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[YOUR CLINIC NAME]

Effective 5/8/2023 document.doc

Error: Reference source not found Error: Reference source not found Manual

Instructions for using this office manual template:

This office manual template is a tool developed for members of the South Island Division of Family Practice. This template includes generic workflows and policies. Physicians should review each section of this manual using the following steps:

1. To insert your full clinic name, click CTRL+F to find the following label, [YOUR CLINIC NAME] in this manual.

2. Click on the “Replace” tab and enter [YOUR CLINIC NAME] in the “Find what:” field and the name of your clinic in the “Replace with:” field.

3. Click on Replace All.

4. There are many section in this document where there are phrases such as [insert location] or [insert instructions]. This is done to make it easy to find sections that need to be modified. You may conduct a find and replace for an open square bracket “[“ as noted above. This will find each spot where you need to modify something to make it specific to your clinic. Some of the square brackets are associated with simple changes like modifying clinic hours, and some are associated with more complex changes such as developing an individual clinic privacy policy.

5. You will need to update the Table of Contents. Go to page 5 and right click anywhere on the Table of Contents. Select “Update Field” and the “Update entire table” option.

Effective 5/8/2023 OFFICE MANUAL Version [xx]


6.

7. Once you have found all the square brackets, and replaced with information pertaining to your clinic, you should read through the entire document ensuring that you agree with the general policies and procedures in this manual. Every section may be modified to suit your clinic. We have included some general policies that you may use, but we do not recommend implementing use of this manual until you have read though each section in detail and modified or signed off on each section.

8. Delete instructions (any text in blue italic font).



This page describes who controls the manual versions, and logs all changes made.

Prepared ByDocument Owner(s) Role

[insert names of people responsible for the document and their roles]

Version Control

Version Date Author Change Description

[insert draft versions with brief description of changes made and who approved]

[add rows as needed]



TABLE OF CONTENTS

1 INTRODUCTION 10

1.1 About [YOUR CLINIC NAME] 10

1.2 Changes to this Manual 10

1.3 [YOUR CLINIC NAME] Values 11

2 DOCTORS 12

2.1 Introducing the Doctors 12

2.2 Doctors’ Hours of Work 12

2.3 Locum Arrangements 132.3.1 Under Private Arrangement....................................................................................132.3.2 Locum under the Rural Practice Program...............................................................14

3 STAFF 16

3.1 Roles 16

3.2 Employee Hours of Work and Pay 16

3.3 Scheduling 17

3.4 Performance Monitoring 17

3.5 Personnel Records and Administration 18

3.6 Workplace Safety 183.6.1 Routine practices to prevent the spread of infectious disease...............................193.6.2 Preventing transmission respiratory infection by of airborne or droplet routes.....193.6.3 Sharps.....................................................................................................................203.6.4 Waste Disposal........................................................................................................203.6.5 Risks of Violence in Health Care..............................................................................21

3.7 [YOUR CLINIC NAME] Employees as Patients 22

3.8 Vacation and other Leave Requests 22

3.9 Relief Shifts 22

3.10 Employee Standards of Conduct 233.10.1 Attendance and Punctuality....................................................................................233.10.2 Harassment Policy...................................................................................................233.10.3 Sexual Harassment Policy.......................................................................................233.10.4 Workplace Violence................................................................................................233.10.5 Gifts.........................................................................................................................23



3.10.6 Dress Code..............................................................................................................233.10.7 Use of Computer, Phone, Internet and Mail...........................................................23

3.11 Privacy and Confidentiality 24

3.12 Training and Professional Development 26

4 CLINIC FACILITY AND ADMINISTRATION 27

4.1 The Facility 274.1.1 Lease.......................................................................................................................274.1.2 Parking....................................................................................................................274.1.3 Ambulance Exits......................................................................................................274.1.4 Cleaning Contract....................................................................................................27

4.2 Garbage and Recycling 27

4.3 Waiting Area 284.3.1 Front Desk...............................................................................................................284.3.2 Tidiness...................................................................................................................28

4.4 Conference Room 28

4.5 Staff Room 28

4.6 Opening and Closing Checklist 29

4.7 Purchasing and Inventory 304.7.1 Roles.......................................................................................................................30

4.8 Exam Room Supply Standards 33

4.9 Emergency Supply Kit 35

4.10 Sterilizing Medical Equipment and Tools 354.10.1 Sterilization Practices and Protocols.......................................................................354.10.2 Instructions for Running the Autoclave...................................................................36

4.11 Mail 36

4.12 Billing 374.12.1 MSP.........................................................................................................................374.12.2 Third party and patient bills (Uninsured Fee Schedule)..........................................374.12.3 WCB........................................................................................................................374.12.4 ICBC.........................................................................................................................384.12.5 Military and RCMP..................................................................................................38

4.13 Finance 38

4.14 Communications 38

4.15 Privacy Policy 40



5 INFORMATION TECHNOLOGY 41

5.1 Phones 41

5.2 Fax 41

5.3 Phone and Printer Directory 42

5.4 [YOUR EMR SYSTEM NAME] 43

5.5 Internet 43

5.6 Information Systems Security 43

5.7 Restarting Email and Fax Services 44

6 PARTNERS 45

6.1 Visiting Specialists 45

6.2 Hospice 45

7 ENQUIRIES 46

7.1 Phone 46

7.2 New Patients 47

7.3 Looking up PHN and Medication History 47

7.4 Requests to Transfer Records 47

7.5 Prescription Renewals 48

7.6 Sick Note Requests 48

7.7 Email 48

7.8 INR Calls 49

7.9 After Hours 49

8 APPOINTMENTS 50

8.1 Standard Appointment Schedule 50

8.2 Appointment Types and Booking Preferences by Doctors 50

8.3 Drivers Physicals 50

8.4 Pre-Op Physicals 51

8.5 Wait List 51



8.6 Advanced Access 52

8.7 Youth Clinic 52

8.8 Urgent Care Clinic 53

9 ENCOUNTERS 54

9.1 Patient Arrival 54

9.2 Patient Prep54

9.3 Exam Room 54

9.4 Appointment Completion 55

10 REFERRALS 56

10.1 Referrals In 5610.1.1 Palliative Patients....................................................................................................56

10.2 Referrals Out 5610.2.1 Referrals to Specialists............................................................................................5610.2.2 Hospice Referrals....................................................................................................5610.2.3 Travel Assistance for Referrals to Specialists..........................................................56

10.3 Prescriptions 57

11 MAINTAIN PATIENT CHART 58

11.1 New Patients 58

11.2 Labs 58

11.3 Pap Recalls 59

11.4 Prescriptions 59

11.5 Scanning and Plunking Documents 59

APPENDICES 62

A. BUSINESS MANAGER JOB DESCRIPTION [SAMPLE] 62

B. MEDICAL OFFICE ASSISTANT JOB DESCRIPTION [SAMPLE] 63

C. EMPLOYEE PERFORMANCE DEVELOPMENT PLAN FORMS [SAMPLES] 65

D. SUPPLY LOCATION LIST [SAMPLE] 69

E. UNINSURED FEE SCHEDULE 72

F. PRIVACY POLICY 73Effective 5/8/2023 OFFICE MANUAL Version [xx]


a. General Privacy Policy 73

b. Detailed Privacy Policy 75

c. Standard Contractual Clause [sample] 75

d. General Express Consent Form [sample] 75

G. Quick Guide and Shortcuts76



1 INTRODUCTION

This manual includes the policies and procedures for the [YOUR CLINIC NAME] and replaces all previous manuals and directives. This document will be maintained and updated by designated staff members.

If you have any feedback on the contents of this manual, please let a Manual Coordinator know, and he/she will take any necessary action.

1.1 About [YOUR CLINIC NAME]

[Clinics may develop their own clinic blurb. You may want to consider include points such as:]

When the clinic opened

Clinic location

Number of doctors and other support staff

Special programs or services

Number of patients (eg: number of patients under regular care or number of patients seen in a year…)

Other pertinent info such as ambulance services, urgent care, etc.

The following is an example:

The Everyone’s Healthy Medical Clinic (EHMC) opened on November 28, 2007 when the Westside Family Medical Clinic and the Northwest Medical Centre joined as a single clinic.

EHMD is located in Southern Vancouver Island’s West Shore and serves rural areas. The area includes a culturally and age diverse population of about 14,000.

EHMC includes six family physicians. The clinic hosts itinerant specialists and family practice residents and provides an urgent care clinic for the general public on evenings and weekends.

The EHMC doctors estimate that almost 70% of the area’s population is attached to their family practices, while their urgent care clinic serves the rest of the population for immediate care issues.

The area is also served by the BC Ambulance Services and a number of Vancouver Island Health Authority Services including Home and Community Care based in Esquimalt, public health services, and an Environmental Health Officer.

The closest hospital is Victoria General Hospital approximately 25 km away.

1.2 Changes to this Manual

Our philosophy is one of continuous improvement, using the Plan – Do – Study – Act quality improvement process. We expect frequent changes to this manual as we continuously implement improvements in our policies and processes.



Roles for policy and process development:

The Doctors approve any changes to policy or procedures.

The Manual Coordinators facilitate policy and procedure change requests, document changes, and update this manual.

Anyone may develop a policy or process for consideration by the doctors.

Everyone should be looking out for and communicating improvements to the way we work.

1.3 [YOUR CLINIC NAME] Values

[YOUR CLINIC NAME] is a group family medicine clinic based on the following ideals:


For everyone on the team:

Patient centered focus for planning and care

Supportive, inclusive, multidisciplinary team approach to Family Medicine

Respect for all roles in the multidisciplinary team, and tolerance of our differences

Open and clear communication among all team members

Recognition of and respect for all team members’ private lives

Mindfulness in delivering efficient and cost effective services.

For the doctors:

Shared on-call responsibilities

Cross-coverage of each other’s practices when needed

Consensus decision making, based on a structured, consistent approach

Physicians as a resource to the larger community

Collaborative approach to teaching responsibilities of medical residents, students

Rotating community roles, e.g_______________

Needs-based planning (services based on community needs and capacity, not simply previous activities or physician interests)



2 Doctors

2.1 Introducing the Doctors

The [YOUR CLINIC NAME] has [#] family physicians, including

[Doctor 1]

Include blurb for each physician

Doctor 2 (etc.)

Doctor 2 blurb


Everyone’s Medical Clinic has 6 doctors including:

Joe Surfer MD CCFP MHSc

Joe graduated from the University of Calgary medical school in 2003 and completed family practice residency in Vancouver in 2005. He also obtained a Masters of Health Sciences in community medicine and epidemiology at UBC in 2010.

Joe’s practice interests include primary mental health care services and pediatric medicine

Joe is married with 2 small children. He enjoys an active lifestyle including competing in marathons, kayaking, biking and skiing.

2.2 Doctors’ Hours of Work

The doctors each have a standard schedule that is the basis for [YOUR CLINIC NAME] hours. Doctors may choose to alter their hours at their own discretion, providing the other doctors and staff with as much notice as possible.

[Include doctor schedule here, if one is available]




2.3 Locum Arrangements

When the doctors are away from the clinic for holidays or other absences, they often arrange for a qualified physician (called a 'locum') to provide relief coverage.

Physicians establish locum arrangements under a private arrangement between themselves and the locum.

[The clinic is also part of the Rural Practice Program which helps arrange and pay for Locum physicians. See http://www.health.gov.bc.ca/pcb/rural.html for more information.]

The processes for setting up a locum arrangement are as follows:

2.3.1 Under Private Arrangement

a. Error: Reference source not found [YOUR CLINIC NAME] physician finds a locum physician to fill the vacancy.

b. The Locum physician completes Assignment of Payment Agreement:


http://www.health.gov.bc.ca/pcb/rural.html


The fillable form is found at: https://www.health.gov.bc.ca/exforms/mspprac/2870fil.pdf

c. The [YOUR CLINIC NAME] physician pays locum according to the Assignment of Payment Agreement.

2.3.2 Locum under the Rural Practice Programa. The [YOUR CLINIC NAME] physician sends request for locum assistance to Rural Practice

Program using this form:


https://www.health.gov.bc.ca/exforms/mspprac/2870fil.pdf


The fillable form can be found at: https://www.health.gov.bc.ca/exforms/rural/2802fil.pdf

b. The Rural Practice Program provides a suitable locum to fill the vacancy.

c. The Locum physician completes Assignment of Payment Agreement

The fillable form can be found at: https://www.health.gov.bc.ca/exforms/rural/2801fil.pdf


https://www.health.gov.bc.ca/exforms/rural/2801fil.pdf

https://www.health.gov.bc.ca/exforms/rural/2802fil.pdf


d. The Rural Practice Program (Ministry of Health) pays locum according to the Assignment of Payment Agreement.

3 Staff

[YOUR CLINIC NAME]Error: Reference source not found employs [#] Medical Office Assistants.

[YOUR CLINIC NAME] also contracts with the following positions:

Business Manager

Information Technology Consultant

Cleaners

3.1 Roles

Human Resource Director: The Human Resource (HR) Director has overall responsibility for managing staff. The role of HR Director is filled by [HR DIRECTOR NAME]

Business Manager: The Business Manager is responsible and main staff contact for payroll and staff work scheduling. Business Manager job description can be found in Appendix A

Medical Office Assistant: MOA job description can be found in Appendix B.

3.2 Employee Hours of Work and Pay

[YOUR CLINIC NAME] uses the BC Employment Standards Act as the basis for policy. Policies in place include:

Maximum Work Hours: Employees may work up to 40 hours per week and 8 hours per day

Time Keeping: describe where hours are recorded and any policies about recording overtime hours.

Overtime: Overtime compensation is paid is in accordance with the BC Employment Standards Act. All overtime work performed must receive a doctor’s prior authorization.

Unpaid Breaks: Employees must have a 30 minute unpaid meal break if a shift is 5 hours or more.

Paydays: [insert payday schedule, e.g. biweekly]

Statutory Holidays: [YOUR CLINIC NAME] observes nine statutory holidays:

New Years Day

Good Friday

Victoria Day

Canada Day

B.C. Day

Labour Day

Thanksgiving Day



Remembrance Day

Christmas Day

For further information about how statutory holidays are paid: http://www.labour.gov.bc.ca/esb/facshts/statutory_holidays.htm

Sick Days: [insert policy]

Vacation Allowance: [insert policy]

Uniform Allowance: [insert policy]

For further information on the BC Employment Standards Act see: http://www.labour.gov.bc.ca/esb/esaguide/welcome.htm

3.3 Scheduling

[Insert who is responsible for scheduling and describe the scheduling process for doctors and support staff]

[insert Where is the schedule located (if electronic, provide link here)]

[Insert The schedule has the following features: (describe schedule features)]

3.4 Performance Monitoring

[here is an example of what one clinic has done – insert your own clinic performance monitoring policy]

Doctors are directly responsible for monitoring [YOUR CLINIC NAME] staff performance.

[YOUR CLINIC NAME] monitors and evaluates every new employee’s performance for three months before confirming his or her appointment in a position. New staff members will be evaluated against their job descriptions:

1. After completing their probation period (three months)

2. Again, in nine months (at the 12month point)

3. After that, the employee will develop an Employee Performance Development Plan.

Employee Performance Development Plan Cycle

Each employee will have an Employee Performance Development Plan (EPDP) which will be reviewed annually. EPDPs will be updated at least every 2 years. The EPDP process includes the following steps:

1. Confirm job duties (job description) (employer)

2. Establish the EPDP which outlines specific areas for development for the employee (employee and employer)

3. Implement the EPDP (employee)


http://www.labour.gov.bc.ca/esb/esaguide/welcome.htm

http://www.labour.gov.bc.ca/esb/facshts/statutory_holidays.htm


4. Evaluate the employee’s progress against the plan and update the EPDP for new learning goals (employee and employer)

5. Renew the plan (back to step 1)

EPDP Roles

Human Resource Director: The Human Resource (HR) Director is responsible for approving all EPDPs including the performance appraisal component.

Business Manager: The Business Manager is responsible for coordinating the EPDP process and ensuring all staff EPDPs are current.

Employees: Employees are responsible for developing and implementing their EPDP and completing a self-evaluation report

Evaluators: Evaluators are responsible for completing a performance appraisal for the employee. Usually two evaluators will complete appraisals for every employee. Either one or both evaluators may attend the performance review meeting.

The EPDP performance review and employee development forms are found in Appendix C.

3.5 Personnel Records and Administration

The task of handling personnel records and related administration functions at [YOUR CLINIC NAME] has been assigned to the [clinic supervisor, business manager, etc]. Personnel files will be kept confidential at all times and are kept [location].

3.6 Workplace Safety

[YOUR CLINIC NAME] is committed to providing a safe and healthy workplace for all staff. A combination of measures will be used to achieve this objective, including the most effective control technologies available. Our work procedures will protect not only our workers, but also anyone who enters our workplace.

All employees must follow the procedures described to prevent or reduce risk of illness or injury. All new employees will be provided with safety training as a part of their initial job training. Policy and procedure reviews will be given annually, or with any updates to the policy.

[YOUR CLINIC NAME] safety procedures are based on guidelines developed by WorkSafe BC and the BC Centre for Disease Control. Every clinic employee is expected to follow these policies and procedures, as an important part of their position at the clinic. These policies and procedures are updated regularly and their use is mandatory.



Each employee is expected to obey safety rules and exercise caution and common sense in all work activities.

3.6.1 Routine practices to prevent the spread of infectious disease

Hand-washing should occur before and after every patient contact. Wash hands with soap and warm water for 15-30 seconds. Waterless, alcohol-based hand-sanitizers are also effective, unless hands are visibly soiled.

Wear disposable, waterproof gloves when touching blood and body fluids, or when handling contaminated items. Gloves should be used in addition to hand-washing, not as a substitute.

Wear other personal protective equipment (for example, face shields, eye protection, and gowns) if there is a risk of splashes or sprays of blood and body fluids.

Handle contaminated equipment and linens according to safe work procedures to prevent the transfer of infectious organisms.

Handle and dispose of sharps according to safe work procedures.

Use mouthpieces or other ventilation devices instead of mouth-to-mouth resuscitation, whenever possible.

Appropriate sterilization and disinfection of reusable equipment and office surfaces (counters and furniture) on a routine basis.

3.6.2 Preventing transmission respiratory infection by of airborne or droplet routes

Screen patients when scheduling appointments. Whenever possible, patients suspected of carrying a transmittable respiratory infection should be booked at the end of the day

Quickly triage patients suspected of carrying a transmittable respiratory infection out of common waiting room areas.

Make waterless alcohol-based hand antiseptics and disposable surgical masks available to all patients. Ask patients suspected of carrying transmittable respiratory infections to don a mask and use the hand-sanitizer immediately upon entering the clinic, and again before seeing a doctor or nurse.

Close the door of examining rooms, limiting access to the patient by visitors and staff members.

Patients known to be carriers of antibiotic resistant organisms should have this indicated in their medical record, and special care should be taken to prevent the spread of these organisms, including disinfecting all surfaces that have been in direct contact with the patient, immediately after a visit.

Routine infection control practices (hand-washing, sanitizing surfaces, and using personal protective equipment) are to be used with all patients, regardless of presumed infection or diagnosis.

Detailed descriptions of policies and procedures for infection prevention and control, recommended by WorkSafe BC and the BC Centre for Disease Control can be found here.http://www.bccdc.ca/NR/rdonlyres/84DA413D-C943-4B5F-94F1-794C5B76C9CE/0/InfectionControl_GF_IC_In_Physician_Office.pdf


http://www.bccdc.ca/NR/rdonlyres/84DA413D-C943-4B5F-94F1-794C5B76C9CE/0/InfectionControl_GF_IC_In_Physician_Office.pdf

http://www.bccdc.ca/NR/rdonlyres/84DA413D-C943-4B5F-94F1-794C5B76C9CE/0/InfectionControl_GF_IC_In_Physician_Office.pdf


3.6.3 Sharps

Used needles and other sharp instruments (sharps) should be appropriately handled to avoid injury, including minimizing contact with used sharps. Sharps should be disposed of in puncture-proof containers, located in the same area where the sharp was used.

Sharps disposal containers are located [location]

As recommended by WorkSafe BC, if you are stuck by a used needle follow these steps immediately:

Let the wound bleed freely

Inform a doctor at the clinic

Go to a hospital within 2 hours

Additional resources for prevention of the spread of disease and infections can be found on the WorkSafeBC website, here: http://www2.worksafebc.com/Portals/HealthCare/InfectiousDiseases.asp

3.6.4 Waste Disposal

Biomedical Waste:Municipal and provincial laws regulate the disposal of biomedical waste.

There are two categories of biomedical waste:

1. Anatomical – including tissues, organs, and body parts (not including hair, nails, and teeth)

2. Non-anatomical

human blood and blood products

items contaminated with blood that would release liquid if compressed

body fluids contaminated with blood, excluding urine and feces

sharps

broken glass or other sharp objects that would have come into contact with blood or body fluids

[describe clinic procedures for biomedical waste disposal]

Pharmaceutical Waste:Pharmaceutical waste (returned medications) is returned to pharmacies or drug company representatives.

[describe clinic procedures for pharmaceutical waste disposal]


http://www2.worksafebc.com/Portals/HealthCare/InfectiousDiseases.asp


Confidential Paper Waste:Confidential paper waste is shredded with a two-way shredder and recycled.

[describe clinic procedures for all types of waste disposal]

WHMIS: The Workplace Hazardous Materials Information System (WHMIS) is a national hazard communication standard. It includes cautionary labeling of containers of hazardous substances, material safety data sheets (MSDS) which provide specific information about hazardous substances, and worker education programs. Employers are expected to uphold WHMIS standards in the workplace, and employees are expected to be familiar with the system prior to beginning employment.

WHMIS information can be found here:WorkSafe BC http://www2.worksafebc.com/Topics/WHMIS/Home.asp

If staff have not completed WHMIS training, or feel that they would benefit from repeating the course, [YOUR CLINIC NAME] will support this training.

Handling of cytotoxic drugs: Cytotoxic drugs are therapeutic agents intended for, but not limited to, the treatment of cancer. They are highly toxic to cells, mainly through their action on cell reproduction.

Based on guidelines from the BC Cancer Society, employees are to be educated on safe handling and exposure documentation of cytotoxic agents within their first three months of employment.

Access to cytotoxic agent storage areas, cytotoxic waste removal, and any handling of cytotoxic agents will be limited to authorized personnel only. These agents are stored separately from other drugs kept onsite, and they will be labeled appropriately. If you feel there is a potential risk in handling of any substance in the office, contact your supervisor immediately, who will assist in a risk assessment.

Do not handle any unauthorized or unknown substances without confirming with a supervisor.For more detailed information about the risk associated with cytotoxic agents, and their proper handling, please visit WorkSafe BC and/or the BC Cancer Society websites:

WorkSafe BC: http://www2.worksafebc.com/Portals/HealthCare/PhysicalHazards.asp

BC Cancer Society: http://www.bccancer.bc.ca/NR/rdonlyres/B10C0DC3-D799-45E8-8A61-A93F00906737/14256/V_10_SafeHandlingStandards.pdf

3.6.5 Risks of Violence in Health Care

According to WorkSafe BC, patient violence is a leading cause of injury in the health system. Additionally, upon examination of the incidents, many of the patients were found to have a history or risk of violent behaviour that was not properly communicated in the patient chart. Privacy laws do not prohibit the labeling of patients with a “risk of violence” tag, and consent is not required when information is being disclosed for worker safety. Additionally, it is not a violation of patient privacy for one organization to disclose information to another, if that information is immediately necessary for the safety of employees. It is important that all employees who are in contact with patients are aware of risks of violence in patients, and any known triggers that may set off a violent event.


http://www.bccancer.bc.ca/NR/rdonlyres/B10C0DC3-D799-45E8-8A61-A93F00906737/14256/V_10_SafeHandlingStandards.pdf

http://www.bccancer.bc.ca/NR/rdonlyres/B10C0DC3-D799-45E8-8A61-A93F00906737/14256/V_10_SafeHandlingStandards.pdf

http://www2.worksafebc.com/Portals/HealthCare/PhysicalHazards.asp

http://www2.worksafebc.com/Topics/WHMIS/Home.asp


If an employee feels that a situation is becoming unsafe, they should leave the area and report to a supervisor. He or she will determine how to control the situation. For a complete description of WorkSafe BC guidelines for responding to workplace violence, visit the Worksafe BC website:

Guidelines for a Code White Response: http://www2.worksafebc.com/pdfs/healthcare/code_white.pdf

Issues of Workplace violence: http://www2.worksafebc.com/Portals/HealthCare/Violence.asp

3.7 [YOUR CLINIC NAME] Employees as Error: Reference source not foundPatients

[Describe policy regarding clinic employees as patients at the clinic.]

3.8 Vacation and other Leave Requests

[List vacation and leave policies. May include: procedures for making vacation requests, policies about shift changes, vacation and leave calendars, number of employees that may be off at any given time, and how vacation requests are evaluated (eg: seniority, previous requests, fairness, etc.]


The Business Manager will maintain and post a calendar showing all approved vacations and leaves of absence. The vacation calendar is posted in hard copy in the staff room.

Staff should submit vacation requests to the Business Manager.

As a general rule of thumb, up to two MOAs will be on vacation at any given time

The Business Manager will communicate dates for submitting vacation requests for major holiday seasons (e.g. Christmas, Easter and summer) staff. Where more than 2 MOAs request the same time, approvals will be granted considering previous vacation times, seniority, and fairness. All other vacation requests shall be granted on a first come first served basis.

3.9 Relief Shifts

Relief shifts to cover will be allocated based on the following criteria:

Skills (if applicable) Availability (not overtime) Seniority Fairness


http://www2.worksafebc.com/Portals/HealthCare/Violence.asp

http://www2.worksafebc.com/pdfs/healthcare/code_white.pdf


3.10 Employee Standards of Conduct

3.10.1 Attendance and Punctuality

[YOUR CLINIC NAME] expects employees to be ready to work at the beginning of assigned daily work hours, and to reasonably complete their projects by the end of assigned work hours.

From time to time, it may be necessary for an employee to be late or absent from work. [YOUR CLINIC NAME] is aware that emergencies, illnesses, or pressing personal business that cannot be scheduled outside work hours may arise. It is the responsibility of all employees to contact all affected parties if they will be absent or late.

3.10.2 Harassment Policy

[YOUR CLINIC NAME] does not tolerate workplace harassment. Workplace harassment can take many forms. It may be, but is not limited to, words, signs, offensive jokes, cartoons, pictures, posters, e-mail jokes or statements, pranks, intimidation, physical assaults or contact, or violence.

3.10.3 Sexual Harassment Policy

[YOUR CLINIC NAME] does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, other unwelcome verbal or physical contact of a sexual nature, or any conduct that creates an offensive, hostile, or intimidating working environment or prevents an individual from effectively performing the duties of their position.

3.10.4 Workplace Violence

[YOUR CLINIC NAME] prohibits workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment, and/or coercion will not be tolerated.

3.10.5 Gifts

Advance approval from management is required before an employee may accept or solicit a gift of any kind from a patient or vendor. Employees are not permitted to give unauthorized gifts to patients.

3.10.6 Dress Code

Employees are expected to dress in an appropriate manner to the clinic. Employees who are engaged in patient interaction are expected to wear hospital scrubs. This is part of the employee safety policy. Employees who are not engaged in patient care are expected to wear business or business casual attire during office hours. Long-term contractors who do not have company uniforms or safety gear are also expected to appear professional. If uncertain whether your attire is appropriate, you are expected to confirm with the doctor currently acting as the Human Resource Director.

3.10.7 Use of Computer, Phone, Internet and Mail

[YOUR CLINIC NAME] property, including computers, phones, electronic mail, and voice mail, should be used only for conducting [YOUR CLINIC NAME] business. Incidental and occasional personal use of clinic computers, phones, or electronic mail and voice mail systems is permitted, but information and messages



stored in these systems will be treated no differently from other business-related information and messages.

3.11 Privacy and Confidentiality

Prior to having access to patients’ confidential medical records, all staff must read and sign a confidentiality agreement. This agreement states that employees will not disclose medical information without written consent from the patient, and that employees will only have access to patient medical information when it is pertinent to their job. All medical records and information are opened on a need-to-know basis only.

For the clinic privacy policy, see section 4.15.

Example Confidentiality Agreement for Employees: https://www.bcma.org/files/Confidentiality_Agreement_for_Physician_Office_Employees.pdf

See BCMA website for other examples: https://www.bcma.org/publications-media/privacy-toolkit


https://www.bcma.org/publications-media/privacy-toolkit

https://www.bcma.org/files/Confidentiality_Agreement_for_Physician_Office_Employees.pdf


Confidentiality Agreement for Physician Office Employees

The BC Personal Information Protection Act (PIPA) legally governs personal information collected, used, stored, and disclosed by this medical practice. As such, you are required to acknowledge each term of this agreement:

I am aware that personal information of both patients and employees that is collected, used, stored, and disclosed, that comes to my attention as a result of my employment with this medical practice, must be kept confidential and secure as per PIPA and the office’s policies, both during and after my term of employment.I understand and agree that it is my responsibility to be familiar with the practice’s policies and procedures regarding privacy, confidentiality and security of personal information and that I am expected to comply.I will access and use personal information of patients only on a “need to know” basis as it pertains to my role and responsibilities.I will only share personal information with individuals who need to know and who are also involved in providing health care services to the patient.I will strive to keep patient personal information accurate and up-to-date.I understand that I cannot access my own personal information or that of family, friends, or co-workers unless they are under my direct care or if I need to do so as part of my official duties and responsibilities with the practice.Should I have reason to believe that a privacy breach has occurred, I will notify the individual responsible for privacy in the office. I hereby acknowledge that failure to comply with these terms can lead to disciplinary action, which may include termination of access, termination of employment, withdrawal of privileges, termination of contract, and/or professional sanctions.

Employee Print Name:

Date (dd/mm/yyyy): ______________________ Signature:

Medical Practice or Physician [YOUR CLINIC NAME]

Privacy Officer Witness Print Name:

Date (dd/mm/yyyy): ______________________ Signature:



3.12 Training and Professional Development

[YOUR CLINIC NAME] will support employees in their professional development, per the program that has been established in their approved Employee Performance and Development Plan.

Clinic-supported education and training programs should be directly related to and needed in the employee’s position at the clinic. Examples of supported training are:

VIHA Practice Support Program (PSP) modules

Training related to preparing patients for their appointments (lab tests, weight, height, BP tru etc.)

First Aid training

WHMIS training

“Code White” training for handling workplace violence

Computer training

CMHA approved MH first aid training

Basic Cardiac Life Support

Medical Terminology training



4 Clinic Facility and Administration

4.1 The Facility

4.1.1 Lease[Include details if pertinent]

4.1.2 Parking[Staff and patients parking]

[Handicapped priority spaces]

[Where not to park]

4.1.3 Ambulance Exits[Include details about ambulances entering and/or leaving the clinic property]

4.1.4 Cleaning Contract

[YOUR CLINIC NAME] has contracted with [cleaning service name] to provide janitorial services [#] days per week.

All staff should be familiar with the cleaning service standards in place and observe whether the standards are being met by the contractor. Staff should note any concerns about cleaning in the cleaning log book located at the front desk. The cleaners will review the log on a regular basis and correct any problems that are being reported.

The cleaning staff must sign confidentiality agreements similar to the staff confidentiality agreements.

The contracted services standards are listed on the following table [describe or include cleaning contract]

4.2 Garbage and Recycling

[YOUR CLINIC NAME] supports efforts to reduce, re-use and recycle whenever possible.

Garbage is to be placed in appropriate receptacles and will be emptied daily by cleaner. Paper and cardboard recycling is to be placed in appropriate blue recycling bins and is taken out daily by the cleaner.

[YOUR CLINIC NAME] has a contract with [waste removal company name] to pick up garbage and recycling every [list frequency]. Locked bins are located [location]

[ e.g. The cleaner has one key to the bins and another key is kept at the front desk.]



4.3 Waiting Area

4.3.1 Front Desk[describe front desk procedures]

Upon arrival, patients are asked to check in. Front desk staff enters the patient as “waiting” in the EMR system.

Two signs are posted at the front desk. “Check In” helps avoid ‘losing’ patients in the waiting area during busy times. “Please take a seat until it is your turn” is intended to provide patient confidentiality at the front desk

as much as possible.

Staff should avoid making or receiving phone calls at the front desk, to ensure patient confidentiality.

4.3.2 TidinessThe waiting area is to be kept tidy at all times. MOAs should monitor the area and tidy it as necessary.

4.4 Conference Room


The Conference Room must be booked in advance through the office administrator who manages the room schedule.

The Conference Room is used by physicians and staff for meetings, group medical visits and videoconferences.

4.5 Staff Room


The staff room is the responsibility of employees. Building cleaners will clean floors and empty garbage and recycling on a daily basis. Cleanliness of the fridge, microwave, and cupboards is the responsibility of users of the staff room. It is expected that staff will keep this space in acceptable order. If an employee wishes to book the staff room for an event, it must be written on the staff room calendar.

Lockers are the responsibility of the employee to whom it is registered. Should an employee leave employment at [YOUR CLINIC NAME], they are expected to clean out this space, and leave the locker unlocked.

Showers are cleaned daily by cleaners. Employees who use showers are expected to take their belongings with them when they are finished. No personal items should be left in the shower area.



4.6 Opening and Closing Checklist

Start of Day

Unlock doorsDisarm alarmAllocate exam rooms to doctorsTurn music onStart coffee maker

Daily

Check mailCheck vaccine supplyEmpty ‘OUT’ baskets in doctors’ offices (11AM, 4PM)Patient remindersCreate MSP claims submission

End of Day

Rooms check - empty of patientsCheck Exam Rooms stockedEnsure all MOA and exam room desks clean (no patient info, Rx pads, etc)Charts pulled for next dayChart room lockedCheck narcotics lockedMusic offConfirm on-call doctor with paging servicePhones set to ‘Night’Lights offSet alarmsLock all doors

Exam Room Prep

Clear counters, sinks and beds and floorCheck computer logged offCloth gowns in laundry (if applicable)Change paper on beds (if applicable)Ensure tissue hand towel supply is not empty

Weekly (Fridays)

Check emergency kitsPAP recalls



4.7 Purchasing and Inventory

4.7.1 Roles[insert individual who is responsible for each role]

Medical Supplies Lab Supplies Office Supplies Computer Lunch Room Cleaning

Monitoring supplies inventory

Purchase Requests

Ordering

Receiving

Paying Invoices

Usual suppliers

Where supplies are kept

4.7.1.1 Monitoring Supplies InventoryMOAs monitor medical and office supplies on an ongoing basis and put forward purchase requests when supplies are running low. Ordering amounts should be established based on the supply order and inventory requirements document, located on the computer hard drive, here: [insert link]

4.7.1.2 Purchase Requests[Describe procedures for making a purchase request. (eg: verbal, whiteboard, written, etc)]

The following is an example:MOAs can make verbal purchasing requests if supplies are running low. Written requests can be made on the white board behind the Utility Room if non-urgent, or in writing via email or EMR messaging to the doctor in charge of supplies.

4.7.1.3 OrderingRegular ordering items and preferred stock are listed in the Supply Order and Inventory Requirements file described above (section 4.7.1.1). This document includes the usual re-order company and usual cost, as well as areas to indicate who ordered the item and when, when the order was approved, when it arrived, and space for any comments. Only MOAs and staff with ordering permission are allowed to make entries or changes in this document.



Several companies have online ordering forms available.

For orders from BC Cancer Society for Gynecological Cytology Supplies:

Online Copy: http://www.bccancer.bc.ca/NR/rdonlyres/299F69DD-84C0-4856-9026-0D0D31B78F74/55758/Gynecytologysupplyorderform2012.pdf

For orders from BC Centre for Disease Control - Harm Reduction Supplies:



Online Copy: http://www.bccdc.ca/NR/rdonlyres/7CF238A1-462F-4256-9FA5-33BB083E7689/0/HRsupplyrequisitionformJan102012.pdf

For orders from BC Centre for Disease Control - Laboratory Supplies:

Online copy: http://www.phsa.ca/NR/rdonlyres/357FE8D0-2020-4A34-9416-8C3B12C4F2C3/0/PHMRLLABREQOrderFormUpdatedNov2011.pdf


http://www.phsa.ca/NR/rdonlyres/357FE8D0-2020-4A34-9416-8C3B12C4F2C3/0/PHMRLLABREQOrderFormUpdatedNov2011.pdf

http://www.phsa.ca/NR/rdonlyres/357FE8D0-2020-4A34-9416-8C3B12C4F2C3/0/PHMRLLABREQOrderFormUpdatedNov2011.pdf

http://www.bccdc.ca/NR/rdonlyres/7CF238A1-462F-4256-9FA5-33BB083E7689/0/HRsupplyrequisitionformJan102012.pdf

http://www.bccdc.ca/NR/rdonlyres/7CF238A1-462F-4256-9FA5-33BB083E7689/0/HRsupplyrequisitionformJan102012.pdf


For orders from BC Centre for Disease Control - STI Medications:

Online copy: http://www.bccdc.ca/NR/rdonlyres/401EFCD3-2381-42C6-ADDB-564D88E62E1D/0/PHARMACY_form_STIDrugOrderRequest_20110408.pdf

4.7.1.4 ReceivingMOAs check accuracy of shipment. If the order received is in line with the original order, the MOA initials the packing slip/invoice included with the shipment and places in the Business Manager’s inbox. The MOA also notes that the order was received on the Supply Order and Inventory Requirements document (see section 4.7.1.1)

The MOA unpacks the shipment and puts it away in the appropriate storage area (see below, section 4.8) and Appendix D.

4.7.1.5 Paying InvoicesThe Business Manager pays invoices.

4.8 Exam Room Supply Standards

The exam room supplies area should be kept clean and items should be organized and easily accessible. Items in the supply room should be organized in the following way.

[Describe the organization of exam room cupboards, desks, drawers, etc.]


http://www.bccdc.ca/NR/rdonlyres/401EFCD3-2381-42C6-ADDB-564D88E62E1D/0/PHARMACY_form_STIDrugOrderRequest_20110408.pdf

http://www.bccdc.ca/NR/rdonlyres/401EFCD3-2381-42C6-ADDB-564D88E62E1D/0/PHARMACY_form_STIDrugOrderRequest_20110408.pdf



Countertop qtips L and S tongue depressors sharps container gloves hand soap

Cupboards – stuff too tall for drawers chlorhexidine FOB cards and hemoccult test solution extra boxes of gloves (one of each size) lube cytology fixative spray dixie cups for drinking styro cups for LN2 wound cleanser/saline

Top drawer with some sort of organizer - injections needles: - 30g light brown (1/2”, 1”), 27g (1 ½”), 25g blue (1 ½”, 5/8”), 22g black (1”), 16g (1 ½”), syringes(1cc, 3cc, one 60cc) etoh swabs spot bandages

Second drawer – wound care bandages scalpel blades (#10) roll gauze 1x1 gauze polysporin paper tape vet wrap – the ripply stuff that sticks to itself

Third drawer – miscellaneous clinical supplies tendon hammer spare BP cuffs tuning fork monofilament for DM foot testing thermometer with sleeves if oral thermometer tape measure

Bottom Drawer – if no space in bed for specs, can use this drawer for specs.

Under Sink extra towels, if necessary spare paper towels extra hand soap spare sharps container extra gloves



Exam table gowns sheets speculae pap slides, pencil, blue cases HPV Focal Study supplies in JA, TF, AR, JP main rooms pap sticks and brushes (light source will be kept in doc’s offices or main exam; up to doc) pap forms cervical swabs, C&S swabs, viral swabs a couple panty liners endometrial biopsy and 1 jar formalin anoscope x 3

Desk drawer pens preg calculator for Robin and Ellen (possibly Jeff)

Desktop lifelabsreq – stamped with doc’s name in primary room, blank in secondary sooke/st A’s xray IHN menu pad Mammo referral forms Rx for Health forms Evergreen physio and CBI physio forms

4.9 Emergency Supply Kit

There is an emergency supply kit is located [location]. [person or role] is responsible for maintaining the emergency supply kit.

4.10 Sterilizing Medical Equipment and Tools

4.10.1 Sterilization Practices and ProtocolsThe following is an example:

1. Transportation of all contaminated instruments from room to room must be carried out in a lidded and closed container (such a stainless surgical tray).

2. Any used and contaminated tools must be placed in the tray containing water/germiphene solution to the right side of the utility room sink for a minimum of 30 minutes to dissolve residues before scrubbing.

3. When preparing for cleaning surgical instruments put on gloves, a gown, goggles and mask to minimize exposure to contaminants, etc.



4.10.2 Instructions for Running the AutoclaveSorting Instruments:


1. Have all the instruments scrubbed with Germiphene, rinsed, and dry

2. Create kits

3. Suture’s Out: Adson forceps & small non-toothed scissors, one with curve notched out of one blade

4. Suture In: Adson forceps, straight scissors, needle driver

5. Leave items as “open” as possible to aid in optimal sterilization

6. Everything else is packaged separately

Running Autoclave:


1. Place all items on the 3 shelves in unit - avoid overcrowding

2. Press and hold Fill/Vent tab until water (distilled) level starts to touch the base of shelving frame

3. Close door and slide handle into fully locked position, being sure of a complete seal

4. Have Temperature Control Dial set on the “black line” we drew onto it”

5. Turn Timer Dial to 20 mins, allow to run full cycle without opening. Once the alarm goes, DO NOT OPEN, just run autoclave for another 20 mins. (it takes most of the first 20 min cycle to get unit up to full heat, then remainder plus the additional 20 mins is what actually sterilizes the instruments

4.11 Mail

The Clinic Mailing address is

[address]

Mail addressed here is delivered to [front desk, mailbox, etc]

Employees take turns in picking up mail on a daily basis.

Mail keys are kept [location]



4.12 Billing

4.12.1 MSP

To be done once a day:

[Step-by-step instructions for MSP billing]

Processing of remittance files

The remittance file happen 2x a month, it contains refused bills and updates to patient information as well as the doctors pay statement and important updates to the MSP billing guide.

[Describe steps to be taken for processing remittance statements]

Please refer to section Error: Reference source not found for further instructions.

4.12.2 Third party and patient bills (Uninsured Fee Schedule)

Doctors will place their completed form in the ”To Be Done Box”

Some doctors will have a bill prepared for the document already.

For ANY bills that are sent please print in the top right corner “Billed and sent via (fax/mail/medi express) and the date, if it was given directly to the patient please indicate that. This makes it much easier if we ever need to track when and where the bill was sent to.

The list of uninsured services is in section 31 of the training manual (Appendix E). There is a cheat sheet specific to our office for our most common codes and then a full BCMA uninsured services fee guide behind it. .

The doctors frequently reduce the amount they will bill the patient and that is at their discretion. Lawyers, Insurance companies and any other 3rd party are always billed at the BCMA rate. Sometimes the insurance companies will indicate the maximum they will pay for a request.

4.12.3 WCB

[YOUR CLINIC NAME] can bill WCB automatically through the EMR. When in the patient chart, bring up the list of custom forms, and then perform the following steps:

Choose Worksafe BC

Fill out the patient demographics, workplace details, date of injury, who provided care, if the attending doctor is that patients regular physician

Tick the box at the top for Form 8 or Form 11. For billing specifics (Body Part, Nature of Injury and Location codes), refer to the appendices at:



http://www.worksafebc.com/health_care_providers/Assets/PDF/body_parts_complete.pdf, http://www.worksafebc.com/health_care_providers/Assets/PDF/natofinjury.pdf,

http://www.worksafebc.com/health_care_providers/side_of_body_codes/default.asp

Fill in billing information, including payee number and practitioner number

4.12.4 ICBC

[list policy]


• Very similar to MSP. Just change the payer from Medical Services Plan to ICBC, and complete the claim as usual.

4.12.5 Military and RCMP

[list policy]


Military and RCMP services are paid directly by Blue Cross. These claims are billed manually. Blue Cross forms are found in the cabinet behind the front desk, in the large black box. There are separate forms for DND (military) and RCMP. If you use the last of one of the forms (or notice that they are running low) please notify the clinic manager, so she can order more forms.

4.13 Finance

The [YOUR CLINIC NAME] finances are based on a Cost Sharing Agreement between the [YOUR CLINIC NAME] physicians. The Business Manager is responsible for managing and reporting on [YOUR CLINIC NAME] finances as well as all bookkeeping activities.

4.14 Communications

Logo

[The Error: Reference source not found established the following logo:]

[insert logo image here]

Where appropriate, the [YOUR CLINIC NAME] logo should be included in communications. Logo formats are available [insert location or link]

Communication Standards

All communications from [YOUR CLINIC NAME] shall be professional, well written and free from grammatical and spelling errors. The standard font to be used is Myriad Pro 10 point.


http://www.worksafebc.com/health_care_providers/side_of_body_codes/default.asp

http://www.worksafebc.com/health_care_providers/Assets/PDF/natofinjury.pdf

http://www.worksafebc.com/health_care_providers/Assets/PDF/body_parts_complete.pdf


Any formal [YOUR CLINIC NAME] communications shall be approved by at least one physician before being distributed.

Currently [YOUR CLINIC NAME] does not have any other standard font specifications or design specifications.



4.15 Privacy Policy

The Canadian Medical Association offers a tool to create a unique privacy policy for each clinic. The CMA Privacy Wizard can be found here: http://www.cma.ca/index.php?no-xform=true&ci_id=395&la_id=1&original_ci_id=40833. Please note that a doctor’s CMA username and password is required to access this section of the CMA website.

[Once the clinic has completed the policy wizard, the documents provided can be inserted into appendices, as listed here]

The complete [YOUR CLINIC NAME] privacy policy for the treatment of patient information can be found in Appendix F. Here you will find the General Policy, Detailed Policy, Standard contractual clause for use when contractors need access to health information, and a consent form for the release of patient information. Patients must have a signed consent form before any information can be given to any party (other than information given to the patient directly).


http://www.cma.ca/index.php?no-xform=true&ci_id=395&la_id=1&original_ci_id=40833

http://www.cma.ca/index.php?no-xform=true&ci_id=395&la_id=1&original_ci_id=40833


5 Information Technology

5.1 Phones

[YOUR CLINIC NAME]’s phone system is [enter description]. Some features of the phones system are:

[enter description].

Phone NumbersPublic Numbers [clinic phone numbers]

Private Lines [insert private lines]

Mobile Phones [Each physician has a mobile and they provide their numbers to patients at their own discretion]

After Hours Answering Service [phone number]

Phone Extensions

• There are [#] phone extensions in the clinic. • Exam rooms are not equipped with phones. • All phone lines are accessible by all extensions• Incoming calls only ring in the MOA areas, not in the doctors’ offices or treatment rooms. • See the phone and printer directory for a list of extensions and their locations.

After Hours Answering ServiceWhen the clinic is closed, patients call the after-hours answering service. The service refers patients to the doctor on call at that time.

Telephone Tree[YOUR CLINIC NAME] has a telephone tree that has the following options if the clinic is closed or all lines are busy:

[Option 1: Information about clinic hours

Option 2: After hours numbers to call

Option 3: etc.]

5.2 Fax

There are [#] fax machines. One is located [location and fax name] and the other is {location and fax name]

[YOUR CLINIC NAME] uses separate fax machines and numbers for incoming and outgoing faxes.



Incoming Fax: [insert fax number]Outgoing Fax: [insert outgoing fax number]

[YOUR CLINIC NAME] tries to minimize the number faxes printed. Please do not print faxes out if an electronic copy can be used.

FAX CONSOLE INSTRUCTIONS(start by double clicking the document you wish to view)

IF YOU WANT TO PRINT THE DOCUMENT• [insert specific printing instructions here]

IF YOU WANT TO SAVE THE DOCUMENT TO SCANNED DOCUMENTS FOLDER• [insert specific saving instructions here]

5.3 Phone and Printer Directory

[here is an example of a clinic phone directory. Insert your own image here, or describe your system]



5.4 [YOUR EMR SYSTEM NAME]

[these are some examples – modify to fit your system]

[YOUR CLINIC NAME] uses [YOUR EMR SYSTEM NAME] as the electronic medical record (EMR) system.

A basic user’s guide can be found in Appendix [#]

With [YOUR EMR SYSTEM NAME], all relevant patient information is available at [in a single view format or list format type]. The system is/has: [these are some examples – modify to fit your system]

• Integrated with a wide range of laboratories and hospitals

• Extensive custom forms and templates library

• Integrated with the mydoctor.ca® Health Portal

• Interactive chronic disease management tools

• Preventative care management

• Drug decision support tools

• Integrated fax solution

• Billing, including easy submission and reconciliation, integrated tracking, intelligent searches and supercodes, as well as patient-direct and third-party billing for uninsured services.

• Appointment Scheduling

For further information about [YOUR EMR SYSTEM NAME] see their brochure at: [insert web link here]

5.5 Internet

All computers at [YOUR CLINIC NAME] have internet connections. In addition, there is a wireless internet connection available. The password for the wireless connection is [password]

The [YOUR CLINIC NAME] internet is intended primarily for office use. Staff should minimize their use of the [YOUR CLINIC NAME] internet for personal email or social networking during working hours.

Anyone using the [YOUR CLINIC NAME] internet connection to access inappropriate sites such as gambling, pornography or other illicit activities will be subject to disciplinary action including dismissal.

5.6 Information Systems Security

Information systems security is the responsibility of all staff members that have access to, use or manage [YOUR CLINIC NAME] information and technology assets. Information systems security includes the protection of personal data, systems, documentation, computer-generated information and facilities from accidental or deliberate threats to confidentiality, integrity or availability.

[YOUR CLINIC NAME] policies that support information systems security include:



• Use of individual confidential and strong passwords to access the electronic medical record or local network. Employees are responsible for protecting their User Name and Password and any actions taken with them. Employees must not share their User Name and Password with anyone. Employees are required to change their Passwords periodically. If employees suspect that their Password has been compromised, for any reason, they should report the matter to the HR Director and change the password immediately.

• The automated audit function in the electronic medical record logs who accesses medical records, when the record was accessed and what was viewed or changed. The doctors perform periodic review of EMR access records for quality assurance purposes.

• Daily offsite back up of the electronic medical record and office network. Staff perform daily backup at the end of the day and [insert name of person managing offsite storage] manages the offsite storage.

• Staff members are required to log off computers when not in use or if away from the workstation even momentarily.

• Use of up-to-date anti-virus software and safe email practices.

5.7 Restarting Email and Fax Services

In event of power failures, surges, or any event that causes the servers to power down, email and fax machines may need to be restarted. Here are step-by-step instructions on how to do this.

Instructions for Restarting Email Service

• [insert specific instructions for restarting the email service]

•

Instructions for Restarting Fax Service

• [insert specific instructions for restarting the fax service]

•

If this does not fix the problem, contact [name of technical support] for technical support at:

Cell: [phone number]

Work: [phone number]



6 Partners

This Chapter describes how the clinic works with other stakeholder groups – to be defined by each practice. This is an example.

6.1 Visiting Specialists

Facility Terms of Use by Specialists- list

Booking Appointments- describe

etc- Describe

6.2 Hospice

Terms of Working Together- List

Hospice Referral Procedures Communications



7 Enquiries

7.1 Phone

Phone NumbersMain Patient Enquiry Numbers [number] and [alt. number]

Incoming Fax: [fax number]Outgoing Fax: [outgoing fax number]

Private Lines: [number] and [alt private number]

Hours of answering general enquiries

[example of hours]

Monday to Thursday [8:00 am to 8:00 pm]Friday [8:00 am to 6:00 pm]Saturday [9:00 am to 1:00 pm]Sunday [10:00 am to 1:00 pm]

After Hours Answering Service

MOAs are to switch the phones over to the answering service when they perform their closing procedures.

While the clinic is closed, the doctor on call can be reached by calling the answering service at [phone number for after hours answering service]

This service is NOT an emergency service (for emergencies, call 911). There may be a significant delay before the doctor on call returns your phone call. The doctor on call may not be nearby at the time of your call. You MUST be a patient of either [doctors names] to use this service.

Telephone Standards

• Telephones should be answered on a timely basis, preferably within 3 rings.

• Messages requiring attention by the end of the business day in the EMR should be designated as ASAP when creating the message. All ASAP messages will be completed by the end of the day. All other messages will be dealt with in a timely manner, usually a day or two if not ASAP.

Scripts

Staff should answer the main lines as follows:

Long form standard answer [example]

[“Good morning (or afternoon or evening), this is the [YOUR CLINIC NAME], (my name) speaking. How can I help you?”]



Short form standard answer:

“Doctors Office, how can I help you?”

If multiple lines ringing at once:

“Doctor’s office, would you please hold for a minute?”

7.2 New Patients

New patients are most likely seen in the [Urgent Care Clinic / Youth Clinic / walk-in clinic]

For Youth Clinic and Urgent Care clinic protocols, see section 8.7and 8.8, respectively. For setting up a new patient file, click here.

7.3 Looking up PHN and Medication History

MediNet

We primarily use the Medi Net service to locate personal health card numbers and to do a Medication History check.

We encourage patients to come with their care card number and to make an effort to locate their number.

If a patient is here for a medication refill and is on a variety of medications including narcotics we always have them sign a pharmanet form. The website to access their system is http://www.medi.net.

• Click on the box that says Log into pharmanet

• Type in your user name and password (these need to be changed every so often and it will prompt you to do so)

• Click on Patient in the main menu. Enter in the patient’s information and search for Care Card number. It will ask for your initials. Always give the patient a copy of their number.

• If we are doing a medication search you may click on full profile or most recent in the main menu. We do not need to print it unless the doctor wants you to.

**It is okay to get verbal consent if only looking up a PHN**

7.4 Requests to Transfer Records

Request for records forms are kept in [insert computer pathway to ‘request for medical records’ forms], with several copies kept [at the front reception desk or other location]. Please fill completely, have patient sign and date. When faxed, stamp ‘faxed’ and scan the document into the patient chart.


http://www.medi.net/


7.5 Prescription Renewals

[YOUR CLINIC NAME] policy requires patients come in to the clinic for a prescription renewal. Exceptions to this are:

• Hospice patients

• Housebound patients

• At individual doctor discretion. The doctors may sometimes agree to do a faxed refill but may charge for this service [insert cost of service]

NOTE THAT TRIPLICATE PRESCRIPTION FORMS FOR NARCOTICS MUST ALWAYS BE PICKED UP BY THE PATIENT, A FAMILY MEMBER, OR SOMEONE FROM THE PHARMACY. TRIPLICATES ARE A LEGAL DOCUMENTS AND THE PHARMACY MUST HAVE THE HARD COPY ON FILE.

If the Doctor agrees to provide a renewal by fax or phone the MOA should message the doctor with the patient’s chart. The doctor will need to know:

• Medication name and dose

• Is the patient picking up the prescription, or are we faxing it?

• Which pharmacy?

7.6 Sick Note Requests

Patients are required to attend the clinic to request a sick note. A private fee will apply, as per the [YOUR CLINIC NAME] private fee schedule.

7.7 Email

Due to the insecure nature of e-mail communication, we do not use email as a means of communication with the public or patients for any of the following reasons:

• questions or issues of a medical nature;

• to establish physician/patient relationships;

• to book or cancel appointments; or

• for inquiries regarding fees, services or similar matters.

E-mail communications regarding such matters will not be responded to and will be discarded unread. If patients wish to contact us regarding medical questions or issues or with regard to appointments, accounts or other questions please they should do so by telephone, fax or regular mail.



7.8 INR Calls

Patients that take Coumadin (also known as Warfarin) must have their blood tested regularly to test their INR “International Normalized Ratio”. This is a test that measures the rate at which their blood clots.

Patients will have this test weekly, bi-weekly or monthly, depending on the doctor’s instructions. (The lab will let you know if the result is critical)

The doctor must be given the result right away, to determine if the level is good or if it must be changed. If the result is critical and that patient’s specific doctor is not in, show another doctor.

Once you have the instructions from the doctor on what dose they should be taking, you must phone the patient and let them know.

For example:

Your INR was 2.1 today, [doctor name] says to stay on the same dose, and recheck in 1 week.OR

Your INR was 4.5 today; [doctor name] says that is high and we need to adjust your dose to… (You will receive detailed instructions from the doctor on what they must take and when to get their INR rechecked).

It is important to call patients with these results as soon as you receive instructions from the doctor.

Once you have called the patient, document the call and archive the message.

If the doctor hasn’t already billed for this, bill under the doctor; diagnostic code 427, billing code 43

NOTE: You do not need to fill out a lab requisition for patients to have their INR’s rechecked, all patients should have a standing order at the lab.

7.9 After Hours

Emergencies (general): [include instructions for how each situation is dealt with, after hours]

Maternity: [include instructions for how each situation is dealt with, after hours]

Hospice: [include instructions for how each situation is dealt with, after hours]

Youth: [include instructions for how each situation is dealt with, after hours]



8 Appointments

8.1 Standard Appointment Schedule

The appointment schedule is based on [example: 10 minute blocks]. Appointments should be booked based on the booking preferences of each doctors as shown in section 8.2 below.

8.2 Appointment Types and Booking Preferences by Doctors

[Here you may want to insert specific instructions about appointment types and booking rules/preferences. You may consider including a table that sets out different scheduling preferences for each doctor at the clinic]

Doctor 1 Doctor 2 Doctor 3Rapid access apptsMax appt per 10 minWCB appt length (min)Physical Exam appts (min)Max number of long appts per half dayPap only (min)IUD insertion (min)Prenatal first appt (min)Prenatal follow-up (min)Complex care plan appt (min)Driver’s exam appts, >80 years (min)Driver’s exam appts <80 years (min)Counseling appt (min)Pre-op exam appts (min)Well child exam <18 months (min)Well child exam >18 months (min)Surgical (excision) appt (min)

[you may choose to include sub-categories in this chart such as whether an appointment requires height and weight pre-testing, whether males or females should undress prior to seeing the doctor, if BP should be taken, etc.]

8.3 Drivers Physicals

All patients require an appointment to complete this form.

There is a [$90.00 private charge] to the patient for the yellow forms (they are not covered by MSP). The finished form will not be faxed until payment is received in full. We accept [CASH or CHEQUE].



The money is then put in the doctor’s envelope and recorded in the blue ledger under the specific doctor who filled out the form.

If you are unsure how to create a bill [instruction on what to do if unsure]

For the Blue forms that are medically required, there is no charge to the patient. These are covered by MSP. The doctors will do the billing for these.

When the patient arrives for his/her appointment, be sure to do an eye exam. The eye chart is located [location] and we ask the patient to stand [specify where patient stands for test].

The patient does not take a copy of the form we fax it directly to OSMV and then scan into patients chart.

8.4 Pre-Op Physicals

When a patient is going in for surgery at the hospital, a pre-op physical must be done within 3 months of the surgical date. It has to be done no later than 72 hours prior to surgery.

Once a pre-op is done, it is good for 3 months, in case the patient has multiple surgeries in that time frame, it can be used again.

You will receive a surgical booking slip from the specialist with all the surgery info (i.e. time, date, location etc….). Copy all the relevant info onto the pre-op physical form. Once this is done, you must phone the patient and book a ½ hour pre-op physical following the time guidelines mentioned above.

When the patient comes in for their appointment the pre-op must be entered into chart, and their height and weight taken (in kilograms/centimeters).

Once the doctor has filled out the form, it must be printed and faxed to the hospital where their surgery is taking place (this will be checked off at the top of the page), and the fax numbers are

VGH: 250-727-4240 or RJH: 250- 370-8899

8.5 Wait List

[YOUR CLINIC NAME] is currently not accepting new patients as the practices of the current six doctors are fully subscribed.

[YOUR CLINIC NAME] encourages prospective new patients to be placed on a wait list at [specify computer pathway to waitlist documents] - in the event space comes available. MOAs should collect as much detail as possible about people on the wait list (e.g. family members, age, phone number, current or past GP, any urgent health issues that might make them a priority).

Exceptions: In cases where patients request to see a particular doctor because others in their family are patients, MOAs should send a message to the doctor in question to request approval.



8.6 Advanced Access

• These are spaces reserved for same day bookings. These spots are to be used for semi-urgent appointments

• Some of the doctors have all their Advanced Access appointments at the start of the day and others have them scattered throughout the day.

• Check the doctor’s booking preferences to see which doctors like more than one person in each advanced access spot

• When a patient calls requiring an appointment for the same day, if an advanced access spot is available the MOA should state that we are able to “fit them in” today and give them a time option.

• If one of the doctors is away the MOA may book with another practitioner if the patient feels it cannot wait. Try to spread them evenly through the other doctors.

• Always ask the doctors before fitting in a Non-Clinic patient.

8.7 Youth Clinic

[Here is an example of how a clinic might describe a youth drop-in clinic. Modify to fit your clinic, or remove this section if your clinic does not have a special youth clinic]

The Youth Clinic operates on [schedule]. Youths aged [ages allowed] to be seen by a female doctor on a drop-in basis. The youth clinic offers confidential physical health care, as well as mental health assessment, advice, and services. These services are open to any youth in the clinic’s service area.

Because personal privacy and confidentiality are a key concern for many, youth are NOT asked the reason for their visit at the front desk. They are shown to an exam room, given a pen and clipboard and a short, 3-item patient questionnaire. Here, they have the opportunity to write down their concerns in a private setting, if they wish. The three questions on the Rx-pad-sized form are:

1. What is the reason for your visit today?2. Do you need prescription renewal?3. Is there anything happening in your personal or family life that might be affecting your health?

This approach means that it is up to the physician to set themselves up for paps and physicals and the MOA needs to ensure the appropriate forms are done, after the fact.

Free condoms are provided and are located discretely inside exam rooms for youth to take. Depending on need, birth control pills may be dispensed from our supply cupboard, or application made through the Society of Obstetricians and Gynecologists of Canada’s Compassionate Pill Program (in custom forms section of the EMR) for up to six months of birth control. Medications used to treat sexually transmitted infections are provided free of charge to patients and their partners where appropriate.



8.8 Urgent Care Clinic

[Here is an example of how a clinic might describe an urgent care clinic. Modify to fit your clinic, or remove this section if your clinic does not have an urgent care clinic]

Treatment centre hours are very specific. We will only see walk in patients during the allotted hours unless it is an emergency. Check with one of the doctors if a patient needs to be seen before clinic hours.

The Urgent Care Clinic hours are as follows: [insert your own hours]

[Monday to Thursday: 5pm to 8pm

Friday: 3pm to 6pm

Saturday: 9am to 1pm

Sunday and Stats: 10am to 1pm]

NOTE: the last patient is admitted and the doors are locked [30 min] before closing time to allow the doctors and staff to leave as close to closing time as possible.

Urgent Care Clinic protocols are as follows:

• All patients generally seen on a 1st come 1st serve basis (unless an emergency arises (bleeding, trouble breathing, chest pain, broken bones etc).

• Sometimes the doctors will see babies, small children and the elderly on a priority basis over other patients.

• Patients may not see a doctor in the Urgent Care Clinic for physicals, driver’s medicals, excisions or forms. On occasion at the doctors’ discretion this may be waived.

• The Urgent Care Clinic is for one problem only.

• Patients must have their care card with them. If they do not have a care card we can do a search on pharmanet (this is only for BC Care Cards). (See section 7.3). Patients must show ID.

• If they do not have their medical number they will have to pay the fee for a private office visit.

• International patients must pay privately and sign an out-of-country consent form. These are stored in the G drive as well as in the files on the front desk. The doctor will advise you on the appropriate fee code to bill the patient and they must pay in cash.

• All patients must be asked if they would like a copy of their report to be sent to their own doctor. If they do, indicate this at the bottom of the walk-in clinic sheet. These will be faxed after the visit.

• All patients must be checked in 30 minutes prior to closing.

• Once the patients are registered we need to check their coverage with MSP

Be in the patient registration screen and pull down the “teleplan” menu and select “check eligibility”

If it says “Elig on DOS: Yes” it means they have coverage.

Names and birth dates can also be checked by doing this.



9 Encounters

9.1 Patient Arrival

• When patient checks in, [specify instruction on checking a patient in – manual or electronic]

• [note any instructions such as how to tell if a patient requires special care such as a wheelchair]

• [how to know if a patient requires extra pre-testing or injections].


• When patient checks in, right click beside their name on the appointment sheet and choose “arrived” – yellow dot appears beside their name.

• If there is a red exclamation point beside the patient name, it means they require extra care which will be specified in the appointment slot – ex: WCB form, Pre Op form, getting an injectable medication ready, preparing for a procedure, BP Tru, urinalysis, prep for Drivers Physical or Holter.

• If there is a syringe icon next to the patient name, they require an injection and that has to be brought to the room with the patient.

9.2 Patient Prep

• When patient is being prepped (ex: BP Tru, urinalysis pending), [instructions on how to manually or electronically indicate if a patient is being prepped]


• When patient is being prepped (ex: BP Tru, urinalysis pending), right click the name and choose the downwards arrow “Being Prepped”

9.3 Exam Room

• When patient is brought to the exam or treatment room, [indicate how to manually or electronically indicate when a patient is in the exam room, ready for the doctor]


• When patient is brought to the exam or treatment room, right click by their name and choose the green dot “In Room”.



9.4 Appointment Completion

• When patient is finished their appointment and has left, [indicate how to manually or electronically indicate when a patient has completed their appointment and left the building]


When patient is seen to be leaving, right click by their name and choose “Finished”, if the doctor has not already done so.



10 Referrals

10.1 Referrals In

10.1.1 Palliative Patients[YOUR CLINIC NAME] doctors accept referrals for palliative patients. We require doctor-to-doctor communication and full medical history in writing prior to accepting hospice patients. Hospice patients will be ‘shared’ amongst all doctors based on their current workload and their physical proximity to the patient’s home.

10.2 Referrals Out

10.2.1 Referrals to Specialists• [Indicate specific instructions for how to create and send a referral letter to a specialist,

including instructions on how to put referrals through to MSP]

10.2.2 Hospice Referrals[include specific instructions for Hospice referrals]

Forms that must be filled out for each patient are:

• Hospice referral form – [location]

• No CPR/Do Not Resuscitate form – [location]

• Plan P – medication coverage in the last six months of life [location]

• Expected Death At Home form – allows family member or nurse to pronounce death. [location]

10.2.3 Travel Assistance for Referrals to Specialists Ministry of Health Travel Assistance Program [location of forms]

• For patients who have been referred to a specialist on the mainland. This form covers the cost of the ferry.

• You must fill out the referring physician information, and the specialist they are seeing including their MSC number.

• The patient must phone for a confirmation number (all the instructions are on the back of the form).



10.3 Prescriptions

Psychiatric Medications

Plan G Forms [location]

• These are forms that allow patients who require psychiatric medications to be covered.

• Fill out the patient information Section A [EMR may auto-populate] and the doctor will fill out Section B

• The patient MUST sign the form before it is faxed off.

• Once filled out it must be faxed and then scanned into the patients chart.



11 Maintain Patient Chart

11.1 New Patients

Registering a New Patient [indicate specific instructions on how to create a new patient chart]

[you might consider including screen shots of your EMR system, for clarity]

Registering a Family Member All steps are the same except instead of Clicking on “File add New Record” you select “add

Family Member”. Most of the information will self populate.

Whenever we register children please put the parents’ names in the comments box at the bottom of the page.

Entering a Baby (still under Mother’s MSP) Register the baby as normal but also type the mother’s name and her PHN number in the

comments box at the bottom of the screen. When it comes time to bill, it will ask the doc if they want to bill under the mother’s PHN.

11.2 Labs

Downloading Labs

Excelleris [these are instructions specific to Excelleris. Modify if you do not use this program]

These are the lab results that are processed at VIHA facilities and Life Labs

1. Open up a patient record

2. Pull down the file menu

3. Click on Open Lab or Hospital Report

4. Click the Download button

5. Click the Excelleris Download Button

6. Click OK in the next window that opens up (the passwords should all be stored in there)

7. A window will pop up quickly and close, there will be a new report with today’s date in the original window, double click that report.

8. Highlight the first line on the lab report and then click enter till the end

9. Once you reach the end it will ask you to post and archive the results, by doing this it sends a not to the doctors and puts the results in the chart. If you accidentally click past this don’t worry. It will tell you that there are no more lines to see. Just say you will open the report later. Follow



the previous steps and you will be able to click on that date again and open it, enter through all the lines and then post and archive.

Note: there are 3 lab reports in the box, they were a glitch and cannot be removed, ignore them.

Medinet [these instructions are specific to Medinet, change or remove if not used]

These are the labs processed at the provincial lab

1. [On the desktop] there should be a Medinet 6 Icon

2. Double click that Icon and a window will open up

3. The user name is [insert username] and the password is [insert password]

4. Click OK and then download

5. The reports will print automatically, and then they get put into scanned documents. The window will close automatically.

11.3 Pap Recalls

When we receive a PAP test report we put it in our EMR so that we can recall them in the recommended time.

To put a recall in the computer have the patient screen open and enter the date of recall and the recall reason in the proper field.

To generate a recall list:

[include specific instructions to generate a pap recall list]

[you may again find it useful to include a screen shot]

11.4 Prescriptions

[include specific instructions for inserting new patient prescriptions into chart]

11.5 Scanning and Plunking Documents

Scanning

[included are basic scanning instructions. Modify as needed for your system]

Documents are scanned into the computer via the scanner on the desk.

Once scanned a window automatically opens.

Documents are saved with the patient’s name (last name, first name).



Once scanned we place a check mark or line in the top right corner and put the finished documents in the scanned file beside the scanner.

If you have multiple documents for 1 patient we label these with a number behind them

- Eg: Mouse, Mickey

- Mouse, Mickey2

- Mouse, Mickey3

Sometimes we have very large documents and these need to be separated into chunks of 6 pages. We label these as part 1, part 2…

- Eg: Mouse, Mickey part1

- Mouse, Mickey part2

- Mouse, Mickey part3

It is essential that these documents are labeled with the correct name and that the entire document is scanned, we do not want to be missing pages. Sometimes the first page will appear to be missing but it is usually only missing a cover sheet (not needed).

When scanning lab work and the doctor has highlighted results we need to mark an arrow or x beside these results (the highlighter will not show once scanned).

When scanning holter monitor reports we only scan the first 3 pages. Once scanned the report gets re-stapled and placed in the “holter reports to be filed” pile located on the wooden shelf by the stairs into the reception area.

Other documents that we save after scanning are Death Certificates; these can be placed on top of the wooden shelf for filing.

When scanning reports from the hospital, the date is often hard to read, just rewrite the date so that it shows clear when scanning.

Plunking [indicate specific instructions for plunking scanned documents into a patient file]

In the [computer pathway] open the scanned documents folder. It is important that you are plunking the list of documents in the order that they were created.

Have the PDF File open on one screen and the correct patient record open on another screen.

Types of Documents and Information Needed

[this section indicates what information is important to record with various documents. Modify to suit your clinic needs]

X-rays/ultrasound/medical imaging – if there is a summary, comment or impression you can just type this. If there is not you will need to type in the report text.

Consult from a doctor – doctors name

Reports or records faxed to a lawyer, ICBC. ECB or insurance company – scan in on date received. In the comment box Type in who the request was from and what date it was faxed or mailed. The message can be archived right away as the doctors have seen it.

If a report has a subcategory of Operative report, Delivery Report, Discharge Summary, or History and Physical you may select this from the Subcategory pull down menu. Reports with this requirement are usually from the hospital.



ECG Reports – In the top centre the report will say Normal or Abnormal and may or may not have more text, these comments need to be typed in the large comment box.

Walk In Clinic Reports – under the category of Urgent Care Clinic. It needs the doctors name if legible or the name of the clinic and if possible the reason for visit.

PAP Smears – do not scan or plunk unless the date for recall is checked off. Enter in the result and the recommendations. The date used is the date the smear was done.

Old and Archived Charts – the message can be archived right after scanning as the doctor has already seen the reports.

Shoulder Injections done under fluoroscopy are scanned in under a Therapeutic Radiology consult

Sometimes 2+ areas are reported on 1 x-ray report. It is important that we record both and bold each area so the docs can see both easily



Appendices

A. Business Manager Job Description [sample]

Job Title: Business Manager

Reports to: Doctor Responsible for Human Resources (Rotates every six months)

Job Purpose:

Carries out several aspects of the [YOUR CLINIC NAME] administration, including:

Finance including payroll, bookkeeping, assisting the doctors in developing and maintaining a budget, financial reporting, banking, cash flow etc.

Serving as the main point of contact between the eight MOAs and six doctors for matters pertaining to pay, benefits and hours worked, and making HR decisions in accordance with policies established by the doctors.

Coordinating performance review process for MOAs Coordinating staff and new doctor recruitment, orientation and training activities Recommending, planning, and implementing pay structure revisions. Ensuring compliance with applicable human resource laws

Maintaining employee human resource files

Developing, recommending approval and maintaining staff hours and vacation schedules.

Providing advice to the doctors on finance, human resources and other administrative matters. Other related duties as required.

Hours and Location:

Works up to 12 hours per week at [YOUR CLINIC NAME] and/or her own place of business. Is also available by email and phone to staff to answer queries during clinic hours (notionally allocate 1 hour

per week to address out of office communications)



B. Medical Office Assistant Job Description [sample]

Job Title: Medical Office AssistantReports to: Doctor Responsible for Human Resources (Rotates every six months)Job Purpose: To support [YOUR CLINIC NAME] doctors in clinic operations and in delivering patient care. All

work should be delivered to standards and procedures established in [YOUR CLINIC NAME] and procedure manual or otherwise requested by [YOUR CLINIC NAME] doctors.

Duties: Coordinates patient care through the clinic –checking in, prepping, escorting to exam rooms, and preparing

exam or treatment rooms for the next patient

Answers enquiries by phone and in person in a helpful, respectful and efficient manner

Operates fax machines

Maintains appointment schedule and manages recalls

Maintains electronic medical record, including the patient chart.

Ensures exam rooms are stocked appropriately and ensures that they are ready for next patient

Ensures patient confidentiality

Cleans and sterilizes materials and instruments.

Performs patient prep procedures and documents findings on the patient record

Performs billing procedures for multiple payers (MSP, ICBC, WCB, RCMP etc) and applies and collects non-insured fees where applicable.

Order and receive office and medical supplies.

Performs all other related clinical, administrative tasks or special tasks as required.

General Skills and Abilities:

Works well in a team environment

Good written and verbal communication skills

Proficiency with a computer including using the internet, the electronic medical record and MS Office software.

Speed and accuracy

Can solve problems

Has good judgment



Clinical Skills and Abilities:

Operate and apply the bpTRU monitor

Prepare patients and set up exam rooms for complete physicals, including pap set up.

Prep child patients for the well child exam

Apply and remove Holter monitor, explain Holter diary to patients, and send Holter to Westheart Cardiology

Accurately measure patient height and weights (including infants)

Operate the autoclave

Perform and record result for various lab tests done at the clinic such as urinalysis and occult stool tests

Basic Cardiac Life Support certificate



C. Employee Performance Development Plan Forms [samples]

Employee Performance Development Plans

Employee Performance Development Plan Cycle

Employee: _____________________________Review Date: ___________________________

SECTION 1: PERFORMANCE REVIEWMAJOR TASKS(from job description)

What I do?

ASSESSMENT OF CURRENT PERFORMANCE(How am I doing?) Scale NA = not applicable1 = needs development2 = satisfactory3 = above average4 = outstanding

COMMENTS

(always include feedback to support 1 and 4 ratings)

1. Coordinates patient care through the clinic – waiting room, prep procedures, exam room.

2. Answers enquiries by phone and in person in a helpful, respectful and efficient manner

3. Maintains appointment schedule and manages recalls

4. Maintains EMR efficiently, accurately and in accordance with [YOUR CLINIC NAME] policy. This includes maintaining the patient chart.

5. Ensures exam rooms are stocked appropriately and ensures that they are ready for next patient

6. Ensures patient confidentiality

7. Cleans and sterilizes materials and instruments following [YOUR CLINIC NAME] policy.

8. Performs patient prep procedures and documents findings on the patient



record

9. Performs billing procedures for multiple payers (MSP, ICBC, WCB, RCMP etc) and applies and collects non-insured fees where applicable

.



SECTION 2: PERFORMANCE REVIEW

PERFORMANCE RATINGSNA = not applicable

1 = needs development2 = satisfactory

3 = above average4 = outstanding

Skills NA 1 2 3 4 Skills NA 1 2 3 4Work Quality (including accuracy)

Solves Problems

Work Volume Demonstrates Cost Awareness

Demonstrates community health perspective in work

Demonstrates good judgment and decision making

Communicating with other Staff

Shows Initiative

Communicating with Patients and families

Organized

Writing Understands when to refer questions to a doctor or others

Is a team player

Comments (always include feedback to support 1 and 4 ratings) Employees – use this space to provide feedback on how the employer can support you in improving your performance.

Evaluator: _____________________________ Date: ______________________

Evaluator: _____________________________ Date: ______________________

Employee: _____________________________ Date: ______________________



SECTION 3: EMPLOYEE DEVELOPMENT PLAN

Employee For Period to

Employee Aspirations and Goals(5 year outlook)

Employee Education Plan(2 year outlook)

Employee Development Plan(what experience would you like to gain in the next 2 years?)

Approval

Employee Signature Date HR Director Signature



D. Supply Location List [sample]

Category Item Location

EmergencyAirways911 box - emergency drugsnebulizers and tubingnebulizers and tubing

isolation gownsOxygen

First Aid/Dressingsbandagesspare bandagesnon sterile gauzespare non sterile gauzesterile gauzeglu-stitcheye kit (fluorescein, anaesthetic drops etc)

meporeiodoform gauze packingspare iodoform gauzetube gauze and finger dressingsthermometers and sleevesspare thermometer sleevesflamazine

Suture and excision suppliessuturesscalpel bladespunch biopsy tools, assorted sizessteri-stripsFriars Balsamsterile instrumentsspare suturesspare scalpelssterilized items

cytology and formalin jarsspare cytology and formalin jarsspare sharps containersneedlesspare needlessyringesspare syringes



Casting SuppliesCast removal

Casting rollsspare soft roll, fiberglass, plasterwalking air casts

Pap/CPX suppliesall supplies in roomsspare lubeexam bed rollsspare slidesspare blue slide casesspare Cx swabsspare C&S swabs

gowns/drapesspare paper gownsspare sheets

Hospice/Invasive CarecathetersIV suppliesSC setsHospice boxes/drugs

General Patient Carebaby scalesBP Tru, BP cuffsspare mercury sphygsAdult scalesspare measuring part for adult scaleurinalysis containersspare urinalysis containerspregnancy testsear syringe suppliesStyrofoam cupsspare styrofoam cupsliquid nitrogen LN2spare otoscope tip holdersspare mounts for diagnostic setsLiving Life to the Full DVDsHolter Monitorspare tongue depressorsspare razor bladesHalo magnifierheadlamps

MedicationInjectables (MTX, B12)



NarcsInsulinSamplesAllergy shotsFlu shots, Pneumovax, Tdspare lock boxesUrgent injectables (benadryl, toradol, gravol, etc)

Cleaning/Storage suppliesPurell refillsCleaning solution/soapSoap refillsspare garbage binsspare organizer binsCavicide

Administrative/Office supplieskeyboard trayspare Rx padsspare organizational unitsspare clear wall 'inboxes'tapeenvelopesfile folderscopy paperStaplesTapepens/pencilsbindersDymo labelstoner/printer cartridgesshredderspare desk lamp with clamplarge file cabinet from former HFMCIspare parts for Plantronics headsetempty clipboardstrays for faxing, scanning, 'to do', shredding

post-it notesspare post-it notes

Construction/Maintenancecords and plug-ins/power barsfanssmall space heaterlarge space heater, oilLight bulbsgrab bars x 2 for bathroomsbolt cutters



E. Uninsured Fee Schedule

Current as at April 2012. For most current BCMA fee guidelines, go to (requires physician log in)https://www.bcma.org/member-publications/bcma-guide-fees

This table is a sample of a fee schedule used by a clinic that does not use the BCMA Fee Guidelines. Insert the clinic rate and add lines for additional fee items.

Fee Schedule for Uninsured Services BCMA Fee Guidelines

Clinic Standard Rate

Clinical ServicesComplete physical exam 149.00Office visit 69.10Missed appointment – regular appointment 69.10Missed appointment- physical 149.00Injection – subcutaneous or muscular (injection only) 21.45

Forms and NotesInsurance form - long 320.00Insurance form – short 153.00Occupational fitness assessment form (non Canada Post) 149.00Other miscellaneous forms or notes n/aPhysical fitness exams for schools, camps, etc. 66.10Sick note 39.15

Industrial and InsuranceDriver’s medical exam and report – non-patient 183.00Driver’s medical exam and report – patient 183.00General insurance exam 188.00

Medical LegalSimple form/letter on patient condition 149.00Medico legal letter/form (short, factual) 320.00Medico legal report (includes symptoms, history, records, diagnosis, treatment, results, and present condition)

958.00

Medico legal opinion (report plus expert opinion) 1,602.00Review of EMR records (15 min) 89.50Photocopying per page (first 10 pages) 1.45Photocopying per page (each additional page after 10 pages) 0.30

MiscellaneousAdvice by telephone (per 15 min) 78.10Renewal of prescription by telephone (per call) 28.00


https://www.bcma.org/member-publications/bcma-guide-fees


F. Privacy Policy

[this section includes samples of what might be produced when you create a privacy policy with the policy wizard on the CMA website]

a. General Privacy Policy

This policy outlines how we protect the privacy of your personal information and medical record. Everyone working for this office is required to adhere to the protections described in this policy. If you have any questions regarding our privacy practices, please contact your doctor or one of our staff.

Collection, Use and Disclosure of Personal Information

What personal information do we collect?We collect the following personal information: Identification and Contact information (name, address, date of birth, emergency contact, etc) Billing information (provincial plan and/or private insurer) Health information (symptoms, diagnosis, medical history, test results, reports and treatment, record of

allergies, prescriptions, etc)

When and to whom do we disclose personal information?Implied consent for provision of care: By virtue of seeking care from us, your consent is implied (i.e., assumed) for your information to be used by this office to provide you with care, and to share with other providers involved in your care.

Disclosure to other health care providers: Relevant health information is shared with other providers involved in your care, including (but not limited to) other physicians and specialists, pharmacists, lab technicians, nutritionists, physiotherapists, occupational therapists.

Disclosures authorized by law: There are limited situations where we are legally required to disclose your personal information without your consent. These situations include (but are not limited to) billing provincial health plans, reporting infectious diseases and fitness to drive, or by court order.

Disclosures to all other parties: Your express consent is required before we will disclose your information to third parties for any purpose other than to provide you with care or unless we are authorized to do so by law. Examples of disclosures to other parties requiring your express consent include (but are not limited to) third party medical examinations, provision of charts or chart summaries to insurance companies, enrollment in research studies and trials.

Can you withdraw consent?You can withdraw your consent to have your information shared other health care providers or other parties at any time, except where the disclosure is authorized by law. However, please discuss this with your physician first.



Patient Rights

How do you access the personal information held by this office?You have the right to access your record in a timely manner. If you request a copy of your record, one will be provided to you at a reasonable cost. If you wish to view the original record, one of our staff must be present to maintain the integrity of the record, and a reasonable fee may be charged for this access. Patient requests for access to the medical record can be made in writing, directed to the physician.

Limitations on accessIn extremely limited circumstances you may be denied access to your records, but only if providing access would create a significant risk to you or to another person.

What if you feel your record is not accurate?We make every effort to ensure that all of your information is recorded accurately. If an inaccuracy is identified, you can request that a note be made to reflect this on your file.

Office Safeguards

How long do we keep information?We retain patient records as required by law and professional regulations.

Complaints process

If you believe that this office has not replied to your access request or has not handled your personal information in a reasonable manner, please address your concerns first with your doctor.

Your may also choose to make a complaint to your provincial/territorial college

(Physician) Signature: Date:

(This policy was created with the help of the CMA PrivacyWizardTM)



b. Detailed Privacy Policy

[The privacy wizard will also create a multiple-page detailed document]

c. Standard Contractual Clause [sample]

This clause is for use in employee or third party contracts/agreements. This contract must be signed before the contracted service provider or employee is given access to health information.

The Contractor (The Employee) acknowledges that confidential personal information, in whatever form, may become available or disclosed in carrying out this agreement. The Contractor (The Employee) agrees to keep such information confidential and to use it only for the purposes outlined in this agreement. The Contractor (The Employee) further agrees that any requests for personal health information should be directed to the Physician. The Contractor (The Employee) agrees to securely dispose [or return as appropriate] the health information transferred. This clause shall survive the termination of the agreement.

Contractor (Employee) Signature: Date:

d. General Express Consent Form [sample]

This brief form must be completed and signed before health information is given to any third party, including other physicians, allied health professionals (physiotherapists, chiropractors, etc), and for any medical-legal requests. All points in parentheses should be modified for the purpose of the request.

DATE:

I, (patient name) consent to (physician name) disclosing relevant portions or a summary ofmy medical record to (to whom disclosed) for the purpose of (add purpose).

(Patient Signature)



G. Quick Guide and Shortcuts

[this is a sample for PSS software. It is recommended that you create a similar document for quick use and shortcuts within your own EMR system]

EMR Shortcut Keys

Patient record right off appt sheet highlight pt, Ctrl-1/Ctrl-2/Ctrl-3New note in pt chart Ctrl-NMessage Ctrl-MInstant message Ctrl-Alt-MOpen/Close pt summary in pt record Ctrl-WOpen/Close demographic info in pt record Ctrl-DBill for pt Ctrl-]Rx for pt Ctrl-BRefill multiple Rx double click Rx symbol next to meds list on pt recordEnter allergy Ctrl-Shift-ASOAP note in pt record type ‘soap’ then type Ctrl-iReferral or any imaging required Ctrl-K and click ‘send message to booker’ Find a patient or appointment Ctrl + F works in patient, appt and records

OR

Ctrl -1 brings up pt from appt slotCtrl -2 brings up the double booked pt in that slotCtrl-N new noteCtrl-] bill this ptCtrl-M message for this ptCtrl-D opens and closes pt demographic in pt viewCtrl-W opens and closes pt summary in pt view (de-clutters the pt view)Ctrl Alt-M instant messageCtrl-I insert stamp. Ctrl Shift-T table of contentsCtrl Shift-A enter allergyCtrl-B prescribeCtrl Alt Bbold type text (may do this prior to typing the text or highlight text and choose this)Ctrl Alt L highlight text (as above)CTRL+F in any screen will search that screen



Practice Solutions Quick Guide

[another sample of a quick guide for EMR – create your own for your software]

KEY EMR FUNCTIONS

1. OPENING PATIENT RECORD

From PS Suite TOOLBAR Press RECORDS, then Ctrl F to find that ptFrom APPOINTMENTS a. Click on pt and click Ctrl 1 (or Ctrl 2 or 3 depending how many pts

booked into that time slotb. Right click on pt, choose “view XX’s records”

2. ENTERING NEW NOTE

Open PATIENT RECORD

Data → “new patient record” Ctrl N

type

3. PRESCRIBING

Double click on “Rx” to the left of the medications box, select all meds you wish to refill, select “prescribe” and go from there, ORFor new Rx: either Ctrl B or Data→”prescribe” to get to prescription page (tab through boxes)

4. MESSAGINGSending a New Message

From PS Suite TOOLBAR Messages→”new message”From PATIENT RECORD, BILLBOOK, PT DEMOGRAPHICS

Ctrl M to make a new message concerning that particular patient

Things to note: To send a message to any MOA, send to ‘book’, otherwise use initials or choose from the listType ASAP in the due date line for anything that needs to be dealt with within one day (INRs etc)

Instant MessagesFor non-pt related or urgent matters, an IM will pop up in the lower right corner of the recipient’s screen

From PS Suite TOOLBAR Messages→”new instant message”From PATIENT RECORD Ctrl-Alt-M

Checking messages for another doctorClick on message menu bar at the top of the PS TOOLBAR



Click on “view another user’s messages” and choose the appropriate personThis will give you the option of looking at their messages while in PATIENT RECORD view (look at the bottom of the patient record window to see how many messages you have).

Viewing Messages/New Labs…Labs arrive in the form of a message to your inbox which will redirect you to a note in the patient’s chartFrom PATIENT RECORD: look at bottom of patient record window to see “view next XX message”. You will be brought through all patient messages that you need to deal with.If the message is a scanned document (consult letter etc), click on the sun icon to view. Completed messages you may click ‘quick archive’ to get rid of the message

5. ORDERING TESTSTo order tests (Diagnostic imagining, Mammograms, etc.) while in the patient record:DATA menu “pending test or consult” (or just click Ctrl K) choose (left click once) the appropriate test using the tabs and lists provided write in text box the reasoning for the test in bottom right corner, choose “add with message tobook” in the bottom right corner (this will send it to our booker)

6. WRITING A CONSULT LETTER

Open PATIENT RECORD

Data → “new letter” Ctrl L

Type in consultant’s name, enter OK

You will be brought back to pt record where the letter is now a noteType your letterCtrl Kclick ‘consultations’tabchoose consultant and specialty, write a message in the box if you want any x-rays/labs etc included in the consultclick ‘add with message to book’ button and close that window – this sends the letter to the MOA to be faxed off

7. BILLING TO MSP [for PSS]

From BILLBOOK Edit → “add record” Or Ctrl A

From APPOINTMENTS Right click → “bill this appt”From PATIENT RECORD Patient → “bill this patient”

Or Ctrl ]

What to do on the billing screen; things you’ll click pastPatient name/# - either enter the name or it’ll be thereEnter through all the fields on the top of the screen but make sure the payee is there, that Rural Retention is set at ‘SK’ and Service Location is ‘A’ (unless you did a home/hosp visit).Now you’re at “Code” – insert billing codeEnter through “Description”Enter through “Date” if it’s correct



Now you’re at “Diagnoses” – insert Dx codeEnter through all the other stuff until you come back to being at “Code”, where it’ll say something like “no more” – click on ‘Save’ or ‘Save and add another’ button at the top

8. SHORTCUT BUTTONS FOR CREATING CUSTOM FORMSEx: pre-op forms, worksafe forms, some growth charts, etc (stuff that normally would be only available on paper and usually for third party use.

OPEN RECORDClick on name in appt screen

Ctrl 1, Ctrl 2 or Ctrl 3

NEW NOTE in pt record Ctrl NFIND a pt while in pt record, pt billing, pt demographics, etc Ctrl FBILL pt in pt record Ctrl ]MESSAGE regarding a pt while in pt record, demographic, billing, etc

Ctrl M

INSTANT MESSAGE Ctrl Alt MPRESCRIBE new meds in pt record Ctrl BPRINT Ctrl PNEW LETTER/CONSULT Ctrl LInsert STAMP into a pt note or letter Ctrl I to chooseSTYLE FORMATTING Ctrl Alt B/U/L for

BOLD/UNDERLINE/HIGHLIGHTLOG OUT (locks screen so pts can’t see confidential info) Ctrl U

IF IN DOUBT, PLEASE ASK IF THERE IS A FUNCTION THAT YOU THINK SHOULD BE THERE, BUT DOESN’T SEEM TO BE (it’s usually there, so just ask) OR USE THE HELP MENU ON THE PS TOOLBAR

9. TOOLBARS

“PS Suite” TOOLBARAPPOINTMENTS – can view appointments for the dayPATIENTS – opens pt demographics windowINPATIENTS – ignoreCLIENTS - ignoreBILLBOOK – opens billing window (Ctrl A will bring up next pt you want to bill)CASHBOOK – ignoreADDRESS BOOK – self explanatoryHANDOUTS – find pre-made handouts and email or print for patientsMESSAGES – opens your inbox, send new messages etcRECORDS – opens pt record

THE PATIENT RECORDFILE – printing, etcEDIT – similar to MS Windows functionsSTYLE – change the appearance of text (bold, underline, etc)SETTINGS – ignorePATIENT – find new pt, look at this pt’s demographics, to bill ptVIEW – changes the layout of pt record view (to look at only labs or certain notes, do key word searches, etc)DATA – anything that can be entered into the pt record (notes, forms, diagrams, prescriptions, allergies, etc)LETTER – appears only when a letter is active in the record; allows you to print, fax, email or view letter
