PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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RATIONALE: Management of Urinary Tract Infections in Pediatric Patients Based on PHHS Clinical Practice Guideline UTI in young children and infants causes fewer recognizable signs and symptoms other than fever but has a higher potential for renal damage than in older children. UTI should be considered in infants and young children, 2 months to 2 years with unexplained fever. GOAL: To prevent chronic renal failure and hypertension Clinical Findings • Foul smelling urine • Crying on urination • Fever • >2 years of age symptoms include altered voiding pattern, dysuria, urgency, frequency or hesitancy. Also nonspecific symptoms of vomiting, irritability, diarrhea, failure to thrive. Testing • Bagged urine culture specimen is unacceptable for diagnosis of UTI. • Negative urinalysis does not rule out UTI • Suprapubic aspiration or transurethral catheterization to obtain urine culture is essential to diagnosis. Management and Treatment • Newborns and infants less than 3-4 months are at high risk for bacteremia and urosepsis. Parenteral antibiotics and hospitalization is strongly recommended in these cases. • Infants and young children clinically evaluated as being toxic, dehydrated or vomiting or non-compliant should receive parenteral antimicrobials (IM Ceftriaxone as a single dose if patient is vomiting, followed by 7-10 days of oral antibiotics) and hospitalization should be considered. Switch to oral antimicrobials when patient is stable and able to tolerate oral nutrition. • Three classes of antimicrobials available: Amoxicillin, Sulfonamides (Trimethoprim-Sulfamethoxazole) and Cephalosporines. First line therapy in local population, considering resistance patterns identified, is Suprax (Cefixime) 8mg/kg/day for 7-10 days. Pyelonephritis should be treated for 10-14 days. • Therapy should be re-evaluated within 48 hours based on clinical response of patient and sensitivities obtained on culture. In older children with uncomplicated UTI 3-7 days antibiotic therapy can be given since recurrence rates are (20%) higher with single dose or
Follow-up • Follow-up urine cultures are not routinely recommended if initial sensitivities predict effectiveness and clinical response of patient is good. Follow-up urine cultures can be done at 3-5 days of therapy if needed and then schedule imaging studies. • Risk of renal scarring is greatest in infants and children 2 months – 2 years, hence they should be kept on therapeutic or prophylactic dosages of antibiotics until imaging studies are complete. Patients with encoparesis and chronic constipation should also be evaluated. Siblings (
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Parkland KIDSfirst, Parkland CHIP P
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Notification of Change in Provider
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CLAIMS SUBMISSION .................
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Quick Reference Checklist This manu
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Plan specified services. However, c
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CHIP Covered Services PCHP provides
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• Surgical implants • Other art
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Outpatient Mental Health Services I
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• Out-of-network services not aut
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CHIP Perinatal Covered Services Cov
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15 Covered Benefit CHIP Perinate Ne
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Covered Benefit CHIP Perinate Newbo
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• Personal comfort items includin
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• Donor non-medical expenses •
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SUPPLIES COVERED EXCLUDED COMMENTS/
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SUPPLIES COVERED EXCLUDED COMMENTS/
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Coordination between Physical and B
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in the provision of care and servic
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statement indicating that members s
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As the Primary Care Provider you mu
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Other Access Standards Service Stan
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Members Right to Select Network Oph
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HMO/Provider Coordination PCHP will
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45 • describe the range of medica
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Coordination of Care The Primary Ca
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Coordination with Texas Department
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Presentation at Emergency Room afte
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If the complaint is received verbal
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Expedited Appeal can be made verbal
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CHIP Eligibility CHIP KidsFirst Mem
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• Information concerning the grie
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Parkland Community Health Plan Memb
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Pregnant Teens Please call Parkland
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your income. Co-payments do not app
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Member’s Right to Designate an OB
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70 To report providers use this add
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5. Network providers must report an
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To request to be a Specialist servi
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• OB/Gyn • Periodic Health Chec
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The table below provides HHSC Manag
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CHIP Cost Sharing Caps Members rece
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of these two dates: July 18, 2007,
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(DD) Diagnosis code by specific ser
Page 93 and 94: (PP) Attending physician ID (UB-04,
Page 95 and 96: (2) post-partum visits within 60 da
Page 97 and 98: CHIP Member Enrollment and Disenrol
Page 99 and 100: • In order to synchronize all CHI
Page 101 and 102: Provider Participation Requirements
Page 103 and 104: • Evidence of state licensure, an
Page 105 and 106: U1 U2 U3 Medically necessary delive
Page 107 and 108: PROCEDURE DESCRIPTION PROCEDURE COD
Page 109 and 110: provider actually treating the memb
Page 111 and 112: themselves appropriately and follow
Page 113 and 114: Medical Record Standards The medica
Page 115 and 116: 1. History and Physical Examination
Page 117 and 118: WIC services include providing nutr
Page 119 and 120: As soon as the member knows they wi
Page 121 and 122: 3) by the director to the employee
Page 123 and 124: In addition to the previously state
Page 125 and 126: Prior Authorization The CHIP Perina
Page 127 and 128: Appendix A Universal Referral/Prior
Page 129 and 130: Appendix B Consent for Disclosure 1
Page 131 and 132: PERMISSION TO RELEASE CONFIDENTIAL
Page 133 and 134: EXAMPLE FORM PRIVATE PAY AGREEMENT
Page 135 and 136: Appendix D Clinical Practice Guidel
Page 137 and 138: Appendix D - Continued Clinical Pra
Page 139 and 140: Appendix D - Continued Clinical Pra
Page 141 and 142: RATIONALE: Attention-Deficit/ Hyper
Page 143: Appendix G Urinary Tract Infections
Page 147 and 148: RATIONALE: Prevention of RSV Illnes
Page 149 and 150: RATIONALE: Treatment of Group A Str
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PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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