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

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NAME CODE YES NO N/A EXPLANATORY STATEMENTS J37 ■ MET ■ NOT MET IV. §481.8 Staffing and Staff Responsibilities. J38 ■ MET ■ NOT MET (a) Staffing. J43 For each qualified nurse practitioner, indicate the number qualifying under the respective parts of §481.2(b): (1) (2) (3) J39 (1) The clinic has a health care staff that includes one or more physicians and one or more physician’s assistants or nurse practitioners. For each qualified physician’s assistant, indicate the number qualifying under the respective parts of §481.2(d): J40 (2) The staff, i.e., the nurse practitioner(s), physician(s), or physician’s assistant(s) meets qualification requirements in section 481.2(b), (c), (d). J44 (1) (2) (3) J41 (3) A physician, nurse practitioner, or physician’s assistant is available to furnish patient care services at all times during the clinic’s regular hours of operation. A nurse practitioner or a physician’s assistant is available to furnish patient care services during at least 60% of the clinic’s regular hours of operation. Clinic’s regular weekly operating schedule: Nurse practitioner or physician’s assistant regular weekly on duty schedule: J42 (4) The staff is sufficient to provide the services essential to the operation of the clinic. Form CMS-30 (05/78) EF 10/2004 7 90
NAME CODE YES NO N/A EXPLANATORY STATEMENTS J45 ■ MET ■ NOT MET (b) Physician responsibilities: J46 J47 J48 (1) The physician provides medical direction for the clinic’s health care activities and consultation for, and medical supervision of the health care staff. (2) In conjunction with the physician’s assistant and/or nurse practitioner member(s), the physician participates in developing, executing and periodically reviewing the clinic’s written policies and the services provided to Federal program patients; and (3) The physician periodically reviews the clinic’s patient records, provides medical orders, and provides medical care services to the patients of the clinic. J49 (4) A physician is present for sufficient periods of time, at least once in every 2 week period (except in extraordinary circumstances), to provide the medical direction, medical care services, consultation and supervision described in paragraph(b)(1) of this section, and, is available through direct telecommunication for consultation, assistance with medical emergencies, or patient referral. The extraordinary circumstances are documented in the records of the clinic. Form CMS-30 (05/78) EF 10/2004 8 91
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Arizona Rural Health Clinic Designa
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Community Environment & Policy 1295
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A. Background Information (con’t)
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B. Rural Health Clinics in Arizona
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C. Number of Rural Health Clinics i
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D. Frequently Asked Questions (con
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D. Frequently Asked Questions (con
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E. Steps to Becoming a Certified Ru
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B. Interpretive Guidelines for Rura
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D. Preparing for the Certification
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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 89: NAME CODE YES NO N/A EXPLANATORY ST
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