MANUAL OF OPERATIONS GUIDELINES:

Table of Contents - TJC Standards

Table of Contents - NCQA Standards
Copyright
Disclaimer
Approval/Signature Sheet
Introduction
SECTION 01 - ACCESS TO CARE
1001 - 24/7 Access
1002 - Access During Office Hours
1003 - Documentation of Phone Calls
1004 - Phone Message Form - Sample
1005 - After Hours Access and Care
1006 - Appointment Scheduling
1007 - Appointment Follow-Up
1008 - Appointment Failure Notification
1009 - Reschedule Notification Letter
1010 - Patient Certified Letter - Second Request
1011 - Patient Certified Letter - Third Request
1012 - Patient Letter - Three Appointments Missed
1013 - Final Patient Notification Letter

SECTION 02 - PATIENT CARE

2001 - New Patients
2002 - Designated Primary Care Clinician
2003 - Interdisciplinary Team/Care Team
2004 - Patient Treatment Plan
2005 - Annual Wellness Visits and Personalized Prevention Plan Services
2006 - Health Assessment Form - Adult
2007 - Health Assessment Form - Obstetric
2008 - Health Assessment Form - Pediatric
2009 - Preventive Care Guidelines for Asymptomatic Male and Female Adults (Over 21 Years)
2010 - Criteria for Testing for Diabetes or Prediabetes in Adults
2011 - Preventive Care Guidelines for Asymptomatic Children and Adolescents (Birth - 20 years)
2012 - Lead Poisoning Evaluation Questionnaire Form
2013 - Adolescent Health Inventory Form
2014 - Medication Patient Information and Reconciliation
2015 - AHRQ Guide to Clinical Preventive Services, 2014
2016 - Clinical Decision Support Tools
2017 - Health Education
2018 - Sample Patient and Family Education Form
2019 - Patient Handwashing Station
2020 - Community Resources List for Patients and Families
2021 - Heat-Related Health Conditions Fact Sheet
2022 - West Nile Virus Fact Sheet
2023 - Confidential Messages
2024 - Automated External Defibrillators (AEDs)
2025 - Child, Adult, Disabled Person or Elderly Abuse - Recognition and Reporting
2026 - Emergencies - Patient
2027 - Drug Seeking Behavior - Identification of
2028 - Emergency Supplies - Office
2028A - Initial Screening for Self-Harm Potential Form
2029 - Invasive Procedures - Staffing of
2030 - Lab and Diagnostic Test Results
2031 - Lab or X-ray Results Patient Notification

2032 - Latex Sensitive Patient - Care of

 2032 - Latex Sensitive Patient - Care of
2033 - Multidrug-Resistant Organisms in Non-Hospital Healthcare Settings - Management of
2034 - Pregnant Patients - Radiological Examination
2035 - Sexual Assault or Abuse
2036 - Reporting of Injuries Related to Criminal Conduct
2037 - Reporting Medically Impaired Drivers to the Department of Motor Vehicles (DMV)
2038 - Tuberculin Skin Test (TST) - Administration
2038A - Zika Virus
2038B - Interim Guidelines for Pregnant Women During A Zika Virus Outbreak
2038C - US Zika Pregnancy Registry
2038D - Interim Guidelines for Preconception Counseling and Prevention of Sexual Transmission of Zika
Virus (Possible Zika Virus Exposure)
2039 - Transferring Care of Patients to Another Practitioner
2040 - Physician Letter - Transferring Care to Another Provider
2041 - Pediatric Patient Transition to Adult Healthcare Provider
2042 - Non-Compliance Letters - Physician to Patient (HMO)
2043 - Non-Compliance Letter #1 (HMO)
2044 - Non-Compliance Letter #2 (HMO)
2045 - Non-Compliance Letter #3 (HMO)
2046 - Examination Equipment

SECTION 03 - INFECTION PREVENTION AND CONTROL

General Policies
3001 - Infection Prevention and Control - Medical Offices
3002 - New Employee Infection Prevention and Control Orientation
3003 - Infection Prevention and Control - New Employee Orientation Outline (Sample Form)
3004 - Standard Precautions
3005 - Hand Hygiene - CDC Guidelines
3006 - Respiratory Hygiene and Cough Etiquette in Healthcare Settings
3007 - Communicable Infections
3008 - Notice - Airborne Infection
3009 - National Notifiable Infectious Conditions
3010 - Quarantinable Diseases

Bloodborne Pathogens and Exposure Control Plan

3101 - Exposure Control Plan

3102 - Sharps Injury Protection Plan
3103 - Sharps Injury Log Form
3104 - Disposal of Sharps
3105 - Accidental Blood or Body Fluid Exposure - Management of
3106 - Accidental Exposure to Blood or Body Fluids - Medical Evaluation Form
3107 - Accidental Exposure to Blood or Body Fluids - Employee Follow-Up Instruction Sheet
3108 - Consent for the HIV Test (Sample Form)
3109 - Authorization for Disclosure of the Results of the HIV Antibody Blood Test (Sample Form)
3110 - CDC - Summary of Recommendations for Immediate Prophylactic Intervention
3111 - CDC - Recommended Postexposure Management by Risk Category and Specific Pathogen
3112 - Infectious Waste Management Plan
3113 - Medical Waste Disposal Guidelines

Employee Health
3201 - Injury and Illness Prevention Program
3202 - Employee Incident Reporting
3203 - Employee Health Program
3204 - Immunization Status of Employees
3205 - Bordetella Pertussis
 3205 - Bordetella Pertussis
3206 - Influenza Vaccination Program for Healthcare Staff
3207 - Measles, Rubella and Varicella Disease Screening - Staff
3208 - Varicella Zoster
3209 - Hepatitis B Vaccine Program
3210 - Informed Consent for Hepatitis B Vaccine Form
3211 - Hepatitis B Vaccine Declination Form
3212 - Tuberculosis Screening Program
3213 - TB Risk Assessment Worksheet
3214 - TB Risk Assessment Flowchart
3215 - Health Questionnaire for Positive Tuberculosis Skin Test Reactions Form
3216 - Suggested Guidelines for Work Restrictions for Staff with Infectious Diseases
3217 - Respiratory Protection Plan
3218 - N95 Fit-Testing
3219 - Staff Latex Sensitivity

SECTION 04 - MEDICATION MANAGEMENT

4001 - Standing Orders
4002 - Influenza Vaccination
4003 - Interim Recommendations for Novel Influenza A Viruses
4004 - Storage of Medications
4005 - Refrigerated Drug Storage
4006 - Medication Refrigerator Temperature Log Form
4007 - Medication Freezer Temperature Log Form
4008 - Routine Vaccine Storage and Handling Plan
4009 - Available Vaccines
4010 - Vaccine Information Statements (VISs) - Use of
4011 - Reporting Vaccine Adverse Events
4012 - Controlled Substance Storage and Documentation
4013 - Narcotic Count Record Form
4014 - Narcotic Drug Dispensation Record Form
4015 - Expired Medication Log Form
4016 - Sample Medications - Physician Offices
4017 - Multiple Dose Vials (MDVs) - Use of
4018 - Insulin Pens
4019 - Medication Recall
4020 - Electronic Prescribing
4021 - Prescription Pad Security

SECTION 05 - WAIVED TESTING

5001 - Waived Testing
5002 - Blood Glucose Monitoring
5003 - Hemoccult Testing
5004 - Rapid Influenza Diagnostic Tests

SECTION 05 - WAIVED TESTING

5001 - Waived Testing
5002 - Blood Glucose Monitoring
5003 - Hemoccult Testing
5004 - Rapid Influenza Diagnostic Tests
SECTION 06 - MEDICAL RECORD
6001 - Confidentiality of Information - General Issues
6002 - Confidentiality Statement (Employee)
6003 - Electronic Health Record System
6004 - Administrative Safeguards - Risk Analysis
6005 - Administrative Safeguards - Risk Management
6006 - Administrative Safeguards - Security Awareness and Training
6006 - Administrative Safeguards - Security Awareness and Training
6007 - Administrative Safeguards - Password Management
6008 - Physical Safeguards - Workstation Use
6009 - Meaningful Use Overview
6010 - Attestation for Meaningful Use (MU)
6011 - Overview of Stage 1 Meaningful Use - Eligible Professionals
6012 - Overview of Stage 2 Meaningful Use
6013 - Overview of Stage 3 Meaningful Use
6014 - Reporting Data Externally
6015 - Medical Records - Availability and Protection of
6016 - Access Requests
6017 - Patient Access to Medical Records
6018 - Release of Medical Information
6019 - Medical Records Request and Release Form
6020 - Release of Information Regarding HIV or AIDS
6021 - Purging and Destruction of Medical Records
6022 - Medical Record Standards
6023 - Medical Office Documentation
6024 - Patient Problem List
6025 - Prescription Medication Record Form
6026 - ICD-10 Diagnosis Codes
6027 - Medical Record Review Form
6028 - Pediatric Medical Record Review Form
6029 - Office Surgical Review Form
6030 - Asthma Review Summary Form
6031 - Diabetes Management Form
6032 - Utilization of the Facsimile Machine
6033 - Faxing Medical Records
6034 - Fax Transmittal Sheet
6035 - Employee Training Log for Computer and Fax Stations
6036 - Guidelines for Use of Electronic Mail
6037 - Social Media - Use of
6038 - Internet Access

SECTION 07 - PATIENT RIGHTS AND RESPONSIBILITIES

7001 - Patient Rights and Responsibilities - Posting of
7002 - Patient Bill of Rights Handout
7003 - Patient Responsibilities Handout
7004 - Informed Consent
7005 - Consent to Sterilization (Elective)
7006 - Advance Directives
7007 - Durable Power of Attorney for Healthcare
7008 - Patient Complaints
7009 - Complaint Log Form
7010 - Patient Communication Rights
7011 - Interpreter Services

SECTION 08 - PERFORMANCE IMPROVEMENT

8001 - Performance Improvement Plan
8002 - Incident Report Form (Internal)

SECTION 09 - ADMINISTRATIVE
9001 - Scope of Services
9002 - Staff Meetings
9003 - Medicare Part D Prescribing
9004 - OIG Compliance in the Medical Office
9004 - OIG Compliance in the Medical Office
9005 - Compliance Plan for Medical Offices
9006 - Medical Office Self-Assessment Tool
9007 - Office Evaluation Form
9008 - HMO Referral Policy
9009 - HMO Prior Authorization Worksheet
9010 - HMO Areas of Risk
9011 - HMO Member Disenrollment Requirements
9012 - Criteria and Procedure for Removal of Members from Your PMG and IPA

SECTION 10 - HUMAN RESOURCES

10001 - Equal Employment Opportunity
10002 - Staff Qualifications and Competency
10003 - Primary Care Clinician Credentialing Process
10004 - Employment Application Form - Sample
10005 - Proof of Right to Work
10006 - Reference Checking
10007 - License Verification
10008 - Inservice Education
10009 - Continuing Education
10010 - Performance Evaluations
10011 - Personnel Action Form
10012 - Attendance and Tardiness
10013 - Dress Code
10014 - Employee Requests for Time Off
10015 - Harassment, Sexual (Either Sex)
10016 - Lunch and Rest Breaks
10017 - Paid Time Off (PTO)
10018 - Workers' Compensation
10019 - Termination of Employment
10020 - Position Description/Performance Evaluation - Office Manager - RN
10021 - Performance Evaluation - Population-Specific/Age-Related Competency - Office Manager - RN
10022 - Annual Competency Clinical Skills Assessment - Office Manager - RN
10023 - Position Description/Performance Evaluation - Nurse Practitioner
10024 - Performance Evaluation - Population-Specific/Age-Related Competency - Nurse Practitioner
10025 - Annual Competency Clinical Skills Assessment - Nurse Practitioner
10026 - Position Description/Performance Evaluation - Physician's Assistant - Medical Office
10027 - Performance Evaluation - Population-Specific/Age-Related Competency - Physician's Assistant
- Medical Office
10028 - Annual Competency Clinical Skills Assessment - Physician's Assistant - Medical Office
10029 - Delegation of Services Agreement Between Supervising Physician and Physician Assistant -
Example
10030 - Approved Supervising Physician’s Responsibility for Supervision of Physician Assistant -
Example
10031 - Position Description/Performance Evaluation - Office RN
10032 - Performance Evaluation - Population-Specific/Age-Related Competency - Office RN
10033 - Annual Competency Clinical Skills Assessment - Office RN
10034 - Position Description/Performance Evaluation - Office LPN/LVN
10035 - Performance Evaluation - Population-Specific/Age-Related Competency - Office LPN/LVN
10036 - Annual Competency Clinical Skills Assessment - Office LPN/LVN
10037 - Position Description/Performance Evaluation - Medical Assistant - Office
10038 - Performance Evaluation - Population-Specific/Age-Related Competency - Medical Assistant -
Office
10039 - Annual Competency Skills Assessment - Medical Assistant - Office
10040 - Position Description/Performance Evaluation - Office Receptionist
10041 - Performance Evaluation - Population-Specific/Age-Related Competency - Office Receptionist

10042 - Annual Competency Skills Assessment - Office Receptionist

10042 - Annual Competency Skills Assessment - Office Receptionist
10043 - Position Description/Performance Evaluation - Office Bookkeeper
10044 - Annual Competency Skills Assessment - Office Bookkeeper
10045 - Position Description/Performance Evaluation - Medical Office Insurance Biller
10046 - Annual Competency Skills Assessment - Medical Office Insurance Biller
10047 - Annual Competency - Joint Commission National Patient Safety Goals and Universal Protocol
for Ambulatory Care

SECTION 11 - SAFETY
11001 - Safety and Health Policies
11002 - General Safety - Medical Office
11003 - Employee Safety Information Form
11004 - Safety Orientation
11005 - Employee Safety Training Verification Form
11006 - Body Mechanics Training
11007 - Hazard Surveillance Program
11008 - Hazard Assessment Checklist Form
11009 - Hazard Communication
11010 - How to Read Safety Data Sheets (SDS)
11011 - Radiation Monitoring Badge
11012 - Silver Recovery
11013 - Workplace Violence Policy
11014 - Smoking Policy
11015 - Fire Safety - General Instructions
11016 - Use of a Fire Extinguisher
11017 - Earthquake Safety
11018 - Explosions
11019 - Posting of Evacuation Routes
11020 - Evacuation Routes Form
11021 - Electrical Equipment Safety
11022 - ADA Accessible Medical Equipment
11023 - ADA Compliant Medical Examination Rooms