Article 1 – Complete Care Model
3.1.5 Scheduling and Access to Care
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Policy
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California Correctional Health Care Services (CCHCS) and California Department of Corrections and Rehabilitation (CDCR) shall utilize systems and processes to optimize access to care and maintain an effective and efficient scheduling system to ensure timely patient access to health care services. This includes a flexible appointment system that accommodates various encounter appointment types, encounter lengths, same-day encounters, and scheduled follow-ups as well as strategies to increase efficiency, such as consolidated appointments. This procedure also specifies roles and responsibilities for key staff involved in the scheduling system.
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Responsibility
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Statewide
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CCHCS and CDCR departmental leadership at all levels of the organization, within the scope of their authority, shall ensure administrative, custodial, and clinical systems are in place, and appropriate tools, training, technical assistance, and levels of resources are available to ensure the scheduling system is successfully implemented and maintained.
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Regional
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Regional Health Care Executives are responsible for the administration of this procedure at the subset of institutions within an assigned region.
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Institutional
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The Chief Executive Officer (CEO) has overall responsibility for implementation and ongoing oversight of the scheduling and access processes at the institution. The CEO delegates decision-making authority to the institution leadership team for daily operations to ensure adequate resources are deployed to support the process including, but not limited to the following:
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Ensuring access to and utilization of equipment, supplies, health information systems, patient registries, patient summaries, and evidence-based guidelines.
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Assigning patients to a Care Team.
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Maintaining a list of the core members of each Care Team, which shall be available to all institutional staff. Patients shall be informed of their assigned Care Team members at intake or upon request.
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Ensuring consistent Care Team staffing with a plan to designate back-up staff.
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Providing Care Team members with the information they need during huddles (e.g., communication of on-call information).
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Ensuring protected time for Care Teams to hold daily huddles and twice-monthly population management working sessions.
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Documenting and tracking huddle actions, follow-up deliverables and attendance.
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Ensuring that at least twice-monthly, each Care Team conducts a Population Management Working Session utilizing tools such as dashboards, patient registries, patient summaries, and other tools to identify potential gaps in care and opportunities to improve safe, appropriate, timely and cost-effective services.
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Adequately preparing new Care Team members to assume team roles and responsibilities.
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Assessing competence of existing Care Team members.
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Updating institution procedures, roles, and responsibilities as new tools and technology become available.
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Reviewing or comparing institution Care Team performance including the overall quality of services, health outcomes, assignment of consistent and adequate resources; utilization of dashboards, patient registries, patient summaries, and decision support tools; and addressing issues as necessary.
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Providing Care Team members with adequate resources including staffing, physical plant, information technology, and equipment or supplies to accomplish daily tasks.
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Working with custody staff to minimize unnecessary patient movement resulting in changes to a patient’s panel assignment.
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Requiring institution leadership to establish a back-up system to ensure that scheduling queues are managed when Scheduling Support Staff are on leave or otherwise unable to meet daily monitoring requirements.
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Ensure Local Operating Procedures are followed by applicable staff under the CEO and Warden’s direction.
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The CEO and all members of the institution leadership team are responsible for establishing an organizational culture that promotes teamwork among Care Team members and across disciplines.
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The CEO and institution leadership team shall review institution-wide scheduling and access to care data monthly in the context of local Quality Management Committee and subcommittee meetings.
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To ensure accuracy of scheduling system data, the institution leadership team shall:
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Periodically evaluate the reliability of scheduling system data through comparison with independent data sources, such as movement or ducat reports and progress notes, or audits for abnormal or incomplete entries.
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Take effective action to remedy unreliable data, including creating or revising decision support, updating desk procedures, and redesigning orientation and training strategies.
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Re-validate problematic data monthly until the data reliability issue is resolved.
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Local quality improvement committees shall act as appropriate to investigate quality problems and develop interventions to improve access.
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The Chief Nurse Executive (CNE) is responsible for:
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The overall daily operations of the scheduling system for medical care.
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The daily coordination of health care services between health care scheduling systems.
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Daily oversight and management of scheduling processes and resources including personnel.
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Ensuring that the institution has a designated Scheduling Supervisor to monitor scheduling processes daily and identify and address or elevate barriers to access.
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Ensuring that Scheduling Support Staff is available daily for all clinical areas.
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The Chief Medical Executive (CME) is responsible for the overall medical management of patients and ensures provider resources are available to meet the needs of the population.
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At least monthly, the CME and CNE shall review the effectiveness of local scheduling processes including, but not limited to, the following in each Primary Care Clinic to determine if adjustments need to be made to the overall clinic operations plan to meet patient care needs in an efficient manner:
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Scheduling Reports.
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Utilization of the consolidated patient provider calendar.
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Utilization of open access time and co-consultation.
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Number of additional “add-on” appointments.
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Current backlog.
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Wait times.
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Refusal rates.
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The Supervising Registered Nurse (RN) and Chief Physician and Surgeon shall meet to review the Care Teams’ performance including the overall quality of services, health outcomes, and level of care utilization and shall utilize dashboards, patient registries, patient summaries, and decision support tools to address or elevate issues as necessary.
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The Scheduling Supervisor over Clinics and the Clinic Manager shall:
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Review select information daily to identify and immediately address scheduling system problems.
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Determine whether all Scheduling Support Staff, Nursing Staff, Primary Care Providers (PCPs) and Medical Assistants, attend their respective clinics that day and shall verify that appropriate back-up has been provided if any of these staff are unavailable.
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Review scheduling management reports daily including, but not limited to, the following:
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Scheduling system diagnostic data to identify data entry errors and appointment trends.
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Scheduling queues not managed properly.
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Duplicate appointments and orders.
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Unscheduleable appointments.
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Other scheduling system issues.
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Review clinic scheduling processes to ensure utilization of strategies such as open access, encounter consolidation, scheduling conflict resolution, and co-consultation to optimize access.
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Improve communication processes within the Care Team and across health care settings that impact scheduling and access, including daily huddles.
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Provide frequent feedback to health care staff involved in the scheduling system on their individual performance based upon findings from daily observation of scheduling processes.
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The Care Team
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At least monthly, the Care Team shall evaluate the effectiveness and efficiency of scheduling processes and overall access to care. The Care Team shall consider trends in the following:
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Adherence to access timeframes.
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Proportion of appointments seen as scheduled and reasons patients were not seen as scheduled.
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Episodic Care referral rates to the PCP.
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Effectiveness of scheduling strategies, such as open access, encounter consolidation, scheduling conflict resolution, and co-consultation.
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Design of clinic schedules (e.g., number of open access slots, allotting certain time blocks for different appointment types).
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Productivity.
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Demand management, including episodic care, chronic care, chronos, medication refusals and other types of non-adherence counseling, and grievances.
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Allocation of work across team members.
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Clinic closures.
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Specialty provider network issues.
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Completeness and accuracy of scheduling data.
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Security and construction impact to access.
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Population management health care alerts.
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The Care Team shall take corrective action to resolve and elevate concerns identified in the review. The Care Team review and corrective action shall be documented and forwarded to the designated committee.
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Health care staff shall be trained in scheduling and access to care concepts and principles. Targeted training shall be provided to those who have specific roles in the scheduling process (e.g., providers, nurses, schedulers). A system for the orientation, mentoring, and cross-training of all critical positions in the scheduling system shall be maintained.
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Each institution shall ensure all Scheduling Support Staff have a desk procedure with guidance on how to employ the scheduling system accurately and effectively with information tailored to different work locations and scheduling functions. The desk procedure shall be updated as scheduling processes change.
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Each institution shall develop or adopt decision support tools (e.g., forms, checklists):
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Prompting clinic staff to communicate clearly to Scheduling Support Staff.
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Giving tips on how to enter data in a way that is recognized by the scheduling system.
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Reminding Scheduling Support Staff and clinic staff of new scheduling procedures and updated access to care timeframes.
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Staff involved in the scheduling system shall receive training on changes to scheduling processes and tools as they evolve and periodic refresher training on their roles and responsibilities.
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Procedure
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General Scheduling Concepts
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Standardized Scheduling System
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All institutions shall use the standardized statewide scheduling system.
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Scope of the Scheduling Process
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The scheduling process shall begin upon a patient’s arrival at CDCR and continue throughout the patient’s stay.
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Scheduling System User Designations and Accessibility
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Staff shall submit a Solution Center ticket to add or change a provider or location.
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Access to Health Care Services
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Hours of Access
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All CDCR incarcerated persons shall have access to medically necessary health care services seven days per week, 24 hours per day.
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RNs shall be onsite at the institution seven days per week, 24 hours per day.
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A Provider-on-call or Medical Officer of the Day shall be available 24 hours a day,7 days a week to provide consultation and onsite care as necessary.
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Medical, mental health, and dental services shall be available at any time.
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STAT laboratory tests listed on the Approved STAT Testing Menu are available seven days per week, 24 hours per day.
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Each institution shall establish hours of operation for Primary Care Clinics, generally at least eight hours per day, Monday through Friday, excluding state holidays.
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Methods of Access
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Licensed Health Care Initiated Appointments
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Access to care includes planned health care encounters scheduled at appropriate intervals and initiated by licensed health care staff as part of ongoing treatment planning and care management to address health care needs.
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Patient Request for Services:
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Access to care also includes episodic encounters requested by patients either through written request, verbal report, or demonstration of urgent or emergent health care needs.
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At any time, patients with health care needs may submit a CDCR 7362, Health Care Services Request Form. Patients with urgent health care needs may complete a CDCR 7362 or notify any institutional staff, including correctional staff for assistance. Patients with life-threatening conditions shall receive immediate medical attention.
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If a patient is unable to complete a CDCR 7362, health care staff shall complete the form on behalf of the patient. Health care staff shall document the complaint and the reason the patient did not personally complete the CDCR 7362 and shall sign and date the CDCR 7362.
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Institutions shall ensure the CDCR 7362 is available to patients in the housing units, clinics, and Reception Centers. Housing unit staff and health care staff shall make the CDCR 7362 available upon request. Each institution shall have at least one locked box on each yard and facility designated for patients to deposit the CDCR 7362, which shall be accessible to patients daily.
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Initial Review and Triage of a CDCR 7362
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On normal business days:
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A designated health care staff member on each yard or facility shall collect the CDCR 7362s from the designated areas, document the date and time of pickup, and deliver the forms to the Primary Care RN (PCRN) for review.
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Upon receipt of the CDCR 7362, the PCRN shall:
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Review and triage patient health needs based on information documented on the CDCR 7362.
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Determine whether the patient requires emergent, urgent, or routine care.
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Immediately refer emergent, or urgent medical, mental health, and dental needs to the appropriate clinician for evaluation consistent with established program guidelines.
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Indicate which discipline the patient is being referred to, and whether the health care request is symptomatic (to include any Substance Use Disorder [SUD] complaint) or asymptomatic.
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Document the following on each CDCR 7362: date and time reviewed by RN; print or stamp name, signature and title.
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Based on the RN’s review in triage, the RN shall immediately contact the appropriate department when indicated and document the name and title of the licensed clinician notified and the date and time of notification on the CDCR 7362.
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Copy and deliver/forward requests for services for more than one area (e.g., medical, mental health, and dental) to the requested service areas as soon as possible.
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On non-business days:
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All CDCR 7362s shall be sent to the Triage and Treatment Area (TTA) RN for review and triage.
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Upon receipt of the CDCR 7362s, the TTA RN shall follow the procedure set forth in Section (c)(2)(B)3.a.2)a)-b) and d)-g) each.
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The TTA RN shall determine whether the patient requires emergent, urgent, or routine care and shall take direct action to coordinate care for patients with emergency or urgent conditions.
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The TTA RN shall ensure that the routine CDCR 7362s are delivered to the PCRN that is assigned to that patient by the beginning of the next business day.
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Emergency Care Required
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Patients with life-threatening medical symptoms shall receive immediate medical attention pursuant to the Health Care Department Operations Manual (HCDOM), Chapter 3, Article 7, Emergency Medical Response.
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The PCRN shall ensure immediate transportation of the patients to the designated area for evaluation and treatment.
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For patients with a potential mental health or dental emergent condition during normal business hours, the PCRN shall immediately assess the patient and communicate findings directly with designated mental health or dental staff.
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Patients with a potential mental health emergency (e.g., danger to self or others or significant impairment or dysfunction due to mental disorder) shall remain under continuous observation until the patient is evaluated by a mental health clinician or by TTA medical staff.
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When a patient is referred to the mental health program, the CDCR 7362 shall be forwarded, and a Mental Health Consultation ordered by the PCRN.
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Urgent Care Required
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Patients with urgent medical symptoms shall be scheduled for a same day face-to-face encounter with the PCRN and other members of the Care Team as indicated by symptoms.
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Any dental or mental health needs that are deemed urgent may be directly referred to the appropriate clinicians for evaluation, as availability allows.
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In such cases, the RN shall immediately contact the appropriate department and document the name and title of the licensed clinician notified and the date and time of notification on the CDCR 7362.
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The referral shall also be documented in the health record.
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For patients with urgent symptoms involving more than one clinical discipline, the PCRN shall ensure any urgent medical, dental, or mental health conditions are evaluated.
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Symptoms One Business Day Required
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The PCRN, using clinical judgement, shall assess any patient who describes symptoms or a potentially harmful situation within one business day.
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If symptoms or conditions are consistent with a standardized procedure, the PCRN shall implement the interventions within the standardized procedure.
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If the symptoms or conditions are not consistent with a standardized procedure, the PCRN shall determine (based upon their clinical judgement) the need for co-consult with the PCP to meet the needs of the patient.
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In addition to the required documentation by the PCRN, the PCP shall document the communication with the PCRN and the medical plan of care in the health record preferably on the day the co-consultation occurs. The PCP shall assess whether an in-person PCP evaluation or follow up are clinically necessary.
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SUD Requests One Business Day Required
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The PCRN shall assess any patient who submits a CDCR 7362 related to SUD that is not emergent or urgent within one business day.
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If the SUD request is emergent or urgent, follow sections above (Emergency Care Required or Urgent Care Required).
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The PCRN may co-consult with the PCP and if needed, co-consult with the Addiction Medicine Central Team.
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Asymptomatic Requests
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The PCRN shall separately address routine CDCR 7362s that do not include symptoms or a potentially harmful situation within 14 calendar days, routing them to appropriate staff or, if clinically indicated, have a face to face encounter with the patient.
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CDCR 7362 requests for programs (dental, mental health, etc.) that do not describe symptoms shall be delivered the same day to the designated program representative on normal business days.
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PCP Referrals
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When the PCRN determines a PCP referral is necessary, the patient shall be seen based on the following timeframes:
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Emergency – immediately
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Urgent – within 24 hours
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Routine – within 14 calendar days
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Scheduling Strategies
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CCHCS staff shall use strategies such as open access, encounter consolidation, co-consultation, and collaborative planning of the clinic schedule to optimize access to medical services.
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Services that Require Appointments
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Health care encounters shall be considered appointments and shall be ordered and scheduled within the Electronic Health Record System including, but not limited to, the following encounter reasons:
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Episodic care encounters, including PCRN encounters and provider referrals.
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Well patient encounters.
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Chronic care follow-up appointments.
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Specialty services.
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Care management encounters.
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Interdisciplinary treatment planning sessions.
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Recurring patient monitoring or follow-up appointments, such as dressing changes and blood pressure checks.
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Injection appointments.
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Public health screening and treatments.
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Patient education and non-adherence counseling.
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Special situations such as hunger strike evaluations and monitoring.
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Follow up after return from a higher level of care.
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Health care grievances.
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Release Planning – Care Coordination.
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In the event a patient transfers to another institution, the receiving Care Team shall ensure that existing health care appointments, including specialty referrals, are reordered at the receiving institution as indicated. All members of the Care Team shall ensure that follow-up appointments are continued in Cross Encounter Reconciliation including, but not limited to, the following:
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TTA encounters.
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Receiving and Release intake.
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Discharge from a higher level of care.
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Integrated Substance Use Disorder Treatment (ISUDT) Behavioral Health appointments.
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Chronic Care PCP appointments.
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Addiction Medicine Central Team orders.
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Translation Services
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Translation services, including sign language, shall be made available to patients as necessary via certified bilingual health care staff, certified bilingual CDCR staff, or by utilizing a certified interpretation service. Each institution shall maintain a contract for certified interpretation services pursuant to the HCDOM, Section 2.1.2, Effective Communication Documentation.
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Scheduling
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General Requirements
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Health care staff shall:
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Communicate to custody staff no later than one business day prior to the scheduled encounter.
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Minimize scheduling conflicts for patients, including avoiding conflicts between health care appointments and other programming such as visitation, Board of Parole Hearings (BPH), and school or job assignments by using the Consolidated Patient/Provider Calendar.
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Each institution shall establish a procedure by which health care ducats are issued as priority ducats and delivery by custody is verified and documented. This procedure shall include the following:
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The method by which priority health care ducats are delivered to each patient.
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The individual responsible for issuing priority health care ducats.
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Verification by custody staff that the priority health care ducats were issued to the patient.
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A method of re-routing priority health care ducats to patients and documentation of the re-routing.
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The patient is responsible to report to the health care appointment at the time indicated on the priority health care ducat.
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Developmental Disability Program or Disability Placement Program designated patients shall be provided specific instruction regarding the time and location of their scheduled appointment. The custody staff delivering the priority health care ducats shall communicate effectively and appropriately based upon the patient’s ability to understand to ensure that the patient arrives at the designated appointment location
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Custody staff shall deliver priority health care ducats to patients prior to their scheduled appointment.
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Failure to Report for a Medical or Dental Appointment
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If the patient (including patients who are in the Mental Health Services Delivery System [MHSDS]) fails to report to a scheduled medical or dental appointment, the assigned health care access clinic officer shall immediately contact the designated housing unit, or work or program assignment to locate the patient and have them escorted or have the patient report to the scheduled medical or dental appointment.
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Custody staff shall locate the patient and escort the patient to the appointment or direct the patient to report to the scheduled medical or dental appointment. If necessary, custody staff shall order the patient to comply with the instructions on the priority ducat.
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If the reason the patient did not report as ducated was beyond the patient’s control (e.g., out to court), custody staff shall advise health care staff of this fact. Health care staff shall document the cancellation and reorder, if clinically necessary.
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If the patient continues to refuse, custody staff shall advise the patient that they are in violation of Title 15, Section 3014, Calls and Passes, which states “Inmates must respond promptly to notices given in writing, announced over the public address system, or by any other authorized means.”
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If the reason the patient did not report as ducated was due to the patient refusing to report as directed, custody staff shall escort the patient to the health care area for health care staff to discuss the implications of refusing health care treatment. Licensed health care staff shall counsel the patient and have the patient sign the CDCR 7225, Refusal of Examination and/or Treatment if the patient continues to refuse treatment after the counseling. The CDCR 7225 shall be filed in the health record.
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Patients who are insistent in their refusal to report shall not be subject to cell extraction or use of force to gain compliance with the priority health care ducat. In these instances, licensed health care staff shall respond to the patient’s housing unit to provide the necessary patient education regarding the refusal. Custody staff cannot accept refusals on behalf of the patient, nor can refusals be taken over the phone.
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The reason for the failure to report shall be documented by health care staff in the health record.
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Custody staff may issue a CDC 115, Rules Violation Report, if the patient refuses to present to the clinic.
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Medical appointments shall be rescheduled as clinically indicated.
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Dental appointments shall be rescheduled according to the HCDOM, Section 3.3.5.1, Priority Health Care Services Ducat Utilization.
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Failure to Report for a Mental Health Appointment
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If a patient in the MHSDS refuses to report for a mental health appointment in person, custody staff shall not complete a CDC 115 or a Counseling Only Rules Violation Report (formerly known as a CDCR 128A, Custodial Counseling Chrono).
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Refer to the CDCR Mental Health Services Delivery Systems Program Guide and current mental health policies for additional procedures regarding mental health appointment refusals.
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Lockdown and Other Security Concerns
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Health care services shall continue to be provided during alarms or incidents not occurring on the impacted clinic yard. For alarms or incidents occurring on the clinic yard, clinic services shall resume as soon as safely possible during and following the alarms or incidents.
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During a facility or prison lockdown, health care staff shall coordinate with custody staff to facilitate continuity of care. Custody personnel shall escort patients to scheduled clinic appointments; lockdown shall not prevent the completion of critical functions such as medication administration and scheduled or unscheduled health care appointments in or out of the institution.
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A system shall be maintained to provide patient access to health care services in restricted housing units and facilities or housing units. Access to health care services shall continue to be managed by the CDCR 7362 process and shall be accomplished via health care staff alerting all patients of the collection of the CDCR 7362 when entering a housing unit for the purpose of retrieving completed CDCR 7362s. This shall be done at least daily in each restricted housing unit and in any housing unit where patients are confined to their cells or the building and have no ability to submit access to care requests. The collection of the CDCR 7362 shall be documented by health care staff in the housing unit logbook.
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Security Precautions During Health Care Encounters
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Health care encounters shall be provided in a manner that affords both auditory and visual confidentiality consistent with security and safety concerns of patients and health care providers.
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Health care staff shall carry a whistle and, where available, a personal alarm and position themselves to have a clear egress route from the treatment room while performing assigned duties.
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Health care screenings, evaluations, interviews, and treatment shall be held in a private setting unless the security of the institution or safety of staff will be compromised, or unless health care staff in the presence of the patient requests the presence of custody staff. As a default, custody staff are not required during a health care encounter with a patient who is not maximum custody or whose current behavior does not present a threat to the safety of staff or other patients.
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A patient shall not be placed in mechanical restraints during a health care encounter unless they are a safety concern for staff or others as determined by custody staff. For mental health treatment, the use of mechanical restraints shall comply with existing mental health policies.
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Health care staff may ask custody staff to leave the room if they are comfortable with the patient and custody staff shall respect the request of health care staff and leave the room.
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If health care staff asks custody staff to exit the room and leave the door propped open, custody staff shall be in control of the door to remain in compliance with State Fire Marshall requirements.
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A treatment module shall be utilized for the duration of encounters with patients who are a safety and security risk. For patients receiving treatment as a part of the MHSDS and requiring the use of a module for safety and security risks, a therapeutic treatment module shall be utilized.
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Upon removal of the mechanical restraints, the front port on the module shall be closed during the encounter.
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Health care staff shall not put their face in or near the opening of a cuff or food port.
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If it is necessary to perform a procedure, the patient shall be removed from the treatment module and placed in waist restraints while being treated outside the module.
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When health care staff are in housing units or on the tiers, custody staff shall maintain visual surveillance.
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Visual surveillance shall not interfere with the privacy of the encounter except for cell front medication distribution.
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When unscheduled clinical encounters need to occur within a housing unit, health care staff shall conduct the encounter in a confidential setting with custody staff maintaining visual observation when necessary.
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Clinic Closure or Cancellation of Scheduled Appointments
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Any modification of clinic hours, clinic closure, and cancellation or rescheduling of scheduled appointments requires the approval of the CEO or a designated clinical executive.
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Timeframes
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Under the Complete Care Model, the goal of all Care Teams is to provide timely access to care and to allow immediate access to necessary services.
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To ensure that patients are not exceeding acceptable thresholds for timely care, access to care timeframes shall be viewed as the maximum allowable timeframe that a patient may be seen and not as a guideline for scheduling.
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Scheduling Support Staff shall set appointments several days in advance of the acceptable threshold.
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Patients with chronic conditions shall have follow-up encounters according to the timeframes in the applicable care guides. If there is no applicable care guide, the follow-up shall be as ordered or no less frequently than every 365 days.
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For follow-up appointments with the PCP after specialty services, refer to the HCDOM, Section 3.1.11(c)(7).
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Patients discharged to an outpatient setting from the TTA who experienced a high-risk event including, but not limited to, suspected drug overdose that responded to naloxone resuscitation or skin/soft tissue infection shall be seen by their PCP within five calendar days of discharge from the TTA.
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Patients discharged to an outpatient setting from the TTA who did not experience a high-risk event, which led to the TTA encounter and do not require PCP follow up within five calendar days, shall be seen by their PCRN or PCP within timeframes that are clinically indicated.
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Patients discharged to an outpatient setting from an unplanned community hospitalization or emergency department encounter, or from a CDCR specialized medical bed stay not related to a mental health crisis or PIP stay shall be seen by their PCP within five calendar days of discharge.
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Patients in the MHSDS shall be scheduled for appointments in accordance with the Mental Health Program Guide and current mental health policies.
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Patients screened positive for SUD with a National Institute on Drug Abuse Quick Screen, or otherwise determined to need completion of SUD assessment shall be referred for an ISUDT Behavioral Health assessment within the following timeframes:
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Patients rapidly induced on medication-assisted treatment (MAT) medications shall be seen within seven calendar days.
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Patients identified in all other circumstances shall be seen within 30 calendar days.
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Patients with a completed SUD assessment indicating Opioid Use Disorder or Alcohol Use Disorder shall be seen by a provider within 30 calendar days for evaluation for MAT.
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Patients releasing to the community who require pre-release care coordination shall have follow-up appointments as dictated by the Earliest Possible Release Date. Refer to the Whole Person Care – Community Discharge Planning/Pre-Release Workflow.
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Patients induced on a MAT medication shall be seen for a Post Induction MAT Medication Evaluation.
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In the outpatient setting, patients shall have MAT Medication Evaluation completed by an RN, Licensed Vocational Nurse, or Licensed Psychiatric Technician within three calendar days post induction.
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In the inpatient setting, patients shall have MAT Medication Evaluation completed by an RN on the day after the induction.
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Scheduling Queues and Building the Clinic Schedule
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Health care staff shall place orders for appointments that need to be scheduled, which will flow into various request queues in the scheduling system. Scheduling Support Staff are responsible for monitoring the appropriate request queue for each Care Team and clinic location daily with particular focus on scheduling appointments for patients within several days of the relevant threshold date.
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Increasing Patient Show Rates and Clinic Efficiency
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When scheduling patients, health care staff shall consider patient preferences regarding access, such as providing appointment times that do not interfere with the patient’s existing health care appointment and the patient’s assigned programming (e.g., BPH, job, school, or other rehabilitative programming).
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Recurring Appointments
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Scheduling Support Staff shall use the recurring appointment function when a provider or clinician’s order will result in a series of appointments with a specified frequency.
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Rescheduling
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Scheduled appointments shall be rescheduled as needed, and efforts shall be made to reschedule within the original order compliance date.
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Cancelling Orders for Appointments and Scheduled Appointments
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Health care staff are prohibited from cancelling or discontinuing orders for appointments and scheduled appointments from the scheduling system unless there is documentation explaining the reason for cancellation, and the health care staff are authorized to perform cancellations.
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Tracking “Reasons Not Seen”
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Health care staff shall record and track reasons that patients are not seen as scheduled. Health care staff shall use the standard “Reasons Not Seen” as listed in the scheduling system.
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Confirmed Appointments Already Seen
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The Primary Care Scheduler, or designee, is responsible to contact members of the Care Team to obtain any missing information or address discrepancies.
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Open Access
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Institutions shall use open access slots to ensure that patients are seen in an efficient manner, in a clinically appropriate setting, and within all mandated timeframes. Approximately 20 percent of Primary Care Clinic appointment slots shall remain open and available for same-day or next-day urgent clinical issues or appointments with short, mandated timeframes.
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Primary Care Clinics shall designate specific times each day as open access times for the Care Team.
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During daily huddles, the Care Team shall identify patients that need to be scheduled into the same-day or next-day open access times and ensure that this information is communicated to the Scheduling Support Staff if they are not present at the huddle.
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Appointments that may be appropriate for open access slots include, but are not limited to, the following:
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Follow-up on abnormal diagnostic results or other critical abnormal clinical findings.
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Return from higher level of care follow-up.
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TTA follow-up.
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High priority specialty referral follow-up.
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High-risk or complex patients new to the Care Team.
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Patients whose condition has become clinically complex.
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Other urgent referrals.
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If open access slots remain available even after all urgent follow-ups are addressed, these slots may be used to schedule other routine appointments.
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Except for certain clinics (e.g., Restricted Housing Unit) where patient need and health care staff coverage may vary, clinic schedules shall be booked 14-30 calendar days out (except for “Open Access” slots).
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Encounter Consolidation (Bundling)
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To increase clinic efficiency and timely access, Scheduling Support Staff shall review all pending appointments for possible bundling and discuss with the Care Team at the daily huddle to determine the total time required for the patient.
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Co-Consultation
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Throughout the day, the Care Team shall look for opportunities to collaborate using co-consultation strategies to resolve issues in one encounter that would likely result in a referral to another member of the Care Team, thus eliminating the need for the patient to return to the clinic for a second time.
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Provision of Additional Health Care Staff During Examinations
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An additional health care staff shall be present during all examinations of patients involving genital, rectal, or breast examinations.
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Upon patient request, an additional health care staff may be present during other examinations.
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Appendices
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Appendix 1: Appointment Timeframes
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References
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Code of Federal Regulations, Title 45, Parts 160 and 164. Health Insurance Portability and Accountability Act
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California Code of Regulations, Title 15, Division 3, Chapter 1, Subchapter 4, Article 2, Section 3270, General Policy
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California Code of Regulations, Title 15, Division 3, Chapter 1, Article 1, Section 3014, Calls and Passes
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Health Care Department Operations Manual, Chapter 2, Article 1, Section 2.1.1, Patients’ Rights
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Health Care Department Operations Manual, Chapter 2, Article 1, Section 2.1.2, Effective Communication Documentation
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Health Care Department Operations Manual, Chapter 3, Article 1, Section 3.1.6, Population and Care Management Services
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Health Care Department Operations Manual, Chapter 3, Article 1, Section 3.1.9, Health Care Transfer
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Health Care Department Operations Manual, Chapter 3, Article 1, Section 3.1.11, Outpatient Specialty Services
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Health Care Department Operations Manual, Chapter 3, Article 7, Emergency Medical Response
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California Department of Corrections and Rehabilitation, Mental Health Services Delivery System Program Guide
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Agency for Healthcare Research and Quality – Patient Centered Medical Home Resource Center, https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/index.html
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The Joint Commission Primary Care Medical Home Certification, http://www.jointcommission.org/accreditation/pchi.aspx
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National Committee for Quality Assurance – Patient-Centered Medical Home Recognition, http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx
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Revision History
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Effective: 06/2016
Revised: 05/19/2025 -
Appendix 1
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Scheduling Timeframes
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