UCAOA Policy & Procedure Manual—2017 Edition

Table of Contents

100.XXX – Administration

1. 100.XXX- Advanced Beneficiary Notice (ABN) English Version 2020 Large Print

2. 100.XXX- Advanced Beneficiary Notice (ABN) English Version 2020

3. 100.XXX- ABN Spanish Version 2020 Large Print

4. 100.XXX- Absent Medical Provider

5. 100.XXX- Abuse Neglect Overview or Reporting Responsibilities

6. 100.XXX- Abuse Neglect Violence State Reporting

7. 100.XXX- Abuse Reporting- Child/ Elderly Abuse Reporting

8. 100.XXX- Abuse Child Report or Neglect

9. 100.XXX- Advanced Beneficiary Notice (ABN) Form Instructions

10. 100.XXX- Advanced Beneficiary Notice

11. 100.XXX- Advance Directives Page 2

12. 100.XXX- Advance Directives Page 1

13. 100.XXX- Animal Bite Control Form- Oakland County (sample—state or county specific)

14. 100.XXX- Animal Bite Reporting

15. 100.XXX- Animal Bite Reporting Guidelines Form- Louisiana (sample—state or county specific)

16. 100.XXX- Animal Bites Reporting- Louisiana (sample—state or county specific)

17. 100.XXX- Care Coordination Follow-Up PCP or Referring Physician

18. 100.XXX- Care Coordination Follow-Up Doc

19. 100.XXX- Care Coordination Referral Letter

20. 100.XXX- Care Coordination Sample Cover Letter PCP

21. 100.XXX- Collection Log Front Desk

22. 100.XXX- Consent In Office Procedure Form

23. 100.XXX- Disruption of Information Process

24. 100.XXX- Established Patient Intake Form

25. 100.XXX- Flag System Form

26. 100.XXX- Flag System- Managing Patient Flow

27. 100.XXX- Front Desk- Influenza Vaccine Consent

28. 100.XXX- Front Desk- Occ Med Acknowledgment of Responsibility for Charges for Workers Comp

29. 100.XXX- Front Desk- Auto Accident Claim Processing- UC

30. 100.XXX- Front Desk- Auto Acknowledgement of Responsibility for Charges

31. 100.XXX- Front Desk -Billing- Global Periods

32. 100.XXX- Front Desk- Billing- Recheck Policy

33. 100.XXX- Front Desk- Cash Pay Flu Shot- Patient Information Sheet

34. 100.XXX- Front Desk- Cash Drawer Log

35. 100.XXX- Front Desk-Chief Complaint /Consent for Treatment- Louisiana

36. 100.XXX- Front Desk- Consent for Treatment & Use of Disclosure of Protected Health Info Form

37. 100.XXX- Consent to Release of Information

38. 100.XXX- Front Desk- Customer Service Encounter

39. 100.XXX- Front Desk- Established Patient Information Short Form

40. 100.XXX- Front Desk- Established Patient Update Form

41. 100.XXX- Front Desk- External Referrals or Service Options

42. 100.XXX- Front Desk Form- for Consent and Chief Complaints

43. 100.XXX- Front Desk Form - Employee Discount Request Form

44. 100.XXX- Front Desk Form- for Notice of Receipt of Privacy

45. 100.XXX- Front Desk Form- Patient Registration

46. 100.XXX- Front Desk Form- Payment Policies

47. 100.XXX- Front Desk Form- Practice to Release Private Health Information to Third Parties

48. 100.XXX- Front Desk Form- Supplemental Claims Information

49. 100.XXX- Front Desk- Forms Request- Completion of Forms

50. 100.XXX- Front Desk- Influenza Vaccine Cash Pay Form

51. 100.XXX- Front Desk- Log Collections

52. 100.XXX- Front Desk- Log Patient Registration

53. 100.XXX- Front Desk- Medical Treatment Discount

54. 100.XXX- Front Desk- Medical Treatment Discount- Discounted Services

55. 100.XXX- Front Desk- Missing Router

56. 100.XXX- Front Desk- Occ Med Employer Authorization Form

57. 100.XXX- Front Desk- Occ Med Medical Record Form

58. 100.XXX- Front Desk- Occ Med Patient Form

59. 100.XXX- Front Desk- Occ Med Patient Registration Form

60. 100.XXX- Front Desk- Occ Med Work Status Form

61. 100.XXX- Front Desk- Occ Med Worker Intake Form

62. 100.XXX- Front Desk- Patient Call Back Forms

63. 100.XXX- Front Desk- Patient Check Out

64. 100.XXX- Front Desk- Patient Identifiers

65. 100.XXX- Front Desk- Patient Information Sample Form

66. 100.XXX- Front Desk- Patient Payments

67. 100.XXX- Front Desk- Patient Presentation of Serious Illness or Injury

68. 100.XXX- Front Desk- Patient Registration

69. 100.XXX- Front Desk- Patient Information Consent Form

70. 100.XXX- Front Desk-Patient Identification

71. 100.XXX- Front Desk- Receipt of Privacy Documents Acknowledgement

72. 100.XXX- Front Desk- Time of Service Collections V.2

73. 100.XXX- Front Desk- Time of Service Collections

74. 100.XXX- Front Desk- Visit Policy

75. 100.XXX- Front Desk- Workers Compensation Claims Policy

76. 100.XXX- Front Desk- Workers Compensation Claims Processing

77. 100.XXX- Governance- Social Media

78. 100.XXX- Governance- Clinical Work Flow

79. 100.XXX- Governance- Corporate Spending Expense Report Sample

80. 100.XXX- Governance- Corporate Spending

81. 100.XXX- Governance- Employee Recognition Committee

82. 100.XXX- Governance- Finance Capitalization

83. 100.XXX- Governance- Management Leadership Competencies

84. 100.XXX- Governance- Mission Statement

85. 100.XXX- Governance- Mission and Core Values Statement

86. 100.XXX- Governance- Operations Committee Policy

87. 100.XXX- Governance- Organizational Chart- Leadership Sample

88. 100.XXX- Governance- Organizational Hierarchy and Clinical Staffing Model

89. 100.XXX- Governance Organization Meetings

90. 100.XXX- Governance- Organization Chart

91. 100.XXX- Governance- Purpose, Governance Policy

92. 100.XXX- Governance- Scope of Service and Population Served

93. 100.XXX- Governance- Scope of Services Policy

94. 100.XXX- Governance- Social Media Policy

95. 100.XXX- Identity Theft and Red Flag Rules

96. 100.XXX- Influenza Immunization Consent Form

97. 100.XXX- Informed Consent for Procedure Form

98. 100.XXX- Informed Consent for Procedure Information

99. 100.XXX- Interpretive Services and Communication Barriers

100. 100.XXX- Interpretive Services- Louisiana and Texas

101. 100.XXX- Minors Treatment- State Specific

102. 100.XXX- Non- Retaliation Policy

103. 100.XXX- Occ Med Audiometer Calibrations

104. 100.XXX- Occ Med Direct Billing Protocol Policy

105. 100.XXX- Occ Med End of Day Staff Activities

106. 100.XXX- Occ Med Pulmonary Function Testing Machine Calibrations

107. 100.XXX- Occ Med Respiratory Fit Test Machine Calibrations

108. 100.XXX- Opening and Closing Procedures with Checklist

109. 100.XXX- Patient Call Follow Up Contact

110. 100.XXX- Patient Intake Form

111. 100.XXX- Patient Rights and Ethical Care

112. 100.XXX- Patient Rights and Responsibilities Policy

113. 100.XXX- Patient Rights Specific Request Form

114. 100.XXX- Policy/ Procedure/ Forms Management

115. 100.XXX- Policy and Procedure Process

116. 100.XXX- Policy and Procedure Request

117. 100.XXX- Policy and Procedure Template

118. 100.XXX- Prescription Secure Handling

119. 100.XXX- Privacy Practices Acknowledgement Form

120. 100.XXX- Radiology Only Process

121. 100.XXX- Radiology Only Log

122. 100.XXX- Router Form

123. 100.XXX- Signature and Initial Sample Log

124. 100.XXX- Telephone Encounter

125. 100.XXX- Terminating a Patient from the Practice

126. 100.XXX- Unable to Reach Patient About Test Results

200.XXX- Human Resources, Orientation, Competencies, Credentialing

1. 200.XXX- Behavior of Employee

2. 200.XXX- Incident Reporting Employee Policy

3. 200.XXX- Peer Review- Medical Provider

4. 200.XXX- Absenteeism and Tardiness

5. 200.XXX- Absenteeism and Sick Leave

6. 200.XXX- ACLS Requirement and Training

7. 200.XXX- ACLS BLS PALS Training

8. 200.XXX- Annual Training and Review Checklist

9. 200.XXX- Annual Training

10. 200.XXX- Appointment Approval Sample Letter

11. 200.XXX- Appointment- Authorization to Release information

12. 200.XXX- Appointment- Authorization Release Form

13. 200.XXX- Appointment- Authorization Consent to Release of Information

14. 200.XXX- Appointment- Provider Checklist

15. 200.XXX- Appointment- Reappointment Application

16. 200.XXX- Background Checks 2

17. 200.XXX- Background Check Release Organization

18. 200.XXX- Background Checks

19. 200.XXX- Behavior- Discrimination/ Harassment

20. 200.XXX- Behavior- Patient Non- Discrimination

21. 200.XXX- BLS Requirement and Training 1

22. 200.XXX- BLS Requirement and Training

23. 200.XXX- Breaks and Meals

24. 200.XXX- Breaks

25. 200.XXX- Catheterization Straight Female

26. 200.XXX- Code of Conduct

27. 200.XXX- Competencies Annual Checklist

28. 200.XXX- Competencies

29. 200.XXX- Competency- Checklist New Hire

30. 200.XXX- Competency- Clean Catch

31. 200.XXX- Competency- Digital X-Ray Images

32. 200.XXX- Ear irrigation

33. 200.XXX- Competency- Injectable Medication

34. 200.XXX- Competency- Injection IM

35. 200.XXX- Competency- Injection Subcutaneous

36. 200.XXX- Competency- Specimen Labeling and Handling

37. 200.XXX- Competency- TB Mantoux Skin Test

38. 200.XXX- Competency- Tuberculin Skin Test Mantoux

39. 200.XXX- Competency- Vital Signs

40. 200.XXX- Complaint Form Employee

41. 200.XXX- Conflict of Interest Form Attachment 1

42. 200.XXX- Conflict of Interest Attachment

43. 200.XXX- Conflict of Interest Policy

44. 200.XXX- Conflict of Interest

45. 200.XXX-Credentialing Appeals Process

46. 200.XXX- Credentialing Disclosure Claims Information Form

47. 200.XXX- Credentialing of Providers

48. 200.XXX- Credentialing- Appointment/Reappointment

49. 200.XXX- Credentialing- Initial Verification Form

50. 200.XXX- Credentialing- License Insurance Verification

51. 200.XXX- Credentialing- Practitioner Profile for Appointment Cover Sheet

52. 200.XXX- Credentialing- Provider

53. 200.XXX- Credentialing- Release and Immunity- Initial Application

54. 200.XXX- Criminal Background Checks

55. 200.XXX- Cultural Diversity

56. 200.XXX- Cultural Awareness and Sensitivity Training

57. 200.XXX- Cultural Sensitivity

58. 200.XXX- Dress and Appearance

59. 200.XXX- Drug/Alcohol Free Environment

60. 200.XXX- Electronic Devices, Use of

61. 200.XXX- Employee Change Form

62. 200.XXX- Employee File Contents

63. 200.XXX- FMLA Disability Forms

64. 200.XXX- Hepatitis Vaccine for Employees

65. 200.XXX- Incident Employee Form

66. 200.XXX- Influenza Vaccination Program for Employees

67. 200.XXX- Job Description Template

68. 200.XXX- Job Description Policy

69. 200.XXX- License Verification-Non-Provider for Louisiana

70. 200.XXX- Medical Staff Appointment-Reappointment Application

71. 200.XXX- Medical Staff Approval of Appointment- Generic Letter

72. 200.XXX- Medical Staff Delineation of Privileges

73. 200.XXX- Non-Discrimination

74. 200.XXX- Onboarding Form- HIPAA Acknowledgement

75. 200.XXX- Onboarding Form- Hepatitis B Vaccination Election

76. 200.XXX- Onboarding I9 Form- Employment Eligibility Verification

77. 200.XXX- Onboarding Provider Checklist

78. 200.XXX- Orientation- and Training- New Hire

79. 200.XXX- Orientation- Checklist Pre-Patient Care

80. 200.XXX- Orientation- Billing Checklist

81. 200.XXX- Orientation- Clinical

82. 200.XXX- Orientation- Employee

83. 200.XXX- Orientation- Physician Checklist

84. 200.XXX- Orientation- Proficiency Requirements

85. 200.XXX- Orientation- Reception Checklist

86. 200.XXX- Peer Review Medical Provider Form

87. 200.XXX- Performance Appraisal Template

88. 200.XXX- Physician Insurance Check List

89. 200.XXX- Privacy Employee

90. 200.XXX- Privileges Delineation

91. 200.XXX- Proficiencies

92. 200.XXX- Reappointment- Release and Immunity

93. 200.XXX- Re-credentialing Verification Form

94. 200.XXX- Reimbursement-CME

95. 200.XXX- Roles and Responsibilities- Medical Director

96. 200.XXX- Scheduling Change Requests

97. 200.XXX- Scheduling Time Off- Holidays

98. 200.XXX- Scheduling Time Off- Provider

99. 200.XXX- Student Letter Sample

100. 200.XXX- Student Rotation or Shadowing Policy

101. 200.XXX- Student Shadowing Form

102. 200.XXX- Student Application

103. 200.XXX- Student Checklist

104. 200.XXX- Substance Use- Prohibited

105. 200.XXX- Supervision- Advanced Practice Clinicians

106. 200.XXX- Termination from Employment Form

107. 200.XXX- Termination Involuntary Form

108. 200.XXX- Time and Attendance

109. 200.XXX- Training- Annual Training Checklist

110. 200.XXX- Training Required

111. 200.XXX- Tuberculosis Annual Questionnaire

112. 200.XXX- Tuberculosis Testing- Employee

113. 200.XXX- Tuberculosis TST Questionnaire

114. 200.XXX- Vacation, Sick, Holiday Pay Eligibility

115. 200.XXX- Vehicle Use- Release of Driving Record Form

116. 200.XXX- Vehicle Use-Safety

117. 200.XXX- Video and Audio Recording

118. 200.XXX- Warning Form

300.XXX- Clinical, General, Occ Med

1. 300.XXX- Abuse and Assault Treatment

2. 300.XXX- Chaperones

3. 300.XXX- Consent- Informed 2

4. 300.XXX- Consent- Informed Form

5. 300.XXX- Consent- Informed

6. 300.XXX- Discharge Guidelines

7. 300.XXX- Discharge Instructions Policy

8. 300.XXX- Discharge Instructions Form Template

9. 300.XXX- Ear Irrigation

10. 300.XXX- Education- Patient and Family

11. 300.XXX- EKG Operation

12. 300.XXX- Emergency Situations

13. 300.XXX- Emergency Transfers 2

14. 300.XXX- Emergency Transfers Log

15. 300.XXX- Emergency Transfers Tracking Policy

16. 300.XXX- Emergency Transfers

17. 300.XXX- Emergency Staff Responsibility During Cardiac Arrest

18. 300.XXX- Eye Irrigation

19. 300.XXX- Fast Track Patient Assessment

20. 300.XXX- Fecal Specimen Collection

21. 300.XXX- Fecal Specimen

22. 300.XXX- Gait Training/Crutch Fitting

23. 300.XXX- Hard of Hearing Patient

24. 300.XXX- Hepatitis B Acknowledgement Form

25. 300.XXX- Identifiers- Patient 2

26. 300.XXX- Identifiers- Patient

27. 300.XXX- Nasal Specimen

28. 300.XXX- Occ Med- Breath Alcohol Testing

29. 300.XXX- Occ Med- Employers Authorization for Examination or Treatment

30. 300.XXX- Occ Med- Pre-Employment/Return to Work Clearance Form

31. 300.XXX- Occ Med- Pre-Placement Examination-Pre-Employment Return to Work Combo

32. 300.XXX- Occ Med- Return to Work Examination

33. 300.XXX- Occ Med- Audiometric Testing and Screening

34. 300.XXX- Occ Med- Breath Alcohol Test Checklist

35. 300.XXX- Occ Med- Breath Alcohol Testing

36. 300.XXX- Occ Med- DOT Physical Exam 2

37. 300.XXX- Occ Med- DOT Physical Exam

38. 300.XXX- Occ Med- Grip Strength Testing

39. 300.XXX- Occ Med- Physical- Return to Work

40. 300.XXX- Occ Med- Pre-Employment Return to Work Clearance Form

41. 300.XXX- Occ Med- Pre-Placement Exam and Physical Exam Form- Two Forms

42. 300.XXX- Occ Med- Pre-Placement Physical Policy

43. 300.XXX- Occ Med- Pre-Placement Physical 2

44. 300.XXX- Occ Med- Pre-Placement Physical

45. 300.XXX- Occ Med- Pulmonary Function Testing

46. 300.XXX- Occ Med- Respirator Fit Tests

47. 300.XXX- Occ Med- Vision Screening-Titmus Ishihara

48. 300.XXX- Orders- Standing

49. 300.XXX- Orders

50. 300.XXX- Oxygen Administration

51. 300.XXX- PCP Follow Up Letter- Rochester (sample)

52. 300.XXX- Pediatric Bulb Suctioning

53. 300.XXX- Pediatric Fever Control

54. 300.XXX- Pediatric IV Therapy

55. 300.XXX- Pelvic Exam

56. 300.XXX- Physical Examinations

57. 300.XXX- Physical- Return to Work

58. 300.XXX- Physical- Sports

59. 300.XXX- Physician Inquiries- Walk-in Established Patients

60. 300.XXX- Referral Letter

61. 300.XXX- Refusal of Care Against Medical Advice-Left Exam Room

62. 300.XXX- Refusal of Care AMA Acknowledgement

63. 300.XXX- Refusal of Care Form 2

64. 300.XXX- Refusal of Care- Left Without Being Seen

65. 300.XXX- Refusal of Care

66. 300.XXX- Refusal of Treatment- Attachment

67. 300.XXX- Return to Work- School Note

68. 300.XXX- Sports Physical Form from Michigan High School Athletic Association

69. 300.XXX- Suture/Staple Removal

70. 300.XXX- Td or Tdap Consent

71. 300.XXX- Telephone Advice

72. 300.XXX- Throat Specimen

73. 300.XXX- Triage Process- Check In

74. 300.XXX- Tuberculosis Skin Test Consent and Results

75. 300.XXX- Tuberculosis Test Consent and Results

76. 300.XXX- Tuberculosis Test Log

77. 300.XXX- Tuberculosis Positive Exempt Surveillance Questionnaire

78. 300.XXX- Tuberculosis Screening Mantoux

79. 300.XXX- Urine Collection- Female Catheter

80. 300.XXX- Urine Collection- Male Catheter

81. 300.XXX- Vaccine Influenza

82. 300.XXX- Vital Signs 2 Attachment

83. 300.XXX- Vital Signs 2

84. 300.XXX- Vital Signs- Pediatric

85. 300.XXX- Vital Signs

400.XXX- Medication

1. 400.XXX- Adverse Reactions Management 1

2. 400.XXX- Adverse Reactions Management 2

3. 400.XXX- Dispensed Medication Log

4. 400.XXX- Dispensing Practitioner- Point of Care Dispensing Indiana

5. 400.XXX- Expired Medication or Hazard Disposal Log

6. 400.XXX- Formulary- Annual Review

7. 400.XXX- Formulary- Approved

8. 400.XXX- Immunization Reporting State- Louisiana

9. 400.XXX- Influenza Control Log

10. 400.XXX- Influenza Immunization Sign in Sheet

11. 400.XXX- Influenza Immunization- CDC Patient Information

12. 400.XXX- Influenza Vaccine Immunization Administration

13. 400.XXX- IV- Adding Medication

14. 400.XXX- IV- Bolus

15. 400.XXX- IV- Discharging

16. 400.XXX- IV- Monitoring the Site

17. 400.XXX- IV- Push

18. 400.XXX- IV- Starting

19. 400.XXX- L.E.T. Application

20. 400.XXX- Medical Recall Log

21. 400.XXX- Medication Refrigerator- Temperature Check Graph

22. 400.XXX- Medication- Administration 2

23. 400.XXX- Medication- Administration Error

24. 400.XXX- Medication- Administration

25. 400.XXX- Medication- Disposal Log

26. 400.XXX- Medication- Expiration Date Audit

27. 400.XXX- Medication- Management Inspection Checklist

28. 400.XXX- Medication- Samples Log 2

29. 400.XXX- Medication- Tracking Form

30. 400.XXX- Medication- Alerts/Warnings

31. 400.XXX- Medication- Disposal Log

32. 400.XXX- Medication- Disposal

33. 400.XXX- Medication- Expired Log

34. 400.XXX- Medication- Injection Log

35. 400.XXX- Medication- Refrigerator Temperature

36. 400.XXX- Medication- Sample Receipt Log

37. 400.XXX- Medication- Samples Management 2

38. 400.XXX- Medication- Samples Management

39. 400.XXX- Medication- Samples Dispensed Log

40. 400.XXX- Medication- Samples Log

41. 400.XXX- Medication- Security Storage Disposal

42. 400.XXX- Medications and Dated Patient Items Review Log

43. 400.XXX- Narcotic Monitoring Daily Log

44. 400.XXX- Narcotic Controlled Substance Inventory Log

45. 400.XXX- Narcotic Controlled Substance Control

46. 400.XXX- Pharma Rep- Confidentiality Form

47. 400.XXX- Recall- Medication, Product, or Equipment

48. 400.XXX- Recall- Medication

49. 400.XXX- Request for New Medication or Service Policy

50. 400.XXX- Td or Tdap Consent

51. 400.XXX- Td or Tdap

52. 400.XXX- Td or Tdap CDC Informational Sheet

53. 400.XXX- Vaccine Encounter

54. 400.XXX- Vaccine Refrigerator/Freezer Temperature Log

55. 400.XXX- Vaccine Reporting Form

500.XXX- Laboratory

1. 500.XXX- Stool Collection Policy

2. 500.XXX- CLIA Waived Testing

3. 500.XXX- Competency- Fecal Occult Blood

4. 500.XXX- Competency- Glucometer

5. 500.XXX- Competency- hCG Urine Cassette Pregnancy Test

6. 500.XXX- Competency- Influenza A & B Test

7. 500.XXX- Competency- Mono Test

8. 500.XXX- Competency- Strep A Test

9. 500.XXX- Competency- Urinalysis

10. 500.XXX- Competency- Critical Test Results- After Hours

11. 500.XXX- Encounter Lab Only

12. 500.XXX- Glucometer

13. 500.XXX- Glucose Level Testing

14. 500.XXX- H. Pylori Testing

15. 500.XXX- Hemoccult

16. 500.XXX- HIV Testing

17. 500.XXX- Influenza Testing

18. 500.XXX- Influenza Molecular Testing

19. 500.XXX- Lab Courier Form

20. 500.XXX- Lab Environment Criteria

21. 500.XXX- Lab Ordering and Tracking Results

22. 500.XXX- Log- Glucometer 2

23. 500.XXX- Log- Glucometer

24. 500.XXX- Log- hCG 2

25. 500.XXX- Log- hCG

26. 500.XXX- Log- Hemoccult 2

27. 500.XXX- Log- Hemoccult

28. 500.XXX- Log- H. Pylori Control

29. 500.XXX- Log- Influenza AB 2

30. 500.XXX- Log- Influenza AB

31. 500.XXX- Log- Bab Daily Quality Controls

32. 500.XXX- Log- Mono Test 2

33. 500.XXX- Log- Mono Test

34. 500.XXX- Log- Room Temperature and Humidity

35. 500.XXX- Log- RSV

36. 500.XXX- Specimen Transport

37. 500.XXX- Log- Strep 2

38. 500.XXX- Log- Strep

39. 500.XXX- Log- Urine Analyzer Daily Maintenance

40. 500.XXX- Log- Urine Dipstick

41. 500.XXX- Manufacturer Package Inserts and Instructions

42. 500.XXX- Mono Test

43. 500.XXX- Non “DOT” Urine Drug Screen Collection

44. 500.XXX- Occ Med Drug Screen, DOT and Non- DOT Collection

45. 500.XXX- Patient Preparation

46. 500.XXX- Point of Care Testing and Results Reporting

47. 500.XXX- Pregnancy hCG

48. 500.XXX- Quality Controls

49. 500.XXX- Reagents- Lab

50. 500.XXX- Records Retention- Lab

51. 500.XXX- Refrigerator- Lab Specimen- Temperature Check Graph

52. 500.XXX- Room Temperature and Humidity

53. 500.XXX- RSV

54. 500.XXX- Safety Overview Lab

55. 500.XXX- Send Out Reference Lab Procedure

56. 500.XXX- Send Out Unable to Complete Test Procedures

57. 500.XXX- Specimen- Blood

58. 500.XXX- Specimen- Fasting

59. 500.XXX- Specimen- Identification

60. 500.XXX- Specimen- Preparation and Transport

61. 500.XXX- Specimen- Urine Clean Catch

62. 500.XXX- Specimen- Wound or Viral

63. 500.XXX- Specimen- Unacceptable

64. 500.XXX- Strep Testing

65. 500.XXX- Training- CLIA Waived Documentation

66. 500.XXX- Urinalysis Results Form

67. 500.XXX- Urinalysis Dipstick 2

68. 500.XXX- Urinalysis Dipstick

69. 500.XXX- Urine Drug Screen Affidavit of Correction (Memorandum for Record)

70. 500.XXX- Waived Testing Overview

600.XXX- Radiology

1. 600.XXX- Outside X-Ray Protocol

2. 600.XXX- Over-reads Process

3. 600.XXX- Over-reads

4. 600.XXX- Patient Log

5. 600.XXX- Pregnancy Consent Form

6. 600.XXX- Radiation Protection

7. 600.XXX- Radiation Discrepancy Policy

8. 600.XXX- Radiation Protection

9. 600.XXX- Radiology Read Discrepancy Log

10. 600.XXX- Radiology Safety

11. 600.XXX- Radiology Summary- Monthly

12. 600.XXX- Radiology Tracking Log

13. 600.XXX- Radiology Tracking

14. 600.XXX- Request for X-Ray

700.XXX- Infection Control

1. 700.XXX- Autoclave- Maintenance Monthly Log

2. 700.XXX- Autoclave- Maintenance

3. 700.XXX- Autoclave- Bio Monitoring Policy 2

4. 700.XXX- Autoclave- Bio Monitoring

5. 700.XXX- Autoclave- Bio Log

6. 700.XXX- Autoclave- Instruments

7. 700.XXX- Autoclave- Log

8. 700.XXX- Autoclave- Procedures

9. 700.XXX- Autoclave- Spore Checks

10. 700.XXX- Cleaning Responsibilities

11. 700.XXX- Communicable Disease Report Form

12. 700.XXX- Communicable Disease Reporting- Louisiana

13. 700.XXX- Communicable Disease Reporting- State Specific

14. 700.XXX- Daily Surface Disinfectant Log

15. 700.XXX- Exposure- Consent Form

16. 700.XXX- Exposure- Control Plan

17. 700.XXX- Exposure- Employee (Biological)

18. 700.XXX- Exposure- Follow Up Protocol

19. 700.XXX- Exposure- Incident Report

20. 700.XXX- Glove Use Audit

21. 700.XXX- Gloving Procedures- WHO Guidelines

22. 700.XXX- Hand Hygiene Policy

23. 700.XXX- Hand Hygiene- CDC

24. 700.XXX- HIV- Healthcare Workers- CDC

25. 700.XXX- Infection Control and Cleanliness Overview

26. 700.XXX- Infection Control- Annual Program Evaluation

27. 700.XXX- Infection Control- Sample Audit

28. 700.XXX- Infection Prevention and Control

29. 700.XXX- Infection Control- Annual- Infection Prevention and Control Surveillance Audit

30. 700.XXX- Infectious Disease- Emergency Response

31. 700.XXX- Infectious Disease Reporting Form

32. 700.XXX- Instruments- Reusable

33. 700.XXX- Personal Protective Equipment- OSHA- Fact Sheet

34. 700.XXX- Personal Protective Equipment- OSHA- Cuts Risk

35. 700.XXX- Reportable Conditions Example- State Specific Policy

36. 700.XXX- Sharps Bloodborne Fact Sheet- OSHA

37. 700.XXX- Sterile Field Preparation

38. 700.XXX- Tuberculosis Annual Screening Questionnaire

39. 700.XXX- Tuberculosis Annual Test Questionnaire

40. 700.XXX- Tuberculosis- Risk Reduction Plan- Louisiana

41. 700.XXX- Universal Precautions- CDC

42. 700.XXX- Universal Precautions Policy

800.XXX- Quality & Safety

1. 800.XXX- Quality and Performance Improvement Plan Form

2. 800.XXX- AED Machine Log

3. 800.XXX- Body Mechanics and Ergonomics

4. 800.XXX- Closure of Center (Unforeseen)

5. 800.XXX- Complaint and Grievance Resolution Policy

6. 800.XXX- Complaint and Grievance- Civil Rights

7. 800.XXX- Complaint- Completing Form and Process

8. 800.XXX- Complaint Form

9. 800.XXX- Complaint Letter- Requesting Emp. Response

10. 800.XXX- Complaint Letter to Complainant

11. 800.XXX- Complaints Tracking Spreadsheet

12. 800.XXX- Crash Cart- Set-Up

13. 800.XXX- Crash Cart- Inventory

14. 800.XXX- Crash Cart-Log (Seals)

15. 800.XXX- Crash Cart- Maintenance

16. 800.XXX- Drill- Behavior Disruption

17. 800.XXX- Drill- EMR Outage

18. 800.XXX- Drill- Internal Event

19. 800.XXX- Drill- Medical Emergency Form

20. 800.XXX- Drill- Missing Person

21. 800.XXX- Drill- Participant Roster

22. 800.XXX- Security Threat

23. 800.XXX- Drill- Severe Weather

24. 800.XXX- Drills- Annual Schedule

25. 800.XXX- Drills- Mock Code

26. 800.XXX- Emergency Preparedness Notification Call Tree

27. 800.XXX- Emergency Evacuation- Fire Explosion

28. 800.XXX- Emergency Evacuation- Sample Center Map

29. 800.XXX- Emergency Management

30. 800.XXX- Emergency Preparedness- Refrigerated Med Test Kits

31. 800.XXX- Emergency Response- Inventory Log

32. 800.XXX- Emergency Response- Inventory Tags

33. 800.XXX- Emergency Response Kit- Inventory

34. 800.XXX- Environment of Care- Annual Assessment

35. 800.XXX- Equipment- AED Daily Log

36. 800.XXX- Equipment- AED Monitoring

37. 800.XXX- Equipment- Annual Evaluation Form

38. 800.XXX- Equipment- Biomedical Inspections

39. 800.XXX- Equipment- Management

40. 800.XXX- Equipment- Management and Maintenance

41. 800.XXX- Equipment- Medical Device Reporting

42. 800.XXX- Equipment- Refrigerator and Freezer Temperature Log

43. 800.XXX-Equipment- Refrigerator Log- Cleaning

44. 800.XXX- Equipment- Refrigerator Log- Temperature with Ranges

45. 800.XXX- Equipment-Refrigerator- Monitoring and Maintenance

46. 800.XXX- Equipment- Refrigerator Temperature Monitoring

47. 800.XXX- Equipment- Refrigerator- Vaccine Storage

48. 800.XXX- Equipment- Safety Evaluation Form

49. 800.XXX- Equipment- Vaccine Refrigerator- Temperature Log

50. 800.XXX- External Events

51. 800.XXX- Fire Drill Record

52. 800.XXX- Fire Safety Inspection Checklist

53. 800.XXX- Fire Safety Version 2

54. 800.XXX- Fire Safety

55. 800.XXX- Fire Audit

56. 800.XXX- Hazardous Materials and Waste Inspection Checklist

57. 800.XXX- Hazardous Mat- Communication

58. 800.XXX- Hazardous Mat- Disposal

59. 800.XXX- Hazardous Mat- List Sample

60. 800.XXX- Hazardous Mat- List

61. 800.XXX- Hazardous Mat- Materials and Waste

62. 800.XXX- Hazardous Mat- Soiled Instrument and Item Transport

63. 800.XXX- Incident and Occurrence- Patient or Visitor Policy

64. 800.XXX- Incident and Occurrences-Corrective Action Documentation

65. 800.XXX- Incident or Occurrence Report- Building

66. 800.XXX- Incident or Occurrence Report- Employee Only

67. 800.XXX- Incident Report- Accident Form

68. 800.XXX- Incident Report- Patient or Visitor Form 2

69. 800.XXX- Incident Report Policy

70. 800.XXX- Incident Corrective Action

71. 800.XXX- Incident- Root Cause Analysis

72. 800.XXX- Incident- Sentinel Event

73. 800.XXX- Incident- Significant Investigative Report Form

74. 800.XXX- Incident- Significant Policy

75. 800.XXX- Medical Equipment Inspection Checklist

76. 800.XXX- Medical Equipment Safety Evaluation Form

77. 800.XXX- Near Miss Report

78. 800.XXX- Patient Satisfaction- Measuring Outcomes

79. 800.XXX- Patient Satisfaction- Phone Survey Spreadsheet

80. 800.XXX- Patient Satisfaction- Survey Policy

81. 800.XXX- Patient Throughput- Time Measuring

82. 800.XXX- Physical Environment- Non-Smoking

83. 800.XXX- PPE- OSHA Facts

84. 800.XXX- Quality and Performance Improvement Plan 2

85. 800.XXX- Quality and Performance Improvement Plan

86. 800.XXX- Quality and Performance Improvement- PDCA Form

87. 800.XXX- Quality Management- Sample Overarching Plan

88. 800.XXX- Safety and Health Overview

89. 800.XXX- Safety Inspection- Environment of Care- Annual Evaluation

90. 800.XXX- Safety- Accessing and Securing the Center

91. 800.XXX- Safety- Annual Assessment Form

92. 800.XXX-Safety- Annual Device Evaluations- OSHA

93. 800.XXX- Safety- Device Evaluation Form

94. 800.XXX- Safety- Electrical and Hazardous Energy

95. 800.XXX- Safety- Electrical Heater and Purifiers Prohibition

96. 800.XXX- Safety- Environmental Annual Assessment

97. 800.XXX- Safety- Environmental

98. 800.XXX- Safety- Facility Hazard Assessment

99. 800.XXX- Safety- Fire Control 2

100. 800.XXX- Safety- Fire Control

101. 800.XXX- Safety- Inspection Checklist

102. 800.XXX- Safety- Monthly Center Evaluation Form

103. 800.XXX- Safety- Monthly Center Evaluation Policy

104. 800.XXX- Safety- Panic Button and Security System

105. 800.XXX- Safety- Panic Button

106. 800.XXX- Safety- Pediatric

107. 800.XXX- Safety- Security Annual Review

108. 800.XXX- Safety- Security

109. 800.XXX- Safety- Weapons Prohibition

110. 800.XXX- Safety Survey- Annual

111. 800.XXX- Security Inspection Checklist

112. 800.XXX- Service Animals Access

113. 800.XXX- Sharps- OSHA Facts Sheet

114. 800.XXX- Utilities- Annual Review 2

115. 800.XXX- Utilities- Annual Review

116. 800.XXX- Utilities- Inspection Checklist

117. 800.XXX- Utilities- Outages

900.XXX- Medical Records

1. 900.XXX- Abbreviations- Do Not Use 2

2. 900.XXX- Abbreviations- Do Not Use List

3. 900.XXX- Abbreviations- Do Not Use

4. 900.XXX- Chart Audit Review- Tool

5. 900.XXX- Chart System

6. 900.XXX- Completion of Forms

7. 900.XXX- Documentation Guidelines 2

8. 900.XXX- Documentations Guidelines

9. 900.XXX- Medical Record Audit

10. 900.XXX- Medical Record Retention

11. 900.XXX- Missing Router

12. 900.XXX- Outages or Disruption

13. 900.XXX- Outages- Disruption in Patient Information Processes

14. 900.XXX- Patient Chart- Computer Down Policy

15. 900.XXX- Patient Chart- Discharge Instructions

16. 900.XXX- Patient Chart- Paper Nurses Note

17. 900.XXX- Patient Chart- Paper Progress Note

18. 900.XXX- Patient Chart- Paper

19. 900.XXX- Patient Medical Record- Processing

20. 900.XXX- Progress Notes

21. 900.XXX- Release of Medical Records Policy

22. 900.XXX- Release of Medical Records Form

23. 900.XXX- Release of Medical Records

24. 900.XXX- Release PHI- Patient Authority

25. 900.XXX- Release- Patient Authorization- PHI to Third Parties

26. 900.XXX- Request for Medical Records Letter Sample

27. 900.XXX- Retention and Management of Medical Records

28. 900.XXX- Router Form

29. 900.XXX- Router

30. 900.XXX- Superbill Sample