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SIGNING OUT FOR MEDICATIONS FROM THE PHARMACY

Effective Date: 
Tue, 03/10/2015
Revised: 
Wed, 02/03/2016
Policy: 

All dispensed prescription medications must be acknowledged and signed out on the signature pad at the pharmacy in the Propharm POS (Point of Sale System) with a valid signature.

If the patient is not the person signing out, then the pharmacy staff member will document the name and/or other identifying information at the Pickup Signature Capture in the Propharm POS prior to having the person sign the signature pad.

Examples:

TV - insurance rebill

RN sign out - when picking up prescriptions to administer or for patients too ill to pick up the prescription on their own

DL - Rx reconciliation - when verifying after the fact that the prescription was picked up

HQ for pt - when signing out on behalf of the patient

 

PATIENT-CENTERED MEDICAL HOME

Effective Date: 
Wed, 03/04/2015
Reviewed: 
Thu, 05/14/2015
Policy: 

The Student Health Center has adopted the practices of a Patient Centered Medical Home.  A Patient Centered Medical Home primary care office provides comprehensive and coordinated primary care in active partnership with the patient.  A Patient Centered Medical Home provides care:   across the life span, across the spectrum of health care needs; preventive, acute and chronic and by coordinating care across the health care delivery system.   A Patient Centered Medical Home provides evidence based quality care and has a quality management program which continuously monitors and improves the care delivered by assessing:  the patient/primary care relationship, accessbility, comprehensiveness, continuity and quality of care.

The Student Health Center demonstrates its practice as a Patient Centered Medical Home when it meets the standards established by the AAAHC in chapter 25, sections A through E.

REFERRALS FROM CAPS TO PRIMARY CARE

Effective Date: 
Mon, 01/26/2015
Reviewed: 
Mon, 01/26/2015
Revised: 
Tue, 11/29/2016
Policy: 

In order to facilitate timely and effective communication between CAPS and primary care providers, all referrals will have a complete CAPS referral encounter note signed prior to the primary care appointment.  There are two types of CAPs referrals to Primary Care:  Same Day Urgent and Non-Same Day.

 

 

Procedure: 

For Same Day Urgent referrals:

The CAPS provider will complete a draft of the Same Day CAPS referral to primary care, providing primary care the pertinent information.

The CAPS provider will contact the Charge Nurse to request a same day appointment and provide the appointment information to the student.

The Charge Nurse will attempt to schedule a 40 minute appointment with a primary care clinician if the schedule permits. Alternatively a 20 minute slot will be used if there are no other options.

The Charge Nurse will enter the reason code as "CAPS URGENT SAME DAY REFERRAL".

The primary care provider will review the CAPS referral prior to evaluating the patient for critical safety and follow up information. In the event there are any additional questions or the CAPs professional  (or bakc-up) has additional information to share, the CAPS provider and primary care provider will communicate directly. 

 The primary care provider will instant message the CAPS provider their signed note upon completion.

 

For Non-Same Day Referrals:

The CAPs provider completes the Non-Same Day Referral chart note, indicating the relevant note for the primary care provider to review.  This note is visible to all primary care staff. 

The CAPs provider instructs the student to present to Primary Care Reception to schedule the appointment. 

If a student presents to Primary Care Reception stating they were referred by CAPs, reception staff will review Visits/Notes in the EMR to review the Non-Same Day Referral from CAPs to SHS for instructions on visit type and priority.

It is the student's responsibility to present to Primary Care Reception to schedule the appointment

INSURANCE ELIGIBILITY

Effective Date: 
Fri, 01/09/2015
Revised: 
Sat, 03/04/2017
Policy: 

UCSC students must all have health insurance.  The SHS Health Insurance Office tracks the health insurance option that the student maintains, in order to ensure that the students have health insurance.

Students are automatically assigned UC SHIP, University of California Student Health Insurance Plan and may waive it with proof of suitable insurance, based on UC-wide waiver criteria.  This includes students "in absentia".

Addressing inconsistencies may be required for withdrawals, leave of absences, late waivers, late enrollments etc.  For the process to address these, see the Procedure.

Procedure: 

WITHDRAWALS - also see policy on Medical Withdrawals

IN ABSENTIA - These students are required to have health insurance however they will be part of a different insurance group.  Insurance staff will document this status in the EMR and the database.  They may be seen at the UCSC Student Health Center.

PLANNED EDUCATIONAL LEAVE (PEL) does not apply at UCSC

LEAVE OF ABSENCE (LOA)

Note: A leave of absence is a type of withdrawal - with the intent and option to return.  If the leave of absence begins after the quarter starts,the student on UC SHIP unless the students requests to rescind the insurance and it has not been used. 

Only students on UC SHIP the previous quarter may voluntarily enroll in UC SHIP after the current quarter, by "voluntary" enrollment through Wells Fargo Insurance Services (WFIS).  This is allowed for up to two ensuing quarters, once in their academic career, (Spring is combined with Summer). 

Documentation of voluntary enrollment:

- Receipt of email notification of voluntary insurance enrollment by WFIS sent to Insurance staff

- insurance database updated by Insurance staff

- electronic medical record updated by Insurance staff as on "voluntary UC SHIP", and eligible to use SHS

If the student does not have UC SHIP or is early enough in the quarter and chooses not to keep UC SHIP

Documentation of the LOA:

- insurance database updated by Insurance staff

- electronic medical record updated by Insurance staff "not eligible" (make sure the student has been credited in AIS)

This change will automatically be updated for WFIS.

LATE ENROLLMENT

Make sure that the insurance database is correct and add the information to the electronic medical record.  Ensure that the student is charged the UC SHIP premium in AIS (if they do not have other health insurance or appropriately waived) if not in the next update, then manually.  The other updates should be done automatically.

For Late CruzCare enrollment, notify Billing.

Documentation for late enrollment in UC SHIP:

- Insurance Database updated by Insurance staff

- EMR updated by Insurance staff

- Checking for charge in AIS - check date; student may have a reg form from Registrar's Office that Insurance staff documents their initials and documents whether to keep UC SHIP or waive.  If student wants to waive, Insurance staff provides late waiver opportunity.

LATE WAIVER (as of closure of waiver site)

Document the waiver results in the database and update the electronic medical record.  The credit will appear in the Academic Information System (AIS) with the weekly updates.

Documentation of late waiver:

- Insurance Database by Insurance staff

- EMR by Insurance staff

- Charge the late waiver fee

NOT ENROLLED / NOT A STUDENT

When a student shows that they are not enrolled, but the rosters for UC SHIP Insurance show that the insurance is active, when the student shows up at the Student Health Center, determine that the student did not voluntarily purchase the insurance via Wells Fargo Insurance Services.  If the student did not enroll in the UC SHIP plan voluntarily, and did not pay for insurance, insurance staff would check AIS to see if billed and paid, and if did not purchase UC SHIP, edit/document in the electronic medical record that the student is not enrolled and is not eligible for services.  If services were rendered and the insurance plan was billed, contact the insurance plan to rescind those claims.  Inform billing via IM.  If there are outstanding bills, the remittance of payment is the responsibility of the patient and the patient should be notified via secure message. 

Documentation for Not Enrolled Student:

- Insurance Database by Insurance staff in the PnC Admin Notes (further updates done automatically)

- EMR by Insurance staff

- Insurance Carrier if claims need to be rescinded (by Billing staff)

- AIS if charges need to be added

REFUNDS

Our policy follows the guidelines set forth by the UCSC Registrar's Office regarding refunds.

For Withdrawals - If the student withdrew prior to the start of the quarter, then they get a full refund of the insurance premium.  If the student withdraws in the first week within the quarter, then the student will show as having UC SHIP and can petition to get off the insurance and get a refund.  If a student withdrew from Day 8 onward, they will remain on the insurance for that quarter.

For LOA's - if a student files an LOA in advance of the quarter with the absence, then they will be refunded UC SHIP premium for that quarter, independent of the timing of the beginning of the LOA.

PROCESS FOR PATIENT CONTESTING FEES

Effective Date: 
Wed, 10/29/2014
Policy: 

The UCSC Student Health Services (SHS) will address requests to reconsider fees that were incurred in the provision of health services.

Fees for  "outside paid services" like reference lab testing, and for consumables like prescriptions or medical supplies, in general, will not be considered.

The Billing staff member cannot reverse fees without manager authorization, notably when the fees have been posted to the Academic Information System (AIS).

UCSC SHS staff cannot reverse late fees.  The student can contact Student Business Services with that request.  Occassionally, the UCSC staff, Billing or managers, may request reversal of late fees from SBS if appropriate and due to SHS actions.

Procedure: 

Procedure for handling requests.

Note: Any communication from Billing or other staff will not guarantee nor infer that fees will be reversed, including late fees which can only be addressed by Student Business Services (SBS).

SCENARIOS

1. Patient comes to the SHS to contest fees. 

The Billing staff member sends a linked secure instant message (IM) to the Billing Supervisor with the request. 

Billing Supervisor Action - The chart is reviewed and potentially referred to another manager for input.  The outcome is communicated to the Billing staff member and action is taken by the Billing staff member if required.  If no billing action is required, a secure message with the appropriate response is sent to the student by a manager.

2. Patient telephones / leaves a message with Billing.

The Billing staff member recommends putting the request in writing and sending it to the Billing Supervisor.  If the telephone message was clear, the Billing staff member may IM the Billing Supervisor, who will take the above "Billing Supervisor Action".

3. Patient emails the request to Billing.

The Billing staff member de-identifies the patient and any PHI and forwards the email to the Billing Supervisor.  The Billing Supervisor will follow the above "Billing Supervisor Action".

Reversals

If a reversal of fees is authorized, the manager will securely contact the Billing staff member and document the authorization to reverse fees with the amount, date and manager signature (or document via IM).

If actions was taken, the Billing staff will add an administrative note in "Registration" with the date, the situation and action, the manager approver and the Billing staff initials.

 

OPTOMETRY SERVICES

Effective Date: 
Tue, 10/28/2014
Revised: 
Mon, 02/29/2016
Policy: 

The UCSC Student Health Services (SHS) provides Optometry Services through a collaboration with the UC Berkeley School of Optometry (UCBSO).
Services are provided by a licensed faculty optometrists in accordance with all laws, regulations and ethics pertaining to optometry.

The UCSC SHS Optometry Department also serves as a training site for 4th year UCBSO student optometrists, who provide exams and eye care services under the supervision of the faculty optometrist.

Procedure: 

Optometry Services from the UC Berkeley School of Optometry includes the following and will be provided by faculty optometrists and/or 4th year UCB student optometrists, under the supervision of the faculty optometrists, who document those services in the UCSC SHS electronic medical record:

  • Optometric exams for eye health screenings and vision care
  • Evaluation of ocular health, and referral to specialist as needed
  • Optometry Technician services
  • Prescriptions for glasses and contact lenses
  • Acquisition of glasses and contact lenses pursuant to prescriptions (from in-house or outside)
    - frames available on-site
  • Fittings for glasses and contact lenses
  • Submission of optometric claims to Vision Insurance providers

Additionally, the optometrist may see patients from the UCSC SHS Same Day Clinic, who present with urgent eye illnesses or injuries in the diagnosis and management of eye emergencies.

OUTSIDE ORDERS FOR MEDICATION ADMINISTRATION

Effective Date: 
Wed, 10/22/2014
Revised: 
Wed, 01/14/2015
Policy: 

The UCSC Student Health Services may follow through with outside provider orders for medication administration.  These orders must be reviewed, approved, and documented in the electronic medical record and a nursing order entered.

Also see "USE OF PATIENT'S OWN MEDICATIONS" policy.

Procedure: 

Any outside medication order must be reviewed by the Medical Director or designee and approved for administration by the RN.  The medication order should be documented in the electronic medical record (EMR) for Nursing staff to follow.  The original order should be signed by the medical director or designee and scanned into the EMR.

The UCSC Medical Director or designee will decide if the treatment ordered is medically appropriate to be administered by the SHS nursing professionals.  In cases in which the Medical Director judges the medication treatment to not be medically appropriate or administration requires skills and equipment not found at the Student Health Center, the Medical Director will contact the outside ordering clinician and an alternative disposition will be formulated. The student will be notified of the disposition and advised to contact their treating physician for an alternative plan. A referral off campus will be authorized when requested by the patient to facilitate treatment.

PHARMACIST DISPENSING OF EMERGENCY CONTRACEPTION, NICOTINE REPLACEMENT PRODUCTS AND NALOXONE UNDER PRESCRIPTION

Effective Date: 
Thu, 09/25/2014
Revised: 
Fri, 03/10/2017
Policy: 

Effective January 1, 2014, licensed pharmacists in the state of California have been given provider status under a bill signed by the Governor on October 1, 2013.  This bill, SB 493, allows pharmacists certain authorities in all practice settings, to include the following:

"The bill would authorize pharmacists to perform other functions, including, among other things, to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers, as specified."

Procedure: 

The UCSC Pharmacy follows all applicable pharmacy laws and regulations.

EMERGENCY CONTRACEPTION

The California State Board of Pharmacy has an established protocol in place for Pharmacists Furnishing Emergency Contraception.

Section 4052.3(a)(2) of the California Business and Professions Code authorizes a pharmacist to furnish emergency contraception prusuant to a protocol appproved by the California State Board of Pharmacy and the Medical Board of California.  Use of ths protocol satisfies that requirement: California Code of Regulations Title 16 ~ 1746. Emergency Contraception and is followed by UCSC SHS Pharmacists.  This protocol can be found in the UCSC SHS Pharmacy Compliance Manual for the State Board of Pharmacy.

 

NICOTINE REPLACEMENT PRODUCTS

The authority to furnish prescription nicotine replacement products for smoking cessation is pursuant to a statewide protocol if certain training, certification, recordkeeeping, and notification requirements are met.  Once a statewide protocol is developed by the California Board of Pharmacy and the Medical Board of California, it will automatically apply to all pharmacists and will be incorporatied by the UCSC SHS Pharmacy.  The protocol under review as of June 2014, currently includes the following:

Allows a pharmacist to furnish nicotine replacement products in accordance with a state treatment prococol, provided:

1. Records are retained of drugs and devices furnished for at least 3 years so as to notify health providers or permit monitoring of the patient

2. The pharmacist notifies the patient's primary care provider of drugs and devices furnished or into a patient record

3. The pharmacist must complete 1 hour of CE on smoking cessation therapy

 

NALOXONE

The authority to furnish prescription naloxone for opioid reversal is pursuant to a statewide protocol if certain training, certification, recordkeeeping, and notification requirements are met.  Once a statewide protocol is developed by the California Board of Pharmacy and the Medical Board of California, it will automatically apply to all pharmacists and will be incorporatied by the UCSC SHS Pharmacy.  The protocol under review as of February 2016, currently includes the following:

Allows a pharmacist to furnish naloxone in accordance with a state treatment prococol, provided:

1. Records are retained of drugs and devices furnished for at least 3 years so as to notify health providers or permit monitoring of the patient

2. The pharmacist notifies the patient's primary care provider of drugs and devices furnished or into a patient record and/or documents the process in the electronic medical record.

3. The pharmacist must complete 1 hour of CE on naloxone.

Until such time as the California Board of Pharmacy and the Medical Board of California formalize the protocol, the UCSC SHS Pharmacists, acting as delegate for E. Drew Malloy, MD, will act under an internal protocol adapted from the protocol currently under consideration from the California State Board of Pharmacy and the Medical Board of California.  This protocol can be found in the UCSC SHS Pharmacy Compliance Manual for the State Board of Pharmacy.

NICOTINE REPLACEMENT PROTOCOL

Effective January 1, 2014, licensed pharmacists in the state of California have been given provider status under a bill signed by the Governor on October 1, 2013.  This bill, SB 493, allows pharmacists certain authorities in all practice setting, to include the following:

B.2.

An established process for informing the patient of the status of the health care professional and obtaining patient consent for such person's participation in or observation of the patient's care.

Notes: 
P&P

B.1.

A definition close and adequate supervision of students and postgraduate trainees.

Notes: 
P&P
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