 2. Note on lab report: first name, last initial, date/time, DPU 3. Note on lab logout binder: date/time, initials, DPU Afternoon: 1. Put back on lab table. 2. Note on lab report; first name, last initial, date/time, DPU, LV 3. Note on lab logout binder: date/time, initials, DPU, LV

What do you do during the second week of lab calls when the patient doesn't pick up?

Morning: 1. Put back in the lab table 2. Note in lab report: first name, last initial, date/time, DPU, LV 3. Note on lab logout binder: date/time, initials, DPU, LV Afternoon: 1. Put back in the lab table 2. Note in lab report: first name, last initial, date/time, DPU, LV 3. Note on lab logout binder: date/time, initials, DPU, LV *Place chart in metal tray for UG Co-Ds to review*

Scenario: (You are PA) Patient comes in with Green Blood Draw Slip, do you do vitals?

No

How many Buns do you get?

ONLY 1

For Med Refills: What form do you fill out?

Prescription Form

For Sunday clinic, where do you log-out vitals?

Reception

Filling out the Problem Sheet

Registration fills out things other (demographics + chief complaint, be specific as possible) than vitals section, which PA fills out usually

Where does Chart go: When a patient is finished with a medical consultation?

To receptionist

Where does Chart go: When a patient is finished with a refill?

To receptionist

Where does Chart go: When a patient finishes their blood draw with green slip?

To receptionist with DONE written on green slip, stapled to the top of the problem sheet

Assume you are with first 6 in room patients: Where do you put your name on the chart?

Translation PA and Vitals PA

For Med Refills: Do you do vitals?

Yes

Scenario: (You are PA) Patient is coming in for a lab consultation ONLY. Do you do vitals?

Yes

List places where filer can retrieve charts

a) Main Chart Cabinet b) "Done" piles from last week, c) Gray Lab Crate, d) Lab call basket/diabetes box, e) Committee Co-Ds f) Room 6 shelves g) VN cares in the back h) Hepatitis box i) Patient might actually be in room j) receptionist