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COVID -19 CASE INVESTIGATION, CONTACT TRACING, ISOLATION AND QUARANTINE GUIDELINES

Effective Date: 
Mon, 01/04/2021
Policy: 

Case Investigation, Contact Tracing, Isolation and Quarantine are components of a comprehensive strategy to help protect students, faculty, and staff and to mitigate the spread of COVID-19.  

Definitions  (as they pertain to this policy):

Case Investigation:  the identification and investigation of patients with confirmed or probable diagnoses of COVID-19 with the intention of  preventing the spread of communicable disease 

Contact Tracing:   the identification, monitoring, and support of contacts who have been exposed to, and possibly infected with, the COVID-19 virus with the intention of preventing the spread of communicable disease

Isolation:  the separation of a person or group of people known or reasonably believed to be infected with the COVID-19 virus and potentially infectious from those who are not infected to prevent spread of the communicable disease 

Quarantine: the separation and restriction of movement of persons who, while not yet infected with COVID-19, have been exposed to COVID-19 and therefore may become infectious. Quarantine measures help prevent the spread of COVID-19 by separating these individuals from others

UCSC Affiliates:  currently active UCSC staff, students and faculty

SHS COVID Team:  a trained team led by the Medical Director that includes the Campus COVID Nurse, RNs, Case Managers and other staff as needed,  to facilitate Case Investigation, Contact Tracing, Isolation and Quarantine management and tracking

Close Contacts:  individuals in close contact with a positive case of COVID-19 as defined by regulatory agencies 

 

Per CA State regulations, local health departments are responsible for leading case investigations, contact tracing, and outbreak investigations.  Due to the large number of COVID-19 cases reported to the Santa Cruz County Health Department, the local health department’s limited resources, and in response to how easily and quickly COVID-19 (SARS-CoV-2) can spread, a partnership was developed between Santa Cruz County Public Health Department and UCSC SHS.  This partnership supports the best possible use and sharing of resources to aid in limiting the spread of COVID-19 in the local community.  Under the terms of this partnership, UCSC SHS, initiates Case Investigation and Contact Tracing for UCSC affiliates that have tested positive for COVID-19 at one of the UCSC campus testing locations and then report these findings to the Santa Cruz County Public Health Department.  Information about non-UCSC affiliates, collected in the course of these investigations is forwarded to the Santa Cruz County Public Health Department – UCSC is not responsible for notification or tracking of non-UCSC affiliates.  Once UCSC staff and faculty have been notified of their positive results, tracking and other processes are covered under broader campus protocols; the remainder of this policy pertains specifically to UCSC students.

 

Procedure: 

For on-campus testing, a positive COVID-19 result is received by SHS via the Electronic Medical Record (EMR).  The Medical Director or designee notifies the patient of the positive result, assesses symptoms, risk, work location,  educates and assesses isolation capabilities, and informs them to expect a Contact Tracer call shortly.

Off campus test results are received in several ways – including from supervisors for student workers and employees, directly from the patient, Health Department notifications.  Students in these cases are contacted by a member of the SHS COVID Team to ascertain symptoms, acuity, risk, work location, educate and assess isolation capabilities and resource needs, and initiate Contact Tracing if indicated.

Contact Tracing for UCSC students is performed by a member of the SHS COVID Team based on standards set by regulatory agencies.  Results are documented in the EMR and forwarded to the County Public Health Department with the required Confidential Morbidity Report (CMR).  Close Contacts that are UCSC students are notified that they are a close contact, educated and assessed for quarantine capabilities or other needs.  UCSC employees who are identified as close contacts are referred to the campus Assistant Director of Workers' Compensation and their PCPs for next steps.  For identified Close Contacts that are not UCSC affiliates, the case patient is instructed to notify the contacts directly. 

Isolation and Quarantine guidelines are determined by Federal, State and Local agencies and evolve as data is collected.  UCSC SHS follows the most current guidelines as set by these agencies.  Students that require assistance with housing, food or other Isolation or Quarantine concerns are referred to a campus team including representatives from housing, dining, Dean of students office, and transportation.  On-campus Isolation and Quarantine housing and food service is available to students living both on and off campus.  On-campus students are required to move to on-campus designated Isolation or Quarantine housing per campus protocol.

During the time students are in Isolation or Quarantine, they are monitored by the SHS COVID team for symptom development, acuity, and other needs.   The team meets regularly to review cases.  Students are expected to complete a daily Isolation or Quarantine survey; results of these surveys help monitor symptoms and acuity.  Clearance from Isolation or Quarantine is determined by current guidelines set by regulatory agencies.  

As the situation evolves, the most current process instructions can be accessed via the electronic medical record references and the shared documents.

 

EMPLOYEE HEALTH: COVID -19 DISEASE SCREENING

Effective Date: 
Mon, 01/11/2021
Revised: 
Mon, 01/25/2021
Policy: 

As part of the UCSC campus COVID-19 mitigation strategies,  daily screening has been implemented for all employees who will be working on-site at a UCSC owned or leased property.  As defined healthcare personnel (HCP), employees of UCSC Student Health Services (SHS) provide direct patient care and are essential to maintaining appropriate staffing ratios and services.  Routine COVID-19 screening and testing processes  are essential to providing a safe work environment for healthcare personnel (HCP) and safe patient care.

In alignment with University of California Consensus Standards for Operation and other federal, state and county guidance, and to help protect staff and students from avoidable COVID-19 disease exposure, UCSC SHS provides a mechanism for daily COVID-19 symptom screening for all HCP working that day.

Procedure: 

An electronic monitoring system was implemented for employees to complete prior to arrival at the facility.  This system has employees report absence of fever and symptoms of COVID-19, absence of a diagnosis of COVID-19 infection in the prior 14 days, and confirmation that they have not been exposed to others with COVID-19 infection during the prior 14 days.  Employees are encouraged to actively take their temperature at home or have their temperature taken upon arrival at SHS.  

UCSC SHS utilizes a daily email symptom check questionnaire, which will provide either a certificate of clearance to work on-site, or a notice to not report to work on-site.   A message is automatically sent to the employees supervisor noting if the employee is “cleared” or “not cleared” to work that day.  Additionally, SHS employees are offered regular asymptomatic COVID testing at no cost to the employee.  

All supervisors will follow these steps:

1.  If an employee reports “yes” to any symptoms on the daily screening questions they will need to be cleared before returning to work.  The employee has 2 options:

 a.  They can consult with their PCP for a COVID-19 symptom and risk assessment,  and clearance to return to work.  

Or

b.  They can consult with the UCSC SHS Medical Director, the COVID Nurse, or the Clinic Director regarding COVID symptom and risk assessment, and complete a COVID test on-site at SHS, at no cost to the employee.  A negative COVID Risk assessment and a negative COVID test reviewed by the Medical Director will suffice as clearance to return to work.

2.        If an employee reports that they have had a positive COVID-19 test or are a definitive close contact with a positive COVID-19 case:

·        The supervisor should first consult with the Medical Director or the COVID Nurse as soon as they are notified by the employee

·        All positive employee cases must be reported to the campus Assistant Director Workers' Compensation within 24 hours and the Director, Environmental Health & Safety and Risk Services must be notified ASAP.  If an employee chooses to consult their Primary Care Providers (PCP's) for clearance to return to work, SHS can override the clearance if the PCP doesn't follow current Cal OSHA or California Department of Public Health (CDPH) guidelines

3.     For situations where an SHS staff member tests positive for COVID or is identified as a definitive close contact, documentation must be submitted in RL Datix.  Supervisors are responsible for this data entry.

 

See attached document for supervisor  directions for entering into RL Datix.

 

USE OF SECURE UCSC EMAIL WITH VIRTRU

Effective Date: 
Tue, 09/29/2020
Policy: 

UCSC has adopted a product called Virtru for secure Email (Gmail via Chrome browser) and Documents (Google Drive).  Select units have been given access to Virtru including many categories and departments of SH&W including management, supervisors, primary care, psychiatry, CAPS, case management, health information management, insurance, ancillary services, SHOP and CARE.

Virtru users can send email containing P3 and P4 data (includes PII or PHI) including attachments as long as they have Virtru enabled correctly and follow the procedures articulated in this policy.

Procedure: 

Eligibility

Contact your supervisor if you fall into one of the approved categories above or feel you have a business need to have secure email

Users are managed via google group named virtru-provisioning.
Only SHS and ITS admins can administer the group.

Installation and Use

It is responsibility of the user to ensure that Virtru is installed and enabled correctly.
Step 1 Install & Activate for email

a. Gmail users install the Chrome extension or Outlook for email add-in (How to for Outlook)
b. You may also install for your Android or IOS Device for email encryption.
c. In the setup process I am being asked to grant Virtru access to information, for both the email and drive installation is this okay? 
d. Yes, Virtru has passed a supplier security review with UCSC.

Step 2 Install & Activate for Google Drive

a. Install for Drive
b. In the setup process I am being asked to grant Virtru access to information, for both the email and drive installation is this okay?
c. Yes, Virtru has passed a supplier security review with UCSC.

When to use Virtru

a. When sending any information containing level P3 or P4 data (includes PII or PHI) including email messages and attachments, send securely with Virtru protection on.

https://its.ucsc.edu/policies/data-protect.html 

b. For student communication – it should be last resort; secure message should be used first.
c. Do not use for PCI (credit card) data

Step 3 Start using

a. How to use Virtru
b. The subject line is clear text – never put anything secure (patient name) into subject line.
c. You can use Virtru to communicate with other staff, vendors, insurance companies, outside providers, etc.

NOTE: they need to already have an approved usage of the data. Don’t just email random people our secure data.

d. Virtru does not replace documenting in the patient/client record. (i.e. I emailed this to a patient).  Document in the note to cover you.

References

https://its.ucsc.edu/policies/data-protect.html 

 

Link to instructions:

https://docs.google.com/document/d/1T0fKybxBd8RQcx_OSv1f9FnrF5XYhC86L0INf628mDo/edit?usp=sharing

SUBPOENAS

Effective Date: 
Fri, 09/04/2020
Policy: 

Subpoena Requests

A subpoena is a request for the production of documents to appear in court or other legal proceeding. It is court-ordered command that essentially requires you to do something, such as testify or present information that may help support the facts that are at issue in a pending case. The term "subpoena" literally means "under penalty".

All subpoena requests are processed by the UCSC Information Practices Department.

Subpoena requests are not accepted at Student Health Services.

All are to be directed to Information Practices - Located at the Chancellor’s office in Kerr Hall.

Procedure: 

1. Server presents at registration or Medical Records - Do not engage - contact the Health Information Systems Administrator (HISA) STAT, if out of office contact Business & Information Systems Director. If unable to contact page another manager or supervisor.

2. Server will be directed to the Chancellors office. Under no circumstances are we to accept/sign for the subpoena.

Telephone Call:

Phone call is received requesting information in regards to a subpoena, forward to the HISA at 459-1628.

FAX:
Subpoena is received via fax; notify the HISA immediately, if HISA is out of office contact the Business & Information Systems Director, who will forward.

MAIL:
Subpoena is received via U.S. Mail; Notify the HISA immediately, if HISA is out of office the Business & Information Systems Director, who will forward to the Chancellors office.

 

 

 

ONLINE BIRTH CONTROL REQUEST

Effective Date: 
Mon, 01/13/2020
Policy: 

ONLINE BIRTH CONTROL PROGRAM

Rapid, easy access to contraception is critical to preventing unintended pregnancy. This standardized procedure allows patients to be evaluated for clinical appropriateness for self-administered birth control (pill, patch, or ring) via an online questionnaire. Once the questionnaire is submitted, it is reviewed by a clinician within 3 business days and if appropriate, the clinician submits a prescription for birth control to the pharmacy directly. With this program, the patient does not have to be evaluated in person.

Patient eligibility:

1.       Registered UCSC students

2.       The program is 100% covered for students with UC SHIP or Cruz Care.

3.       The program is fee for service for students who do not have UC SHIP or Cruz Care.

Procedure: 

Patient Procedure:

1.       The student logs into the student health portal (My Health e-Messenger) and schedules an “Online Birth Control Request.”

2.       The appointment date and time are placeholders and do not require the student to come to the clinic or speak with the clinician during that specified time.

3.       The student is prompted to complete the online questionnaire regarding their most recent blood pressure, birth control history, medical history, and preferred pharmacy.

 

Clinician Procedure:

1.       The clinician (physician, nurse practitioner, or physician assistant) goes to the “Online Request” schedule. This schedule is found on the most right hand column of “Primary Care” in Department view.

2.       The clinician right clicks on the appointment to “View Appt Questionnaire.” If the patient has not completed the questionnaire, the clinician would send a secure message to the patient to complete the questionnaire.

3.       If the patient has completed the questionnaire, the clinician right clicks on the appointment to change the status to “Check In” and then right clicks again to change the status to “Start Visit.”  If a window pop-up requests the number of labels to be printed, please click “Cancel.”The clinician clicks on OpenChart to access the associated encounter note.

4.       The clinician opens the encounter note associated with the appointment and reviews the patient-submitted questionnaire.

5.       The clinician completes the provider section of the template:

a.       Patient Request: new start, refill or other

b.       Medications: review current medication list

c.       Allergies: review current medication/material allergy list

d.       Problem List: review medical history

e.       Blood pressure: review whether patient has had a blood pressure taken in the clinic the past 12 months or whether the patient has had a recent self-measurement within the past 6 months

f.        Assessment: indicate whether patient meets CDC U.S. Medical Eligibility Criteria for Contraception

g.       Diagnosis: indicate most appropriate diagnosis, e.g. “Contraceptive Management”

h.       Encounter Code: click on the encounter code which reflects the time spent reviewing the patient questionnaire and responding to the request, e.g. “Professional:  ONLINE EVAL/MANAGEMENT SERVICE 5-10 MINUTES (99421)”

i.         Medication Orders: if appropriate, prescribe birth control. If it’s a new start, Tarina Fe 1/20 or Aubra EQ 1/20 would be prescribed.  If appropriate, prescribe 1-year prescription (13 packs if taking placebos or 16 packs if continuous dosing). If patient needs follow-up in 3 months, prescribe 3-month supply.

j.         Contraception Prescription: indicate whether 12 months or 3 months prescribed.

k.       Patient Education: indicate what patient education information will be sent in secure message. Or: click the applicable patient counseling topics that will be submitted in the secure message (see text macros at the end of this document).

l.         STI Screening: review patient’s chart for most recent STI results. Indicate whether patient has had STI screening within the past year or not.

m.     HPV Vaccination: review patient’s immunization record and/or scanned documents for documentation of HPV vaccine. Indicate whether patient has completed or not completed HPV vaccine series.

n.       Cervical Cancer Screening: review patient’s chart for most recent pap. Indicate whether patient is up-to-date or due for pap test.

o.       Handouts: click on appropriate patient education handouts to be posted on the student health portal for patient to review, e.g. Combined Contraceptive Pill, HPV FAQ, Asymptomatic STI screening, PAP FAQ, etc. 

6.       The clinician sends a secure message to the student informing them that their online birth control request has been reviewed and what was prescribed or advised.

7.       The clinician returns to the appointment page and right clicks on the appointment to turn the status to “Check Out” after signing the note.

 

SPECIAL CONSIDERATIONS

1.       Blood pressure – if there hasn’t been a blood pressure taken within the past year or if the blood pressure measurement is borderline or elevated, can ask patient for blood pressure to be obtained in clinic or self-measured. Adjust number of packs prescribed accordingly.

2.       “Yes” responses – if there are any “yes” responses, can send a secure message to the student to clarify or schedule a telephone visit to obtain additional information.

3.       Nuvaring – acceptable to refill

4.       Contraceptive patch – acceptable to refill

 

EXAMPLES OF TEXT MACROS

No Patient Questionnaire Submitted (.onlineNF)

Thanks for signing up for the online birth control pill request!

I see that you haven't completed your questionnaire.

Would you log back into Health e-Messenger (https://healthcenter.ucsc.edu/information/make-appointment.html) and complete the questionnaire?

Once you complete the questionnaire, let me know by replying to this message.

Prescription Dispensed (.onlineOCP)

Thanks so much for submitting the online birth control pill request form!

 

[  ] I have sent a birth control prescription to the on-campus pharmacy with 12 refills. The pharmacy will give you a quarter's supply of pill packs at a time. This prescription will be ready for pick up within 1 school day.

 

[  ] I have sent a birth control prescription to the on-campus pharmacy with 3 refills. The prescription will be ready for pick up within 1 school day. Within the next 3 months, please schedule an in-person appointment at the Student Health Center to receive additional refills. Call (831) 459-2500 to schedule. I recommend calling sooner than later because there can be a one-month wait for appointments.

 

[  ] Based on your responses, we would like you to schedule an in-person appointment at the Student Health Center. Call (831) 459-2500 to schedule.

 

[  ] Because we don't have a recent blood pressure measurement for you, please measure your own blood pressure at the blood pressure station outside of Student Health Outreach and Promotion (SHOP) next door to the pharmacy. Reply to this message with your blood pressure measurement. Or you can stop by the Student Health Center on the first floor and tell the receptionist that you need to get your blood pressure checked for online birth control.

 

This is the birth control prescription I sent to the pharmacy:

 

It is common to have spotting (bleeding) during the first 3 months after starting the birth control pill. After 6 months, your periods may become lighter or with no bleeding. If this worries you, please complete the online birth control request form again. Let us know you have too much spotting and/or too light of periods. We can switch you to a different pill.

 

Please see below for additional important information.

Let me know if you have any questions!

 

*************************************************

 

I posted some handouts on your portal, including:

Combined Oral Contraceptives - The Pill

Self-Directed STI Screening - Asymptomatic

Pap Test - Latest Recommendations

HPV FAQs

Progesterone Only Pill

 

The pill handout provides information about how to start the pill, potential side effects, and important reminders. Look out for severe adverse side effects and warning signs of a blood clot, including "ACHES" (Abdominal pain, Chest pain or shortness of breath, Headaches, Eye or vision problems, and Severe leg/calf pain or swelling). Stop the pill and return to the Student Health Center or go to the Emergency Department if any blood clot signs/symptoms develop.

 

If you are traveling on a long train, plane, or car ride, reduce your risk of a clot by walking around at least hourly.

 

Stop by SHOP for more information about birth control options and use.

 

If you're interested in STI screening, read the instructions in the self-directed STI screening handout.

 

Starting at age 21, we recommend pap tests (cervical cancer screening) once every 3 years. If you're 21 years old or older and haven't had a pap test (cervical cancer screening) within the past 3 years, schedule an appointment at the Student Health Center by calling (831) 459-2500.

 

If you haven't completed your HPV (human papillomavirus) vaccine series, please read the HPV handout for more information. Schedule an appointment at the Student Health Center to receive your HPV vaccine.

 

Skipping placebo – new start (.skip)

If you're interested in skipping your periods, I recommend taking the pill as packaged (with the placebo week, 4th week of the pill) for the first 3 packs, and then you can skip the placebo pills afterwards. This is to allow your body to adjust to the pill first before skipping your periods.

 

COVID -19 TESTING

Effective Date: 
Fri, 05/01/2020
Revised: 
Fri, 02/26/2021
Policy: 

Testing to screen for COVID-19 is one component of a comprehensive strategy to help protect students, faculty, and staff and slow the spread of COVID-19.  UCSC Student Health Services (SHS), in collaboration with the UCSC Molecular Diagnostic Lab (MDL) provides testing for COVID-19.

Testing populations, mandates, and frequencies are determined by UCSC Campus administration based on guidance from regulatory agencies including but not limited to the CDC, Santa Cruz County and California State Public Health Departments, and the University of California Office of the President.

 

Procedure: 

ASYMPTOMATIC TESTING

Asymptomatic students and staff/faculty can schedule their tests on-line by logging into the SHS secure messaging system Health e-Messenger, using their CruzID and gold password.  Appointments can also be made by calling the SHS appointment line at 831-459-2500.  Once an appointment is made regular reminders are sent electronically.  Asymptomatic testing, voluntary or mandatory, is provided at Kiosk testing locations throughout campus. Kiosk testing site locations were evaluated and selected in collaboration with the Campus EH&S (Emergency Health & Safety) department and the Santa Cruz County Public Health Department.  (See attached Kiosk Testing Process for more detailed steps)

 

SYMPTOMATIC TESTING

To decrease the risk of COVID transmission, symptomatic students and asymptomatic students that are confirmed close contacts of a known COVID-19 case are directed to the SHS or the Nurse Advice line for evaluation.  If testing for COVID-19 is indicated it will take place at the SHS.

Staff and Faculty who are symptomatic are directed to their off campus Primary Care Provider for evaluation and testing.

Currently, the majority of testing is done via an anterior nares self-collected PCR swab.   If the test is collected during an in person visit, appropriate Infection Control measures are taken, including proper PPE donned by staff observing the collection and post collection room cleaning.   Infection Control measures are in-place at the testing Kiosk sites (see attached COVID-19 Testing Kiosk Procures).  Test results are available within 24-72 hours and if negative are sent electronically to the Health e-Messenger portal.  Patients with positive results are called by the SHS Medical Director or designee, and Case Investigation and Contact Tracing is initiated.

 

 

TELE-HEALTH VISITS

Effective Date: 
Wed, 04/01/2020
Revised: 
Mon, 01/04/2021
Policy: 

Telehealth visits are provided at UCSC Student Health Services to meet the needs of students who are unable or not recommended to have an in person appointment at UCSC Student Health Services.  Telehealth includes online contraceptive requests.

For Primary Care

This is a clinician-patient encounter conducted via tele-health whereby a patient is able to consult with a health care provider and receive medical advice, evaluation, and/or treatment to the extent possible given the absence of a physical exam. The appointment duration is limited to 20 minutes, although it can be extended to 40 minutes on a case-by-case basis. This encounter is for non-urgent medical concerns that do not require immediate assistance.

 

Types of telephone visits:

New medical concern
Follow-up of a medical concern that was previously evaluated through an in-person visit at the student health center.

 

This also meets the need for access to contraception via UCSC Student Health Services provision of 0nline oral contraceptives ( ocp ).  See separate policy and procedure.

Procedure: 

Patient access to telephone visits:

Web-booked: patient schedules a telehealth visit by logging onto My Health e-Messenger. 
Scheduler booked: patient interacts with a scheduler and a scheduler puts them in a specific provider’s schedule (for follow-up) or the generic telehealth provider schedule (for new issue)
Nurse advice line booked: patient speaks with a nurse through the nurse advice line and it is determined that the patient would benefit from additional consultation with a clinician. The nurse would book the patient in a specific provider’s schedule (for follow-up) or the generic telehealth provider schedule (for new issue).

  • Health care providers available for this encounter: physicians, NPs, and PAs
  • Eligible patients: enrolled students with UCSHIP - there is no co-payment
  • CruzCare and No SHIP will be charged a fee (see below)

E/M codes:  

  • Physician/QHP Telephone Encounter ( 5 to 10 minutes)    99441  
  • Physician/QHP Telephone Encounter (11 to 20 minutes)   99442  
  • Physician/QHP Telephone Encounter (21 to 30 minutes)   99443 

*QHP stands for “qualifying health care professional” which can be nurses, NPs, and PAs

Process:

  • Initial patient information is collected via patient questionnaire or via advice nurse. 
  • Patient completes telehealth consent in advance, but if this consent was not completed, the clinician will need to obtain this consent during the telephone visit.
  • At the appointment time and/or within 20 minutes of the appointment time, the clinician will contact the patient on the phone number provided on the patient questionnaire or advice nurse note. A total of two call attempts will be made. If the clinician is unable to reach the patient after two call attempts, the clinician will send a secure message to the student inviting them to reschedule the appointment. 
  • If contact is successful, the clinician will introduce themself and verify the patient’s identity using name and date of birth. If the telehealth consent was not completed on the form, the clinician will review the following points:
 I understand that I am to be evaluated using a telehealth visit type (i.e. telephone visit).
 I understand that I have the right to refuse this type of evaluation at any time during the appointment 
and am aware of alternatives to this type of evaluation (e.g. in-person visit at the clinic, going to 
urgent care, or going to an emergency department).
 I understand that there are limitations with this type of visit and that I may need further evaluations 
in the future.

The clinician will then proceed with the clinical encounter. During the encounter, the clinician will review medications, allergies, and problem list. 

If lab tests need to be ordered, the clinician will confirm with the patient which lab they want to use (e.g. on campus vs. off campus). If an off-campus lab is requested by the patient, the clinician will order the lab tests using the same procedure as for the on-campus lab (excluding in-house labs). Lab tests done off-site are limited to blood/serum and urine tests. No swab tests can be ordered if done off-site. The clinician would send a secure message to Health Information Management with the subject line “Outside Lab Orders.”  Health Information Management (Medical Records) will prepare a pdf copy of the lab requisition and will send the pdf to the patient via secure message. The patient would print out the copy of the lab requisition and bring their insurance card / app to the Quest Diagnostics lab location of their choice. The charge/cost for outside labs is subject to a $300 deductible.

If prescriptions need to be ordered, the clinician will confirm with the patient whether they want to: pick up the prescription from the campus pharmacy, have the prescription mailed by the campus pharmacy, or pick up the prescription from an off-campus pharmacy. If the patient would like the prescription mailed from the campus pharmacy, the clinician will confirm with the patient if they would like a 90-day supply (if clinically appropriate) and include “mail order” in the Comments section of the prescription. The clinician will confirm the patient’s mailing address if they would like the prescription to be mailed by the campus pharmacy. The clinician will confirm the name, address, and phone number of the off-campus pharmacy if the patient wishes to pick it up from a local pharmacy.  On-campus pharmacy copays are less than off-campus pharmacy copays.

If a referral needs to be submitted for a provider or specialist, the clinician will confirm with the patient whether they want to be seen within the Santa Cruz area or outside of the Santa Cruz area. The clinician would submit a referral using the usual process. In the “Clinical History/Referral Reason” section, the clinician would specify that the patient would like to be seen in xxx city/town. If it appears that the student may need to see multiple specialists (e.g. physical therapy, sports medicine, etc.), then submit one referral to “General Care.” This referral is a more flexible umbrella referral that covers primary care and different specialists. The “General Care” referral can also be submitted if a patient needs to see primary care in their area. 

If the patient would like to submit a photo to assist with clinical evaluation (example: facial acne), there are two options: 1. The patient can send the photo to Medical Records, using the secure message system in Health e-Messenger.

2. The clinician would send a secure message to the patient. The patient would then reply to the message and attach the photo(s).

After the encounter, the clinician may send a secure message to the patient to summarize the encounter, post patient handouts on the patient portal, and/or provide additional information (e.g. lab orders, prescriptions, precautions, etc.). If the encounter is straightforward and/or brief, this after-visit summary does not have to be sent or if sent, it can be brief.

The clinician will document the telephone visit using the “PC Telephone Encounter” template. A section can be inserted into the Telephone Encounter Template (e.g. UCSC Respiratory or Urinary Symptoms) to assist with documentation.  A diagnosis and E/M code are required. The clinician would select the E/M code according to the duration of the encounter (telephone call duration, care coordination, and decision-making). The clinician can use the check boxes in the Plan section of the chart to communicate what is needed to the MA.

LOGISTICS OF CHECKING IN THE PATIENT AND DOCUMENTING

When the clinician is ready to start the encounter, the clinician would right click on the appointment to “Check In” to turn the appointment red and then right click again to “Start Visit” to turn the appointment blue. With the appointment highlighted, the clinician would go to Open Chart (on the right upper hand corner of screen). The clinician would open the telephone encounter that is associated/attached to the appointment. 
After the telephone call and note are completed, the clinician would right click on the appointment to “Check Out” to turn the appointment green.

IF A PATIENT IS A “NO SHOW”

The clinician would document in the chart the two times the calls were made. 
Diagnosis would be “No Diagnosis” (this is a default option in template) and E/M code would be “No charge.”
The clinician would send a secure message to the student inviting them to schedule a new telephone visit if they would still like to be contacted. 
No show fees are not charged for missed telephone visits.

IF A PATIENT IS TAKING LONGER THAN THE ALLOTTED 20 MINUTES

The clinician has the following options: 

Notify the student that the appointment time is up and that additional concerns can be addressed through another telephone visit or in-person visit if more appropriate.
Notify the charge nurse that the current telephone visit is taking longer and ask the charge nurse to assign the next scheduled telephone visit to another clinician who may have an open slot in their schedule.

 

COVID -19

Effective Date: 
Tue, 03/17/2020
Revised: 
Fri, 02/26/2021
Policy: 

Current and ongoing policies and procedures have been enhanced to address public health and public safety (i.e. masking and social distancing), handwashing, cleaning, disinfecting and decontamination, screening of staff, students and visitors, laboratory testing, expanded online services including Tele-Health, online visits and maintenance of clinical records (see policies on Tele-Health and COVID-19 Testing), vaccinating to prevent COVID-19, and the use of Personal Protective Equipment (PPE) and other resource management.

In early 2020, the novel coronavirus, SARS-CoV-2,  pandemic quickly swept the globe and significantly impacted all UC locations.   UCSC quickly modified all areas of operations and implemented a comprehensive strategy to help protect students, faculty, and staff and slow the spread of COVID-19.     Mitigation strategies were implemented under the direction of regulatory agencies including the CDC, Local and State Public Health Departments, OSHA, and the University of California Office of the President.  Examples of strategies to reduce spread of COVID-19 included:  decreasing campus population density, instituting distance learning and work, requiring facial coverings in public, promoting social distancing, mandatory screening and testing for students and staff.  Many of the special actions taken are included and summarized in the links and attachments in this Policy.  Appropriate links to COVID-19 resources are included in this Policy as a single locus for where to find appropriate, integral information.  As new data, best practices, and local conditions evolve, UCSC will change or modify strategies as indicated. 

UCSC Student Health Services (SHS) is one entity in overall campus services and is designated as an essential service.  As an essential service, UCSC SHS has remained open to provide access to care for students and as a resource for staff/faculty during the pandemic.  Under the direction of the UCSC SHS Governing Body, the UCSC SHS Medical and Executive Directors, along with their designees meet regularly with UC campus, Santa Cruz County, and UCOP COVID-19 Planning and Response committees and task forces to develop and lead the organizational responses to COVID-19.  Balancing delivery of healthcare and the safety of students and staff, required comprehensive changes to processes, care delivery, and the practical realities of managing operations. 

As the situation evolves, the most current process instructions can be accessed via the electronic medical record references and the shared documents.

The multi-pronged, comprehensive strategies included:

  • Mandatory symptom and risk screening and masking for anyone entering the SHS buildings
  • Mandatory masking at all times for all SHS staff while in shared spaces
  • 6 ft. Distancing markers for all SHS waiting areas, standing and seated
  • Separation of “sick” and “well” waiting and exam areas
  • Initiation of telehealth services and expansion of other online services including online visits and maintenance of clinical records (see policies on Tele-Health)
  • On-going, frequent inventory count and management of PPE supplies and other resources
  • Frequent staff meetings and trainings on changing protocols, including PPE use, infection control and management of isolation rooms, treatment and testing options
  • Development of COVID-19 resources for SHS staff to aid in processing, testing, and treating possible COVID cases
  • Self-collected  mass testing for students/staff/faculty with separate testing areas designated for asymptomatic screening testing and symptomatic diagnostic testing (see policy on COVID-19 Testing)
  • Designation and training of SHS staff for COVID-19 Case Investigation and Contact Tracing
  • Implementation of EMR modules and creation of chart note templates to help facilitate efficiencies in the management of quarantine and isolation cases, Case Investigation, and Contact Tracing
  • Development of an SHS “COVID-19 Team” comprised of MDs, RNs, and Case Managers.  This team meets regularly to review and manage quarantine and isolation cases.  Additionally, per a Memorandum of Understanding with SC County, the team is responsible for Case Investigation and Contact Tracing of UCSC affiliate COVID-19 cases
  • Regular updates to the SHS website as a means of communication to the campus community

PHARMACY UTILIZATION MANAGEMENT - PRIOR AUTHORIZATIONS

Effective Date: 
Wed, 05/27/2020
Policy: 

UC SHIP benefit plan includes a formulary of allowed medications for prescriptions.  In an effort to reduce expenses and to follow all safety guidelines, UC SHIP has a Utilization Management Plan within that formulary.  This formulary is updated twice annually in January and July.

Establishing guidelines for use
The benefit plan has a review committee of doctors and pharmacists meets often to review medications and consider coverage under pharmacy UC SHIP. They also recommend quantity limit guidelines, exclusions, step therapy and prior authorizations.

UC SHIP’s QUANTITY LIMITS program protects patients and can help patients get the best results from medication therapy. Along with safe and appropriate doses, QUANTITY LIMITS can also keep prescription drug costs lower.

Determining quantity limits
Quantity limits are meant to lower the risk of overuse. Quantity limit rules are based on:
• Food and Drug Administration (FDA) approved uses
• Medication instruction labels
• Accepted or published clinical recommendations

PRIOR AUTHORIZATIONS are required for medication coverage because they’re only approved or effective in treating specific conditions. See the Process in the Procedure.

STEP THERAPY requires that less expensive and/or safer products be used first, before selecting newer or special products.  A PRIOR AUTHORIZATION may be needed for the newer/special product.

Procedure: 

PRIOR AUTHORIZATION PROCESS

1. Check the EMR for the formulary in Orders > Medication Orders

2. Check the EMR References for Utilization Management

3. go to the login for PreCheckMyScript (PCMS) at https://provider.linkhealth.com/#/ 

4. Enter the patient information including the Anthem Insurance Number.  Note: Use just the number, unless the number is preceded by CA.  If so then include CA.

5. Agree to the requirements

6. Enter the medication and select the formulation

7. Answer the associated questions and enter any supporting documentation if required

8. Wait for the response

9. Cut and Paste the response in the EMR in the patients medical record

10. Alert the Pharmacy with an IM or Secure Message for that encounter note, if the student will receive the medication from the UCSC Pharmacy

11. Set a "Reminder" in the EMR for the date it will expire and will need to be re-authorized

12. When the response is loaded into the EMR, acknowledge the document 

 

For any problems, call 800-626-0072

 

Attached File: 

ITS QUICKSUPPORT FOR REMOTE ASSISTANCE

Effective Date: 
Mon, 04/27/2020
Policy: 

ITS is implementing a program called QuickSupport which allows ITS staff to remotely access a computer to provide requested support.  When an IT ticket is opened, the tech who responds may request that they connect to your computer using QuickSupport in order to diagnose and/or resolve your issue.  Generally, SHS IT issues are reported to internal support staff (Robert Antonino or Cathy Sanders) who handle all issues with the EMR and minor to moderate system software/hardware issues. 

 

In the event that a SHS staff member needs to contact ITS directly for workstation support, the following procedure must be followed when using QuickSupport:

Procedure: 

Procedures for HIPAA Units/Clients

  • Some mechanics of receiving remote IT support:
    • ITS uses a program called QuickSupport for remote assistance.
    • ITS techs will not connect to your computer without your permission. You give your permission by providing your QuickSupport ID and password to the tech. The tech will help you do this. There will also be a screen for you to “accept” the session.
    • Your QuickSupport ID is specific to your computer. A new password is generated each time you launch the program. 
    • Once you connect, the name and phone number of the ITS technician is displayed in a separate small window during the remote control session. Make sure this matches the person on the phone with you. If you don’t have confidence that you are talking to an ITS employee, decline the session, hang up, and contact the Support Center (9-HELP) to verify.
    • Have the tech explain why they are calling before accepting a remote assistance session. The reason should match what the client expects.
  • Tell the tech that they will be working on a HIPAA machine.
  • Inform the tech if the nature of the problem means HIPAA-related data might displayed on the screen. This includes pop-ups from HIPAA-related apps. It's not OK to open or run any HIPAA-related programs during a remote assistance session. If this will be required, remote assistance isn't an option and an in-person visit will need to be scheduled.
  • Close windows and log out of all HIPAA-related sessions (PnC & other health systems, PPS, email for Benefits Office) before accepting a remote support session. No ePHI or HIPAA systems can be open or visible on the computer.
  • Be aware that if your computer is rebooted during a QuickSupport session, the tech might automatically be reconnected.
  • Files containing restricted data of any sort may not be transferred using QuickSupport.
  • Be aware that techs are supposed to confirm required HIPAA security settings when working on a HIPAA machine if this hasn’t been done in the last 90 days. This is in addition to assisting with the specific problem at hand.
  • Always quit QuickSupport when the remote assistance session is complete. The tech should tell you when to do this, but be sure to ask, just to be safe.
Key Points: 
  • ITS can  now support SHS HIPAA systems using a tool called QuickSupport.
  • Specific rules must be followed to ensure protection of SHS HIPAA systems and data.
  • Always quit QuickSupport when the remote assitance session is complete.
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