PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

HOME HEALTH ................................................................................................................................................................................. 105
MEDICAL RECORD STANDARDS ............................................................................................................................................................ 106
PATIENT VISIT DATA ............................................................................................................................................................................ 107
MEDICAL RECORD CONFIDENTIALITY ................................................................................................................................................... 108
MONITORING COMPLIANCE .................................................................................................................................................................. 109
HEALTH DEPARTMENTS ....................................................................................................................................................................... 109
WOMEN, INFANTS AND CHILDREN PROGRAM (WIC) ............................................................................................................................. 109
SPECIAL NEEDS OF MEMBER POPULATIONS ........................................................................................................................ 111
TRANSPORTATION ................................................................................................................................................................................ 111
CULTURAL SENSITIVITY ........................................................................................................................................................................ 111
LANGUAGE/INTERPRETER SERVICES ..................................................................................................................................................... 111
HMO/PROVIDER COORDINATION ......................................................................................................................................................... 112
CONFIDENTIALITY ......................................................................................................................................................................... 112
CLINICAL PRACTICE GUIDELINES ............................................................................................................................................ 116
CHIP PERINATAL PROVIDER RESPONSIBILITIES................................................................................................................. 117
PRENATAL CARE .................................................................................................................................................................................. 117
PROVIDER ACCESSIBILITY .................................................................................................................................................................... 117
RESPONSIBILITY TO VERIFY MEMBER ELIGIBILITY AND/OR AUTHORIZATION FOR SERVICES..................................................................... 117
PRIOR AUTHORIZATION ........................................................................................................................................................................ 118
EMERGENCY SERVICES AND CARE ........................................................................................................................................................ 118
WHEN A MEMBER ACCESSES CARE ....................................................................................................................................................... 118
NOTIFICATION OF CHANGES IN MEDICAL OFFICE STAFFING AND ADDRESSES; ...................................................................................... 118
PROVIDER TERMINATION FROM HEALTH PLAN ...................................................................................................................................... 119
LABORATORY TESTS ............................................................................................................................................................................. 119
COORDINATION OF CARE ..................................................................................................................................................................... 119
COMPLIANCE WITH PCHP POLICY AND PROCEDURES .......................................................................................................................... 119
APPENDIX A ....................................................................................................................................................................................... 120
UNIVERSAL REFERRAL/PRIOR AUTHORIZATION FORM ........................................................................................................................... 120
APPENDIX B ....................................................................................................................................................................................... 122
CONSENT FOR DISCLOSURE .................................................................................................................................................................. 122
APPENDIX C ....................................................................................................................................................................................... 125
PRIVATE PAY FORM ............................................................................................................................................................................. 125
APPENDIX D ....................................................................................................................................................................................... 127
CLINICAL PRACTICE GUIDELINES - DIAGNOSIS AND MANAGEMENT OF PEDIATRIC ASTHMA .................................................................... 127
APPENDIX E AND F .......................................................................................................................................................................... 133
ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) ................................................................................................................... 133
COMPCARE STRATEGIES FOR TREATMENT OF ADHD ........................................................................................................................... 133
ASSESSMENT OF SYMPTOMS ............................................................................................................................................................... 134
DIFFERENTIAL DIAGNOSIS .................................................................................................................................................................. 134
CO-EXISTING PSYCHIATRIC CONCERNS .............................................................................................................................................. 134
APPENDIX G ....................................................................................................................................................................................... 136
URINARY TRACT INFECTIONS IN PEDIATRIC PATIENTS ........................................................................................................................... 136
Management and Treatment .......................................................................................................................................................... 137
Follow-up ....................................................................................................................................................................................... 138
APPENDIX H ....................................................................................................................................................................................... 139
RSV ILLNESS ........................................................................................................................................................................................ 139
APPENDIX I ........................................................................................................................................................................................ 141
GROUP A STREPTOCOCCAL PHARYNGITIS ............................................................................................................................................. 141
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