Arizona Rural Health Clinic Designation Manual - Arizona Center for ...

More documents

Recommendations

Info

B. Rural Health Clinics in Arizona (con’t) Phone: (928) 722-6112 Fax: (928) 722-6113 Year of Certification: 2004 Type of Clinic: Independent Hospital Affiliation: N/A 10) Sage Outpatient Clinic Location: Ganado, AZ Mailing Address: P.O. Box 457 Ganado, AZ 86505 Phone: (928) 755-4640 Fax: N/A Year of Certification: 2000 Type of Clinic: Provider-Based Hospital Affiliation: Sage Memorial Hospital 11) Sulphur Springs Medical Center Location: 900 W Scott Street Willcox, Arizona 85643 Mailing Address: Same as Above Phone: (520) 384-4421 Fax: (520) 384-4645 Year of Certification: 2004 Type of Clinic: Provider-Based Hospital Affiliation: Northern Cochise Community Hospital 12) Sunsites Medical Clinic Location: 225 Frontage Road Pearce, Arizona 85625 Mailing Address: P.O. Box 186 Pearce, Arizona 85625 Phone: (520) 826-1088 Fax: (520) 826-1089 Year of Certification: 2004 Type of Clinic: Provider-Based Hospital Affiliation: Northern Cochise Community Hospital 13) Superior Clinic Location: 14 N Magma Ave. Superior, AZ 85273 Mailing Address: Same as Above Phone: (520) 689-2423 Fax: (520) 689-5237 Year of Certification: 2005 Type of Clinic: Provider-Based Hospital Affiliation: Cobre Valley Community Hospital 14) Tri-Valley Medical Center Location: 39726 Harquahala Road Salome, AZ 85348 Mailing Address: Same as Above Phone: (928) 859-3460 Fax: (928) 859-3475 Year of Certification: 2006 Type of Clinic: Provider-Based Hospital Affiliation: La Paz Regional Hospital 15) Wickenburg Hospital Clinic Location: 520 Rose Lane Wickenburg, AZ 85390 Mailing Address: Same as above Phone: (928) 684-5421 Fax: (928) 684-5081 Year of Certification: Type of Clinic: Provider-Based Hospital Affiliation: Wickenburg Community Hospital 16) Wide Ruins Clinic Location: Wide Ruins, AZ Mailing Address: P.O. Box 457 Ganado, AZ 86505 Phone: (928) 652-3231 Fax: N/A Year of Certification: 1997 Type of Clinic: Provider-Based Hospital Affiliation: Sage Memorial Hospital Source: Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities 8
C. Number of Rural Health Clinics in the United States, 2004 1 Total # of Clinics United States 3,599 Alabama 64 Alaska 6 Arizona 2 15 Arkansas 72 California 343 Colorado 35 Connecticut 0 Delaware 0 District of Columbia 0 Florida 152 Georgia 95 Hawaii 1 Idaho 44 Illinois 197 Indiana 51 Iowa 129 Kansas 168 Kentucky 115 Louisiana 56 Maine 49 Maryland 0 Massachusetts 0 Michigan 156 Minnesota 72 Mississippi 137 Missouri 271 Montana 41 Nebraska 89 Nevada 6 New Hampshire 18 New Jersey 0 New Mexico 11 New York 9 North Carolina 109 North Dakota 59 Ohio 17 Oklahoma 42 Oregon 44 Pennsylvania 42 Puerto Rico 0 Rhode Island 1 South Carolina 95 South Dakota 54 Tennessee 40 Texas 344 Utah 14 Vermont 18 Virgin Islands 0 Virginia 55 Washington 109 West Virginia 63 Wisconsin 62 Wyoming 18 1 Source: Centers for Medicare and Medicaid Services, Standard Online Survey and Certification Reporting System (OSCAR), Report 10. Accessed through: http:// www.statehealthfacts.org. 2 According to the Arizona Department of Health Services, Division of Licensing Services, Office of Medical Facilities Licensing, Arizona has 15 certified Rural Health Clinics in as of 2008. 9
Page 1 and 2: Arizona Rural Health Clinic Designa
Page 3 and 4: Community Environment & Policy 1295
Page 5 and 6: A. Background Information (con’t)
Page 7: B. Rural Health Clinics in Arizona
Page 11 and 12: D. Frequently Asked Questions (con
Page 13 and 14: D. Frequently Asked Questions (con
Page 15 and 16: E. Steps to Becoming a Certified Ru
Page 17 and 18: B. Interpretive Guidelines for Rura
Page 29 and 30: D. Preparing for the Certification
Page 37 and 38: 30 Most Common RHC Survey/Certifica
Page 39 and 40: F. RHC Cost Report The Medicare cos
Page 41 and 42: F. RHC Cost Report (con’t) •Wor
Page 43 and 44: F. RHC Cost Report (con’t) 11) Li
Page 45 and 46: G. Important Resources (con’t) -A
Page 47 and 48: Appendix A. Important Contact Infor
Page 49 and 50: Appendix B. Definitions for Rural H
Page 51 and 52: Appendix C. Federal Primary Care HP
Page 53 and 54: Appendix • C. Federal Primary Car
Page 55 and 56: Appendix D. Federal MUAs in Arizona
Page 57 and 58: Instructions for completing HCI App
Page 59 and 60:
A. PLEASE LIST IN THE SPACE PROVIDE
Page 61 and 62:
MEDICAL FACILITIES LICENSING 150 N.
Page 63 and 64:
ARIZONA DEPARTMENT OF HEALTH SERVIC
Page 65 and 66:
MEDICAL FACILITIES LICENSING 150 N.
Page 67 and 68:
http://www.azdhs.gov/als/forms/otcs
Page 69 and 70:
Appendix F. Certification Forms 1.
Page 71 and 72:
3. Has successfully completed a for
Page 73 and 74:
DEPARTMENT OF HEALTH AND HUMAN SERV
Page 75 and 76:
DEPARTMENT OF HEALTH AND HUMAN SERV
Page 77 and 78:
According to the Paperwork Reductio
Page 79 and 80:
MEDICARE ENROLLMENT APPLICATION INS
Page 81 and 82:
2990 (Cont.) Form CMS 222-92 03-02
Page 83 and 84:
RURAL HEALTH CLINIC SURVEY REPORT F
Page 85 and 86:
NAME CODE YES NO N/A EXPLANATORY ST
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
show all

Arizona Rural Health Clinic Designation Manual - Arizona Center for ...

Create successful ePaper yourself

Delete template?

Save as template?