PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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• describe the range of medical conditions or procedures affected by the conscience objection.
Advance Directives – Members
Members have the right to pick the medical care they want or do not want. Emancipated members or guardians
can ask for doctors, nurses, and other people to handle their care, what type of care they want and the kind they
don’t want. In some cases members can choose to:
• accept care
• reject care
• stop care
There can be circumstance in which emancipated patients can ask for a doctor to perform or react in advance of
a procedure. Patients often become to too sick to talk, or slip into a coma. Advance Directives aid providers in
carrying out incapacitated patient wishes. An Advance Directive protects patient wishes when they can’t speak
on their own behalf.
There are two types of Advance Directives:
• Advance Directive:
This is a record of their wishes. They can either write down their wishes or inform their doctor. Should an
emancipated child patient become incapacitated, an Advance Directive details the type of care they want or
do not want. For example: “if I have a heart attack, I do not wish to be revived.”
• Appointed Health Care Representative:
An emancipated child member can pick someone to make decisions about their health care needs if they are
not able to. They must put this choice into a legal document (letter). The person chosen can be a friend,
family member or lawyer.
Members can choose both to inform a doctor ahead of time and to pick a person to make choices if they cannot
do so for themselves. If you have any questions about member rights or how to put them down on paper, call us
toll free at 1-888-814-2352.
Referral to Specialists and Health-Related Services
We are committed to promoting the “medical home” and expect participating primary care providers to direct
their patient’s care, including referring members to specialists as needed. A referral is a primary care provider’s
request that a member’s covered services be provided by another participating provider. Because the Primary
Care Provider is responsible for coordinating his/her patient’s health care, the Primary Care Provider must
authorize a referral prior to the visit to a specialist.
The exceptions to the Primary Care Provider referral authorizations are:
• Services the member may access directly without a referral, such as obstetrical care of behavioral health
services.
• Services that require prior authorization by the health plan (refer to Medical Management section and
current Prior Authorization list)
The Primary Care Provider may authorize a referral to an in-network specialist by completing the Texas
Referral/Authorization Form or any other mutually agreed upon format. The referral must include all pertinent
clinical information necessary to provide continuity of care and reduce unnecessary duplication of services,
such as test results and consultation reports. The referral does not need to specify the services to be performed