CLINIC PROTOCOLS

CLUSTER 1 – APPOINTMENT SETTING

1. *New Patient Qualification --- (For Establishment) - 30 mins

(Unallowed):
a. History of substance abuse
b. Noncompliance – HELLO *CLINIC Schedule:
bad records, misdemeanor, cancellation/not showing up appt MON-THURS 8AM-5PM LB: 12PM-1:30PM
c. Underage (we can only cater 16 y/o or above) – FRIDAY 8 AM-3:30PM LB: 12PM-1PM
Weekend: Closed
refer to pediatric clinic
Holidays: NONE

NEW PATIENT FORM Facility: Hello Clinic

“You can find it on our website at www.helloclinic.com or complete Provider: Dr. Hello
it in person at our office. After submitting, we will contact you Address: 4990 East Mediterranean Drive
Suite A, Sierra Vista, AZ 85635
within 48 hours. Please note that our office manager will review
Phone: 520-439-5186
your profile to confirm eligibility before approval.” Fax: 520-439-4466
-website: CANNOT be downloaded/printed NP: 1234567890
-Front desk: has hard copy Tax ID: 100-2233-456

If 48 hours have passed, follow up with OM and tell px

Hi, we apologize for the wait. I’ll contact our office manager now, but don't worry we will get in touch with you
as soon as your application is approved. We appreciate your patience.
NEW PATIENT CLEARANCE (from OM)
- the validity is 3 months once approved;
- if not, it needs to be filled out again and after 48 hrs we can book you a schedule.
WHY? Any changes or updates to your medical or personal info are reflected. (MESSAGES section)

Px urgent problem = go to the ER OR nearest urgent facility or dial 911

2. *New Patient Qualification --- (3 years and up / re-establishment)

- ALWAYS acknowledge px's concern first then proceed to resolution.
- Px not seen in clinic >3 yrs
o do not schedule appt!
o need re-establish in the clinic = fill out NP forms.
▪ (CHECK ENCOUNTERS) SCHEDULING
New patient (30MINS appt)
- if px has NO chart  NO documentation is needed provider: Assigned TS
- if px has chart but NO msgs/encounters/appoints = check DOCS tab Appt type: New patient
 andun NP form = process for appt scheduling ------- >
 No NP form, need re-establish in the clinic = fill out NP forms. Duration: 30 mins

& do documentation for any px with chart!!

- Px not seen in clinic >3 yrs
RESOLUTION:
- However, upon reviewing your chart here, we cannot proceed with your appointment since your last visit
was 3 years ago. For us to proceed with any medical services, you need to fill out a new patient form to
update your records. After 48 hours of checking, we will reach out to you.
-

3. *Regular appointment AMEN -30 mins (urgent appt)

APE (encounter: 3 yrs)
- Offer earliest available time always! MW (>65/medicare)
- If there are no vacancies, they can go to the nearest ER for ER/Hosp ff (X combine -unrelated,
urgent care. WC., MVA, APE, Forms)
New patient appt
- For appt status: always untick canceled and no-show

- Provider: Assigned TS
- Appt: check-up (15 or 30mins-AMEN)
- Cc: main concern for calling (put addtl concerns next)

4. *Same day appointments *SDA

-I’m so sorry to hear that you're experiencing ___. However, upon checking our clinic's schedule, I see it is
fully booked today, and the next available appointment is tomorrow. May I ask if you've been to the ER? If
not, given the urgency of your situation, I advise you to visit the nearest ER facility or call 911 immediately.
Thank you!
- SDA (Urgent appts – 15 mins)
o Shortness of breath SOB / difficulty breathing
o UTI / bladder issues / dysuria – pain in urination / Hematorrhea – blood in urine
o Chest pain (no need for Pain scale)
o General PAIN (pain scale + tolerability)
- If appt full, advise: I advise you to go to the nearest ER for your immediate medical attention.
- everything else – NON-URGENT (Next day appointment)
- APPOINTMENTS
o SDA + APE = Not allowed  resolution [book next day]
o SDA + FORMS (work notes) = yes (related)
____________________________________________________________
5. *Appointment cancellation
Schedule appt tab
*cancellation Know the date and px names ,
3 cancelled appointments (last 3 months)- TERMINATION Go to date , Ctrl F + px name
YES: I would be able to cancel your appointment. Click pending change to
May I know the reason why you canceled? canceled: write px reason before
Would you like us to reschedule your appointment? confirming

3 cancellations w/in 3 months already:

- Upon checking your chart, I can see here that you already incurred 3 cancellations. Please note that
medical services for you are currently on hold, while the office manager is reviewing the chart.
- This is possible grounds for termination, which is up to our OM to decide. I will call u bank once OM has
made a decision. As of now, you can go to the ER for your immediate medical attention.

*PENDING or NO SHOW not counted only CANCELLED (3 consecutive months)

Message for OM: [DOCUMENTATION]
Subject: TERMINATION
Hi OM
I wanted to inform you that Px called today to cancel their appointment again. I have already explained
our cancellation policy to the patient, and they have now incurred three cancellations.
Waiting for your recommendation.
Medical services are already on hold now. Thank you

6. *RESCHEDULING Px charts  summary  upcoming appt

*may I know the reason for rescheduling? click [check CC to know if its combinable /
May I know if when would be the most available time for non combinable]
you then?
Check -> APPOINTMENTS TAB: Upcoming
APE + reschedule = YES (30 mins)
FMLA + reschedule = YES (15 mins)
**Click on the appointment in the patient’s chart and edit the
date and time to the patient’s preferred date as long as it is
available.

*DO not create a schedule– just reschedule – DO NOT DELETE!

Same week = just drag
Next week = go to appt time, manually edit and save
7. *Annual physical appointment *APE – 30 mins appt
QUALIFIED FOR APE --- [within 3 yrs encounter & last APE was 366 days]  new patient (not yet for APE)
I have advised you that you are due for an APE; however, you have politely declined and would like to have it
done at the next available time.

8. *Medicare wellness *MW – 30 mins appt - APE and MW cannot combine w:

- MVA
>65 Y/o with Medicare insurance (Profile / documents) ---- [within 3 yrs
- WC
& last MW was 1 yr ago]
- ER hosp ff
- SDA
“Upon checking, you are due for APE/MW, - Nursing appt
do you want me to schedule you for one?”

REMINDER FOR PX:

“for your APE - fasting is not required but lab orders might be ordered, all depending on Dr. Hello's
recommendation”

9. *ER / Hospital Follow up ER CANNOT combine w:

30 mins appointment* - unrelated concerns
*We need the medical records (CLINICALS) 1st from the ER dept before we - WC
schedule appointment = - MVA
Gather the ff details: - APE
 Facility name: ok - Forms
 Reason for admission
 Date of admission: (date to put @ MRR msg) If SDA (upon probing)
 Date of discharge magiging SDA ang protocol
bale na rule out na ung ER Ff
up no need to check
*CHECK if clinicals (MRR) are in DOCUMENTS:
clinicals.
If clinicals are IN – book appt
Ask px if he/she went to the ER for the same concern, if YES: ask for the 4 info Standalone protocols:
Check documents(clinicals)  schedule appointment ER >> WC >> MVA
If clinicals are not yet in
[[[ X combine appt if NOT
process request MRR to CVMC (facility), upload to patient chart [documents] – related to px main concern]]]
turnaround time: 48 hrs after send
Call px = waiting for MRR & will just call back:
“Upon checking, we will be confirming this with your facility, and we are still waiting and will call you once
it is available. Please note that there is a TAT of 48 hours after we sent the Form.
If available, we can now schedule you for an appointment.”

After call = do a TASK reminder (N+T) – “after 48 hrs call px to update” -assign to self
We will only schedule appt once we have the records already

MRR SAMPLE TO CVMC

10. *Terminated patients *TERMED – after px last name @ chart (edit at PROFILE tab)
no longer receive medical services in the clinic
OM will msg patient  HVA: relay info (discuss reasons for termination & follow the OM’s msg)
“We cannot render you any medical assistance anymore”

Termed px
- the decision is final, possible reinstatement is no longer given.
- can still request records – DO NOT MENTION (unless asked)

MEDICAL RECORDS
the patient is already termed, but they called that he needs the records.
Yes, you can give them = just apply MRR protocol (pick up office, fax, snail mail records, etc.)

- I’m sorry for your frustration. Upon reviewing your chart, as Possible reasons for termination:
advised by our office manager, Hello Clinic will no longer -Noncompliance (3 cancellations/3
continue providing medical services to you due to months)
noncompliance. However, we can provide you with your -Misdemeanor
-Behavioral issues
records, and we recommend finding another primary care
provider. Thank you
11. *Appointment confirmation *confirmation
- Confirm in PF px chart a day before the schedule
- If px sets appt for the next day. Ask patient in resolution area:
- “Are u confirming this appointment for tomorrow?” Schedule appt, calender input
- Ex: appt is Friday, today is Monday (make NT reminder) date(tom) CTRL + F px name – scroll
right edit confirmation (tick
confirmed) “spoke with px” save
- Hi I'm calling to confirm your appointment for tomorrow, which you
called in last week. Is this still a convenient time for you?

CLUSTER 2 - MEDICAL SERVICES

1. *Motor Vehicle Accident *MVA - 15 mins Standalone protocols:

ER >> WC >> MVA
- Car accident qualifications [PROBE PROBE PROBE]
- Patient has to be INSIDE the vehicle [[[ X combine appt if NOT
- Unregistered e-bikes/wheelchairs = NOT included related to px main concern]]]

- Accepted insurance for MVA: AHCCCS or Medicare

- Px insurance different insurance:
o Unfortunately, your insurance does not cover MVA appt, we can still schedule you in but for this, you have to pay
OOP. Would that be okay with you?

- If px is due for APE Ask if they want to schedule APE for another day, set MVA first (APE next day)
- If px is DRIVING during work
- cancel MVA change to WORKMANS COMP (MVA weakest out of 3)
- If SDA(due to pain scale) SDA + MVA
o Appt type: MVA (15 mins)

MVA CANNOT be combined with:

-NP(should be separate)
- APE and MW
- ER/Hosp follow up
- WC
- Pre-operative clearance visits
- TB shots - Nursing visits
- Forms (work notes, excuse letters, medcerts) *if px needs, need to set up appt on diff day [[even if related to mva!]]
 Why not FORMS + MVA?? = due to insurance and documentation

PROCESS:
-locate the insurance under profile or docs
-appt type: MVA
-schedule
-documentation: always include the insurance
__________________________________________________________________________________________________

2. *TB TESTING - *Nursing appointments New appt:

- Mention that 2 appointments are needed Appt type: Nursing only
cc: TB shot (MTW)
o Tb shot – MTW only
TB reading (WTF)
o TB reading – WTF only (interval is 2 days or after 48 hrs) 15 mins
- Px missed interval?
You have to schedule an appt and redo the TB shot again, because there is o CANNOT be combined with any
an inaccuracy of results if more than 2 days have passed since your shot. but can be FOLLOWED by
- ER shots – NOT read by the clinic. We will only read TB shots that our another appt same day
office administered o APE + TB SHOT same day? =
o need to set up appt if they want reading in our clinic yes  APE (30 mins) then TB
shot (15 mins) [[can vice versa]]
- If patient wishes to reschedule:
o Do you wish to proceed with reschedule, because if we reschedule, you need to re-do the TB shot, and then 2 days
after TB reading?

- THURS TODAY:
- “For your TB Shot, there are 2 appts required, 1 for TB shot & 1 for the reading.
- Hello Clinic only offers it every MTW. Since today is a Thurs, we cannot schedule you for today.
- The explanation is that there is a 48-hour interval for the TB reading after the TB shot,
- and since we are closed on the weekends, the reading cannot be completed since if the reading
- is not done within 48 hours after the TB shot, the results may not be accurate, and you
- would need to redo the test.” [new appt]
-

3. *Vaccination
- All services we do not offer in Hello Clinic (vaccines, immunization, shots, vitamin shots)
- checkup or refer px to pharmacy
- If routine vaccination:
o “Unfortunately, we are unable to administer the vaccine at our office. You can visit any nearby pharmacy to
receive the vaccination shots that you need”
- If px have fever and chills upon probing, direct patient to book appt to set up appt
o ”Unfortunately, we are unable to administer the vaccine here at Hello Clinic.
If you would like an assessment and evaluation, we can schedule an appointment with Dr. Hello.
However, we do not administer the vaccine here.
We recommend you visit any nearby pharmacy to receive the vaccine.
Thank you!”

4. *Workmen's compensation *WORK *WC - 15 mins Standalone protocols:

– injuries or accidents @ work ER >> WC >> MVA

[[[ WC X combine appt if NOT

related to px main concern]]]
- during working hours & within the office & work-related injury
- Employer will cover the patient's bills
- I'm sorry to hear that happened. Since you mentioned that it is an injury acquired while working, your employer
will cover the bills, and you won't need to pay.
- Appt type: WC
- 15-min appt Cannot be combined with:
PROBE: New patient (should be separate)
- Did you acquire the injury during working hours? APE and MW
- Are you in the company premises while it happened? (delivery services ER/Hosp ff
included while working) MVA
- Pain scale / tolerability-- for SDA Pre-operative clearance visits
- Have you gone to ER? TB shots - Nursing visits can
- Gather details: consecutive after appt, not single appt
o Date of injury Forms (work notes, excuse letters,
“May I ask, when did this happen?” medcerts) *if px needs, need to set up
o Contact person (employer) / employer’s name: appt on diff day
“What is the name of your employer?”
o Employer address: (employer not company building) (to send the charge If qualify as SDA due to pain scale:
for the visit) Appt type: SDA
“May I also have the Employer address for billing purposes?” CC: WC + ((pain))
15 mins
Send message to TS for proper documentation

5. *Preoperative clearance *clearance

- surgeons will require to be cleared by the PCP clearance, provider will review next course of action to patient
- Px will call us: “Hi i need a Pre op clearance surgery”
- OR "i just got off my surgery: cataract surgery, hernia repair, laminectomy, knee or hip replacements"
- Immediately check clinicals in documents
- Could you please let me know which institute that is?
- ***no need to probe***
- Ask the ff Surgery details
o Facility name:
o Surgeons name:
o Proposed date of operation: march 14
o procedure/name of the operation: cataract

- Next steps:
- Check clinical (at documents sections) - sent by surgeon
- Upon checking your chart, it seems that we have your clinicals here. I’ll go & book the appt now:
- “Pls note that the appointment of surgical procedure must be scheduled 14 days in advance to allow time for
required tests, results to be sent, and Dr. Hello to review them for to ensure accuracy of results.

- CLINICALS are PRESENT [document type: Pre-Operative Clinicals]

o Book the appointment - 2 weeks EXACTLY BEFORE surgery**
o Sample order labs and rads for the surgery* -
Hi HVA! Kindly inform the patient that he is due for a recheck on his A1C and Lipid Panel. I already sent the lab
order so he can just schedule his blood draw at LabCorp. Thank you.
o Dr. will send msg to us: inform/relay to patient of what all Dr. said in msgs
o Appt type: preop clearance (15 mins)

- CLINICALS are NOT PRESENT in document:

- Do not proceed with appt, just let px know:
o Explain to px:
o For now, we cannot schedule your appt yet, we’ll need to wait for Dr to send us your clinicals for the appt.
Hopefully, we can send it before the scheduled appointment.
o No need to write MRR, just wait for doctors’ message/clinic to send it

Cannot be combined with:

ER / hosp follow up
MVA
WC
Nursing
SDA
If due for APE / MW:
Appt type: APE / MW
CC: APE/MW + preoperative
clearance

*RESCHEDULE
-explain why
-reschedule exactly 14 days before surgery.

CLUSTER 3 - DOCUMENTATION

1. *New Referral --- (note: SPECIALIST)

 ALL REFERRALS ---set up appt
- I would like to see a specialist** Due for APE and needs referral = CAN combine
- Probe: What is the reason why you need a referral? “Upon checking, you are due for APE, do you
o May I know what is the diagnosis? want me to schedule you for one with your
o Have u seen dr hello regarding this referral?  YES: Recurrent referral appointment?”
referral, NO: New referral Appt type: APE (30 mins)
Never seen our provider Cc: new referral
Usually fairly NEW ung story ni patient

Have u seen this specialist/provider before?

- NOT YET (NEW REFERRAL)
o Recommendation: Set up an appointment with us and Dr. Hello will evaluate and access.
o “Since you have not seen the specialist before, we advise you set up an appointment with us for a new referral.
Dr. Hello will then evaluate and access the referral that you need. “
o Appointment type: Check up
o Cc: New referral?

- YES, I have already seen Dr. Hello

o Go to PF encounters and messages (Provider: 👍) - automatically approved
o “I see that Dr. has already sent a message.
o Please give me 5-10 minutes to process the referral, and then you can call dermatology in about 30 minutes.”
(recap & closing spiel)
o *SAMPLE DR. message “REFERAL”
▪ Hi HVA, Pls send a referral to Epiphany Dermatology. Thank you@
▪ Dx: (R21) Rash and other nonspecific skin eruption.
- Next: Create a Referral form – RX PAD
- Check documents  search for the FACILTY NAME
- Patient name: ___
- Document name: fac name.
- Document type: Referral Provider: Assigned TS
-
2. *Recurrent referral -- no need for appt!
- to be valid, check px chart if pc has previous referral
-continuously sees this specialist for a continues period of time with same diagnosis
- ask the diagnosis
- PROBE:
- Have u seen this specialist/facility before? YES
- “Have you seen our provider before? YES
- What is the reason for this referral? – diagnosis

- For a recurrent to be valid: make sure that all info is correct:

a. Same facility (@documents referral form)
b. Same diagnosis “May I know your current diagnosis?” (@documents referral form)
c. Previous referral to the facility is uploaded (@documents)
d. Within the last 12 months encountered notes - 1 year (@encounter notes)
e. Referral PA validity – expired PA (@documents section)

- What if one of the requirements are not met?

Ex: diff diagnosis
o NOT anymore valid  next protocol:
NEW REFERRAL / SET UP WITH Dr. hello
“Since this is for a different condition from your previous one, we will have to schedule you another appt with Dr.
Hello so that he can evaluate and assess properly.”

Ex: PA is still valid

o Advise px to call specialist to set appt directly:
o - “Upon checking your documents your PA is still valid so you can go to your specialist directly and no longer need
to set up an appointment with dr. hello, for a referral.”

- If all requirements are met CHECK everything:

- proceed to write the order and upload already, then no need to meet dr hello
o NO NEED to set appt

RESOLUTION if all 5 requirements are met:

“Upon reviewing your chart, I can see that you have been seen by the specialist's office for the same concern. Please
give me 5-10 minutes to process this referral, and you can call the specialist in about 30 minutes to 1 hour. Thank
you.”
 Recap – closing – spiel - END call
 Then process the referral: RX PAD
o you will only COPY THE PREVIOUS REFERRAL CREATED Patient name: ___
o JUST CHANGE CURRENT DATE AND UPLOAD AGAIN Document name: Fac name.
o HOW TO PROCESS REFERRAL Document type: Referral
- download previous referral Provider: Assigned TS
- edit/change the date – date today
- change signature - name initals FED
 - resend to the receiving specialist/facility
5 MINS AFTER CALL = REFERRAL MAKING + PROPER DOCUMENTATION

2. *Referral for a third party (another specialist/provider)

- 3 facilities involved
- Fac B refer px to Fac C(but has IL), Fac B will call us to make referral but we need 2:
o Clinicals – @ documents sections (pending/signed)
o Insurance limitation (ask FAC B to verify)
- ***ASK Fac B name of FAC C
- [no clinicals = no process]

CALLER:
-Patient = Verify w/ FAC B
-Fac C (3rd party specialist NON-Mutual Fac) = Verify w/ FAC B
-Fac B (Specialist Fac / Mutual Fac) = check clinicals and verify Insurance Limitation

-Fac B + with Clinicals + IL = process the referral

-Fac B + without Clinicals + IL = remind them to send clinicals first before we process the referral

PATIENT: PROBING:
Were you recommended by a provider to see this specialist?
Who is your _____cardiologist FAC B???
Look for: Clinicals + reason :
 CLINICALS: “Can you please confirm with them if they’ll be able to fax over your clinicals to us?”
 INSURANCE LIMITATION: “May I also know if they told you why they can't process it themselves??”

CLINICALS ARE IN & NO IL

you will still not process referral, you still need to check if the reason is due to IL
RESOLUTION In your case I will have to call your fac b so I can double check, for the reason why they are unable
process it themselves.

NO CLINICALS & NO IL:

RESOLUTION I noticed that you need a referral for a third party, we actually need 2 requirements that is your clinicals
and the reason. May I know if they told you why they can't process it themselves??”
As of this time we have none, what I will do is call fac b, I will verify everything for them and will just call you back
once we have the necessary details.

FACILITY B: PROBING
is this for a mutual patient?”
may I ask which facility you want this to be referred to?
may I know why your office cannot process the referral for this patient? = bc of insurance limitation*
were you able to fax the clinicals over to us?” = 520-439-4466

⮚ With clinicals: - make a referral (ilalagay sa referral details ni FAC C)

PROCESS:
 - go to the documents tab
- Search the specialist facility
- Open to most recent
- check: referral to same dept
- Check validity of clinicals: if valid – proceed, if expired: follow up clinicals

3. *Referral and order status - Px will call u to check *status of the referral *order status *RAD ORDER
just check documents/messages if approved PA or not (STATUS OF PRIOR AUTHORIZATION) & (MSG from PCP)

Approved PA: process or MAKE A REFERRAL

(wala pang referral) Create a referral form using the diagnosis from provider.
- you make one (rx pad) -> apply -> save -> go to documents-upload-desktop -> click

Doctor msg sample:

- maski walang PA okay lang, make a referral:

o “Hi HVA, px is already due for Chest Xray to Carter imaging for COPD. Kindly send order.”
- need na may PA document, if wala set up appt.
o “Kindly check PA if approved process, if not, schedule an appointment”

-THEN GO AHEAD AND MAKE A REFERRAL- -

“Your PA has been approved let me go ahead and make a referral let me just process it for 30mins – 1 hour, and
then you may call your specialist in 30 mins so you can book an appointment with them.

Document name: Facility name

Docu type: “Referral

Provider: TS = Save

Sample referral form:

 - Denied PA: follow what provider says/inform px of dr’s msgs (usually pinagsasama sa ibang protocols)
- *Note: explain that insurance will approve or deny
o “Our facility doesn't approve/deny your request, your insurance does,"
o “For future inquiries kindly call your insurance"
o If DENIED: “Upon receiving your PA form, the status of your request was denied because, as per your
insurance, it was deemed unnecessary.
o SET UP APPT WITH DR. HELLO Deemed medically unnecessary according to insurance and the provider
wants to schedule an appt for you for more options.

SAMPLE SCENARIO

- I’m calling for an update about my referral, I already came in last time to request for referrals
- “What about the referral”
- Check if PA: Approved or Denied
- PA denied or approved: [depending on insurance]
- why was it denied? –*IF tinanong lang ni caller – pls contact the insurance company
- Check Messages:
- HI, I Would like to check the status of my referral to Sierra Vista Medical Group in ORTHO approval
- *note: explain that insurance will approve or deny
o “Our facility doesn't approve/deny your request, your insurance does,"
o “For future inquiries kindly call your insurance"
- Steps:
- Go to messages (to check if approved)
- Go to the documents section
- If APPROVED: Create a referral form using the diagnosis provided by the provider.
- If DENIED: inform px of dr’s message
o “Upon receiving your PA form, the status of your request was denied because, as per your insurance, it
was deemed unnecessary.”

- If denied and still want a referral, set an appt for NEW REFERRAL

4. *New laboratory/radiology order *xray *rad order *lab

- px orders / needs: xray – BOOK AN APPT for proper documentation/evaluation
PROBE:
o “What is this order for?” - Standalone protocols:
o "Why do you need this xray order?" ER >> WC >> MVA
o If px has injury: “How and where did you acquire this injury?
[[[ WC X combine appt if NOT
o “Have you been to the ER,..working…driving..etc”
related to px main concern]]]
o “Have you seen Dr. Hello for this one yet?”
- NO [set up appt] - proper documentation/evaluation
- YES [check msgs, create order in RX Pad]
- PROBE!! Kasi -- Sample:
- Px calls for xray – right knee swelling
- [upong probing: got in car accident🡪 MVA]
o Appt type: MVA
o cc: right knee swelling + lab order for xray
 - If px already did xray and has PENDING LAB ORDER:
- PROCESS  send to radiology order to facility & advise px
- STEPS
o Check msgs from provider
o Make a rad order in Rx Pad ----- in PC only RAD order**
- (Just copy the diagnosis/ICD 10 code)
- if hindi kasama sa msg and ICD code ex: lung disease: i search mo ang code.
- Phone and fax number: search google ung facility
- After, upload in documents section (like referral) & tag TS

- *pag dumagdag ang ICD Code magiging – new referral???

Sample RAD form

____________________________________________________________________________________

6. *Medical Records Request *MRF *MRR – hospital ff up (requesting labs)

- Only: patient
- mutual facility
- insurance company MRR FORM
- hospital - associated with hosp/EF ff protocol
- can request and receive medical records from Hello Clinic - Medical Records Request Form
-used when we (Hello Clinic) would request
without MRRF
records from OTHER facilities
- TAT: 24 hrs for us to process/prepare records
-48 hrs TAT
- After 24 hrs, we call the patient to set up an appointment for
an ER follow-up MRF (found @ website www.helloclinic.com)
CAN BE DOWNLOADED /
- Sample MRR protocol: NP form CANNOT BE DOWNLOADED
- A. (px is requesting to send Mutual facility) -Medical Release Form
- got off phone with gastroentologist -associated with MRR protocol
- they need a copy of my labs that need to send to specialist -used when OTHERS like NOK/friends would
-what HVA will do: “I will just fax them the MRR [TAT: 24]” request records from OUR facility.
 *Then just DOCUMENTATION: recap chuchu + I have already processed and sent to the specialist

- B. If px requests for lab results but Dr. Hello has no msgs yet:
- Lab results are in but we will wait for Dr. hello’s recommendation first. [no TAT, can call back anytime]
- You can get a copy of the result if u like but this has not yet been reviewed by dr. hello so this will have no
interpretation yet.

- If not within the 3 requesting / receiving MRR = MRF required [TAT: 24hrs] (w/ px physical sig)
- NOK: MRF is needed, px should fill it out and sign you can send it through our fax and email,
- MRF can be sent / we can RECEIVE the signed MRF them via:

o email to [email protected]
o via fax number 520-439-4466
o -you can get our MRF, how would you like to get it hardcopy, encrypted USB flash drive or CR? after you
can print out and have your father sign it. Once it is filled out and sign you can send it thru our email, once
we have it that is where out TAT, after 48 hrs, you can now pick up records in the office or by snail mail or
fax.
- MRF is needed if: (Medical Release Form)
o patient requests record but receiver is not px [if px is dead, say : [go to: DECEASED PROTOCOL]
o it's not the px requesting and receiving the records (ex: next of Kin)

The medical records can be provided physically as: (WHAT FORM DO THEY WANT?)
a. Hardcopy (printed copy)
b. Encrypted USB flash drive - provided by the clinic
c. Encrypted CD by the clinic

AFTER WE PROCESSED THE FORM:

We can SEND the medical records can be via: (X allowed for email -HIPAA compliance)
- Px Snail mail, px Fax, Pick it up in the clinic
TAT: 24 hrs after we receive MRRF

Sample MRR – Medical Records Request

7. *Deceased Patient – add DECEASED
- For px who passed away, we can get a call from them stating that they died:
o Authorized person (next of kin)
PROCESS STEPS:
o Hospital
o mortuary, Emphatize for the loss of the family
- Ask & gather the ff info of px: I am so sorry for your loss.
o PX Name: May I kindly ask for a few details? : Name, DOB,
Date & time of death, cause of death
o DOB:
Then ask, is there anything else that you need?
o Date & time of death:
If medical records are needed:
o cause of death:
“pls call hospital or mortuary to request the records
- NEXT: Update px chart
from us”
o add DECEASED after px last name
Recap and end the call
o Send msg the OM with the info u gathered
Update px profile - click profile, edit and add the
DECEASED after last name, and save
Ex: NOK will ask for the records of a deceased, but After the process send message to OM
unfortunately, px will not be able to sign the MRRF

How to process medical records of a deceased px?

- Advise that only the mortuary or hospital can ask the records from us, because they are the mutual facilities.
- advise them to call the hospital or mortuary to ask the records from us.
- If they will call us, MRRRF will be applied and after 24 hrs it will be available in the office.
_____________________________________________
8. *HIPAA Compliance Health Insurance Portability and Accountability Act
- always verify caller before with any transaction and disclosing any info
- NOK “there is an added layer of security, can you please provide that one for me?"
 o Max 2 people – authorized contacts
o Can sched, resched, cancel appt
o Can obtain recommendations, lab/rad results verbally (over the phone) - [still needs: Dr Hello’s msg to you
for confirmation that you can relay info to px/nok]
o If incorrect pw? (1 TRY only) – advise to call again providing the correct info of the added layer of secu

- How to update authorized person/NOK and password: -NEED HIPAA FORM

o PATEINT should drop by our clinic’s front desk and sign HIPAA Privacy rule form (no appt needed)
o Verbal updates of pw is not allowed

- Updating Px number, Address and preferred pharmacy

o only PATIENT can update that over the phone

o NOK needs a physical appointment

- not NOK scenario:

“Thank you for reaching out. Upon checking, I see that you’re not listed as the next of kin. As much as I’d like to assist,
we’re unable to provide you with the details at this time. To move forward, could you please contact your daughter
directly regarding this matter and feel free to call us back anytime? Thank you”

9. *Insurance Verification - In PC – only protocol w/ 2 phone calls

- Process:
o TS will send a message or will give px name or dob. “Title: insur verf”
o See appt tab – appt for tom  do appointment confirmation
o Insurance details: @ px profile or documents type: insurance ID and click (INSURANCE ID @ profile)
o Call insurance company & get the details (go to my *STICKYNOTES) = say RING RING INSURANCE
- Hi, this is Faye from Hello Clinic. I am calling because I would like to verify one of our patients'
eligibilities and benefits, please.
o Once done:
o Reply to the TS msg – copy all details from call
- “I called the patient and updated insurance details are listed below” and copy paste
o Don’t upload form in documents section
o If TS in msgs says that you need to update the patient as well RINGRING PATIENT

-  call the px after and inform of necessary details

10. *Recommendations
- Messages coming from provider or OM (referrals/lab orders/rad orders/other pcp info/ px advises)
- VALID: if msg is within 24 hrs
 - if no msgs/interpretations from PCP – don’t give details to px -including lab or rad results
o “I apologize, but upon reviewing your chart, we haven’t received any messages from the provider yet but
since there is no turnaround time, we just need to wait for provider’s recommendation.”
o DOCUMENTATION TO MSG: Px called today to follow up on her laboratory results. still no recommendation
to the provider. I haven't relayed any information to the px.

to verify: *can you tell me which facility where you went in yesterday? ⮚ PROCESS for PCP msg:
-check msgs w/in 24 hrs for provider's reco
- If msg/interpretation already given by PCP, relay everything -copy paste the reco to notepad and
o give all the necessary details to the verified caller understand it
o if ex: px only asked about choles level, TELL ALL details -read the msg carefully
o “Hi, ur lab results are already, pls give me a min or two so I -relay to px in layman’s terms
-Follow all he wants you to do
can discuss to you all details”  read PROCESS

- if px wants a copy of the document

o “We can give you the copy of lab/rad orders however, there's no reco from the provider yet”

- If px tend to ask us additional questions:

o “We are not allowed to give our own further recommendation specific details are needed, we can set up an
appt for a proper evaluation and recommendation”

DR. HELLO MESSAGES what HVA must do the messages reco:

⮚ If may task reminder after a few months: N+T {assigned to u}

⮚ If may referral (follow referral protocol)

 spiel: Please give me 5-10 minutes to process this referral, and you can call the specialist in about
30 minutes to 1 hour. Thank you
o upload and process it
o search for clinics and specialists
o get the diagnosis from the message
o write the referral letter form
o upload it to px chart.
-
⮚ If asking preferred pharmacy – ask px and message provider after call
 msg: Hi provider: px preferred pharmacy is at BeWell Pharmacy

12. *FORMS / Work Notes *fmla

– needs appointment
- FMLA Forms Family and Medical Leave Act, Disability forms, Medical clearance forms, Work notes, School
physical forms
“We can provide you with the Forms you need and for that, Cannot be combined with:
we’ll need to schedule you up for an appointment sp Dr. Hello
- MVA (bc of insurance)
to further assess and evaluate your condition before providing
- WC (bc of billing)
them.”
- ER Follow-up (bc of documentation
Examples of appt types: & TAG URGENCY of appt purposes),
o Checkups + FORMS = FORMS (15 mins) - Nursing → only TB Reading (bc nurse will
- Med refill + FORMS = FORMS // Cc: FMLA + med refill do it but can be scheduled consecutively
- Pre op + FORMS = PREOP // cc: forms after provider's appt)
- New rad order + forms appt type:?? cc: forms ------------------------
o APE / MW + FORMS = APE / MW (30 mins) cc: forms Appointment Type: Forms
o SDA + FORMS (if related) = SDA (15 mins)
Cc: [[reason for call]]
NOTE: not allowed if condition is NOT RELATED
Time: 15 mins
- Ex: I’d like to request work notes because I had an accident at school yesterday because I had bladder issues

Cluster 4 – MEDICATION (RESOLUTION: always appt setting

APPOINTMENT TYPE: checkup [appt setting] Can be combined with:

Cc: (px concern or medication name)
- APE / MW
Min: 15 mins
- MVA
- ER / Hospital follow up
- WC
1. *NEW MEDICATION – always appt setting - SDA (medication shld be related)
Ask: - Normal checkup
- Medication name: - Referral
- Dosage:
- how to take the medication (signa): Cannot combine: TB shots (Nursing)
- Ask px why they need the medication? -

*PROBE why they need the medication?

- to rule out other protocols

a. New/Unlisted Prescriptions
- Whatever px is asking that is not listed in the medication sections in the profile summary
- Upon checking on your listed medications, i would suggest you book an appointment for the
medication to be listed and documented and so Dr. Hello can also check if that is the right medication
for you

b. Historical Medications
- Stopped by the provider (listed below the medications section)
 - In your chart I can see that ____ was a medication that was stopped already, so we need re-
evaluation. It is advised to book an appt, so Dr. Hello could check if still need to prescribe the
medication again.

c. Non-Refillable Medications
- Only prescribed for a certain number of days = antibiotics and OCPs*
- Can you give me another round of Zithromax
- Ask dosage and how do u take this?
- Resolution: have u completed the 7-day treatment?
- As for checking, this medication was only prescribed for _ days, given this u need to book an appt
again to check if u still need to be prescribed this medication again

d. Change in dosage & Noncompliance

- Px changes the original dosage medication prescribed to them
- Ex: 100mg in call, but in PF is 50mg only
- Sir upon checking the chart, your supposed dosage is __ if u want a lower or higher dosage i suggest
you book an appt for re-evaluation for us to know if that is the correct effective dosage for you.

E. Lost medication-
- Px: hi can u send a refill of my pioglitazone 45mg but i misplaced it, send it again to my preferred pharmacy? No ~
- Reasons why we can’t give?
o Insurance – may/may not be covered by insurance purposes (We need to know if we can still give it or if
it is still covered by the insurance)
o Remaining # of medicine (For us to know the remaining number needed to be given to the px; fox
medication given 3 days ago pero may 37 days pa)
o Re asses px for overdosage/change of dose (Overdosage might be a reason or change of doses)

2. *Controlled substances ALL pain meds (including OTC), behavioral, mental

- Has a potential for abuse or addiction use psychiatric medication, (anxiolytic medications)
medications.
*ALEVE -NSAID
Ask: *Buspirone - anxiolytic
- Medication name: *Eszopicion (Lunesta) – for insomnia
- Dosage:
- how to take the medication (signa) *Sertraline (Zoloft) - antidepressant
- Ask px why they need the medication? *Alprazolam (Xanax XR) – sedative
*Acetaminophen (Tylenol) – pain
- PMP Report - regulates the intake of the
controlled substance and will be checked during *Phenobarbital
the appointment

Can be combined with:

- APE / MW
 For controlled substances, a PMP will be reviewed and uploaded by the provider during the appointment.

*PROBE why they need the medication?

- to rule out other protocols
*can you rate the pain 1-10

“-unfortunately, this medication is one of the controlled substances, and for this we need to book an appt for proper
evaluation and documentation of the medicine and Dr Hello will also need to review your Prescription Monitoring
Program (PMP) report so you need to upload it. “