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

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NAME CODE YES NO N/A EXPLANATORY STATEMENTS J59 ■ MET ■ NOT MET (c) Direct services. J60 (1) General. The clinic staff furnishes those diagnostic and therapeutic services and supplies that are commonly furnished in a physician’s office or at the entry point into the health care delivery system. These include medical history, physical examination, assessment of health status, and treatment for a variety of medical conditions. J61 (2) Laboratory. The clinic provides basic laboratory services essential to the immediate diagnosis and treatment of the patient, including: (i) chemical examinations of urine by stick or tablet methods or both (including urine ketones); (ii) microscopic examination of urine sediment; (iii) hemoglobin or hematacrit; (iv) blood sugar; (v) gram stain; (vi) examination of stool specimens for occult blood; (vii) pregnancy tests; (viii) primary culturing for transmittal to a certified laboratory; and (ix) test for pinworms. Form CMS-30 (05/78) EF 10/2004 11 94
NAME CODE YES NO N/A EXPLANATORY STATEMENTS J62 (3) Emergency. The clinic provides medical emergency procedures as a first response to common life-threatening injuries and acute illness, and has available the drugs and biologicals commonly used in life saving procedures, such as analgesics, anesthetics (local), antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids. J63 ■ MET ■ NOT MET (d) Services provided through agreements or arrangements. J64 (1) The clinic has agreements or arrangements with one or more providers or suppliers participating under Medicare or Medicaid to furnish other services to its patients, including: (i) inpatient hospital care; (ii) physician(s) services (whether furnished in the hospital, the office, the patient’s home, a skilled nursing facility, or elsewhere); and (iii) additional and specialized diagnostic and laboratory services that are not available at the clinic. J65 (2) If the agreements are not in writing, there is evidence that patients referred by the clinic are being accepted and treated. Form CMS-30 (05/78) EF 10/2004 12 95
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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
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F. RHC Cost Report The Medicare cos
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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 93: NAME CODE YES NO N/A EXPLANATORY ST
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