Full Clinical Guidelines - Community First Health Plans.

More documents

Recommendations

Info

CFHP OB/GYN SPECIALTY MEDICAL RECORD AUDIT TOOL Physician: Nurse Reviewer: Date of Review: Provider Number: Provider Type: A. Documentation ______ B. Continuity of Care ______ C. Preventive <strong>Health</strong> ______ 1 2 3 4 5 6 7 8 9 10 Y N Y + N S C O R E Y Y+Nx100= % compliance _________________________________________ Plan -- Age-- A. DOCUMENTATION 1. Patient identification on each page 2. Personal/Biographical information 3. Allergies prominently noted 4. Problem List (pts w/3 or more visits) 5. Medication List (pts w/3 or more visits) 6. Entries legible 7. All entries contain author identification 8. All entries are dated 9. Advance Directives (Medicaid 18 & older – OB/PCPs) B. Continuity of Care 10. Past medical history (pts w/3 or more visits) 11. Tobacco, alcohol, & other substances use assessed (12 & older) 12. Chief complaint noted 13. History & exam pertinent to complaint 14. Working diagnosis consistent with findings 15. Basic teaching provided 16. Appropriate plan of treatment 17. Appropriate use of consults 18. Appropriate studies ordered 19. Unresolved problems addressed 20. Physician review on studies 21. Results of consultations are reviewed & filed 22. Date of next visit/instructions for follow-up 23. ER and Hospital reports/records 24. Patient is not placed at inappropriate risk 25. Evaluation of Abuse/neglect or other socio environmental factors (Medicaid) VALIDATIONS - √ for compliance (not scored) 26. Diagnosis Validation 27. Claims Validation P: Quality Management\Medical Record Review\SFY2012\Audit Tools Revised 12/04, 7/07, 1/10, 8/11 150 H EALTH PLANS www.cfhp.com
CFHP OB/GYN SPECIALTY MEDICAL RECORD AUDIT TOOL Physician: Nurse Reviewer: Date of Review: Provider Number: Provider Type: PREVENTIVE CARE _________________________________________ Plan-- Age 1 2 3 4 5 6 7 8 9 10 Y N Y + N S C O R E Y Y+Nx100= % compliance PRENATAL CARE 1. Comprehensive history documented 2. Complete physical exam documented INITIAL LAB WORK 3. Hematocrit or hemoglobin 4. Urinalysis 5. ABO/Rh typing & antibody screening 6. Rubella screening 7. VDRL, Gonorrhea* & Chlamydia* Screening (* = Optional) 8. Cervical Cytology (as needed) 9. Hepatitis B Surface Antigen 10. HIV screening FOLLOW-UP OB VISITS 11. Vital signs & weight 12. Urine check for protein and glucose 13. Fundal height measurement 14. Edema check 15. Signs & symptoms of preterm labor; or other risk factors 16. Fetal heart tones noted 17. Fetal movement noted FOLLOW-UP LABS 18. Triple screen (8-20) weeks) 19. Glucose challenge/H&H/Ab screen (24-28 weeks) 20. Group B Strep/ H&H/ VDRL (35-37 weeks) POST PARTUM CARE 21. Interim history & physical exam 22. Evaluation of weight 23. Vital signs 24. Cervical Cytology (as needed) 25. Family planning/contraceptive practices 26. Education provided on STD prevention 27. Assessment for postpartum depression GYN Preventive Care 28. Pelvic & Pap Smear 29. Mammogram (Every 1-2yrs for women 50 & older) 30. Rubella Antibody Titer (High risk) 31. Family planning/Contraceptive Practices 32. Education provided on STD prevention X = Patient qualifies for screening but timeframe has not yet expires P: Quality Management\Medical Record Review\SFY2012\Audit Tools Revised 12/04, 7/07, 1/10, 8/11 H EALTH PLANS www.cfhp.com 151
Page 1 and 2:
Community First Health Plans Qualit
Page 3 and 4:
10.5 ATP III Classification of Chol
Page 5 and 6:
Such information is released only t
Page 7 and 8:
Non Voting • Martin Jimenez, Dire
Page 9 and 10:
The purpose of these guidelines is
Page 11 and 12:
Table 1. Adult Preventive Services
Page 13 and 14:
Recommended Adult Immunization Sche
Page 15 and 16:
Footnotes — Recommended Adult Imm
Page 17 and 18:
CFHP has adopted the National Asthm
Page 19 and 20:
Patient Name ______________________
Page 21 and 22:
Managing Asthma Long Term 41 FIGURE
Page 23 and 24:
FIGURE 14. CLASSIFYING ASTHMA SEVER
Page 25 and 26:
FIGURE 16. STEPWISE APPROACH FOR MA
Page 27 and 28:
FIGURE 20. CLASSIFYING SEVERITY OF
Page 29 and 30:
II. Some hyperactive-impulsive or i
Page 31 and 32:
COMMUNITY FIRST HEALTH PLANS BEHAVI
Page 33 and 34:
Criteria Requirements 33. Release o
Page 35 and 36:
The evaluation of breast disease is
Page 37 and 38:
Prevent Child Texas, a non-profit o
Page 39 and 40:
AMERICAN ACADEMY OF PEDIATRICS: Fai
Page 41 and 42:
possible), a careful, complete, and
Page 43 and 44:
Examination/Test Oral / Dental Insp
Page 45 and 46:
GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47 and 48:
Publication # 45-11647 Targets* A1
Page 49 and 50:
WORKSHEET Revised 10-20-05 Advancin
Page 51 and 52:
D. Optimizing analog insulin use Re
Page 53 and 54:
Publication # 45-11266 Age 126 mg/d
Page 55 and 56:
Hypertension Algorithm for Diabetes
Page 57 and 58:
Lipid Algorithm For Type 1 and Type
Page 59 and 60:
References: Revised 1-24-08 • Col
Page 61 and 62:
WEIGHT LOSS ALGORITHM FOR OVERWEIGH
Page 63 and 64:
Publication #45-11825 Screening 1 :
Page 65 and 66:
Publication #45-12000 DIABETIC FOOT
Page 67 and 68:
DIABETIC FOOT CARE/REFERRAL ALGORIT
Page 69 and 70:
Publication # 45-12083 WEIGHT MANAG
Page 71 and 72:
9 H EALTH PLANS www.cfhp.com 71
Page 73 and 74:
Revised 10-25-07 IV INSULIN INFUSIO
Page 75 and 76:
Revised 10-25-07 Publication #: 45-
Page 77 and 78:
Revised 2-21-08 Publication #: E45-
Page 79 and 80:
Abbreviations AGI Alpha-Glucosidase
Page 81 and 82:
Orders for Adults with DKA and Hype
Page 83 and 84:
D i a b e t e s t r e a t m e n t a
Page 85 and 86:
CFHP has adopted the National Insti
Page 87 and 88:
No CHD; 0 to 1, or 2+ Risk Factors
Page 89 and 90:
NATIONAL CHOLESTEROL EDUCATION PROG
Page 91 and 92:
NATIONAL CHOLESTEROL EDUCATION PROG
Page 93 and 94:
Identification, Evaluation, and Tre
Page 95 and 96:
11.3 Treatment of Hypertension H EA
Page 97 and 98:
ALGORITHM FOR TREATMENT OF MAJOR DE
Page 99 and 100: CFHP has established guidelines for
Page 101 and 102: A. Documentation ______ B. Continui
Page 103 and 104: CFHP PCP MEDICAL RECORD REVIEW TOOL
Page 105 and 106: 13.3 Specialist Medical Record Docu
Page 107 and 108: 13.4 Specialist Medical Record Revi
Page 109 and 110: Risk Factors for Osteoporosis Fract
Page 111 and 112: It is well documented that obesity
Page 113 and 114: CLASSIFICATION OF OVERWEIGHT AND OB
Page 115 and 116: 16.1.1 Preventive Pediatric Health
Page 117 and 118: H EALTH PLANS www.cfhp.com 117
Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
Page 125 and 126: CHILDREN’S SERVICES HANDBOOK P h
Page 127 and 128: CHILDREN’S SERVICES HANDBOOK P R
Page 139 and 140: H EALTH PLANS www.cfhp.com 139
Page 141 and 142: FIGURE 2: Recommended immunization
Page 143 and 144: Comprehensive antepartum care is vi
Page 145 and 146: The following variables should be e
Page 147 and 148: CRITERIA 19. Unresolved Problems Fr
Page 149: CFHP OB/GYN SPECIALTY MEDICAL RECOR
Page 153 and 154: According to the National Institute
Page 155 and 156: . aminotransferase (AST) and alanin
Page 157 and 158: PREVENTION RECOMMENDATIONS 1. The E
Page 159 and 160: 2 to 20 years: Boys Body mass index
Page 161 and 162: AsthmaMatters is an initiative deve
Page 163 and 164: According to the Centers for Diseas
show all

Full Clinical Guidelines - Community First Health Plans.

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?