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Guidelines for Discharging Patients [Updated 1/7/08] DISCHARGE REQUESTS. All requests to discharge patients for non-compliance in any of the three identified categories - - patient attendance, clinical (including violation of Controlled Substances Agreements) or behavioral must be submitted in writing and forwarded to the Practice Supervisor where the patient receives services. The Practice Supervisor will investigate the request and execute the appropriate procedure(s) that are listed further in this handout. If the circumstances of a case are particularly complex, the Practice Supervisor, at her/ his discretion, may consult with the E/TFHC’s Director of Quality and Disease Management for additional review and feedback. In such instances, the Quality Director will also investigate the matter. Collectively, those administrators will determine the course-of-action to take: 1) If the request has merit based upon the content of this policy, both the Practice Supervisor and the Quality Director will sign the request and the Practice Supervisor will execute the actions listed below. 2) If the request is denied, the following administrative staff will meet with the Quality Director and the Practice Supervisor to determine a course-of-action for the patient-in-question: a) Attendance Non-compliance: Executive Director b) Clinical Non-Compliance: Medical Director + attending Provider c) Behavioral Non-Compliance: Executive Director STEPS IN NOTIFYING/DISCHARGING PATIENTS. Based upon the circumstances of the request, the following steps should occur when notifying a patient at he/she is being discharged: 1) The appropriate written notice (i.e., letter) will be generated and forwarded to the patient via registered mail (i.e., requiring a return signature upon receipt). Please note that depending upon the issue for which the patient is being discharged - - i.e., attendance, clinical or behavioral - - several levels of notification can occur before the final discharge letter is sent (see Policy AD 113 “Discharging Patients.”) 2) A copy of the letter should be filed in the patient’s chart. 3) If the patient has been sent a discharge letter, the following actions will occur: a) The patient’s “discharged” status will be recorded in the patient’s medical record (Medmate) under area “f8” of the patient demographic screen as well as the effective date and the reason for discontinuing services. b) All future non-emergent appointments will be cancelled. c) A memo or e-mail will be sent to the Practice Supervisors or Office Coordinator’s at every E/TFHC clinical site regarding the patient’s status (please refer to item 3.a. below). 1. d) Receipt of the Post Office’s signed notice will be filed in the patient’s Medical Record, (i.e., paper copy) as well as noted in area f8” of the patient demographic screen of the patient’s MedMate record- - i.e., the date the notice was received. e) If the notice is returned without signature by the Post Office, the unopened letter and envelope will be filed in the patient’s medical record. f) If the patient contacts the office at a later date, after confirming the identity of the patient, he/she will be verbally informed of his/her discharge. In addition, a second copy of the discharge letter will be sent via registered mail. g) All discharged patients will have direct clinical services discontinued as of the date of the notification letter and patients’ clinical practitioners only will provide urgent care services, if needed, for up to thirty (30) days of the date of the notification letter. The E/TFHC’s Executive Director must approve any exceptions to this procedure. ADDITIONAL CONSIDERATIONS. 1) Once a patient has been discharged from one E/TFHC service location, he/she will be considered to have been discharged from all E/TFHC locations. The Practice Supervisor/Office Coordinator who forwards the patient his/her discharge letter is also responsible for notifying all other E/TFHC service locations of the patient’s termination status. 2) If a patient has been discharged from the E/TFHC for non-compliance as outlined in this policy, and he/she requests to become an active patient again, he/she MUST meet with the Practice Supervisor of the Health Center involved before being reinstated. In such instances, the Practice Supervisor will, prior to meeting with the patient, meet with the patient’s most recent provider, the E/TFHC Medical Director and the Executive Director to review the request and make a determination regarding the request. Prior to the patient becoming “active” again, the patient, in writing, must agree to a contract that outlines the E/TFHC’s expectations and contingencies for remaining an active patient going forward. 2. PATIENT DISCHARGE REQUEST Patient Name: Pt. No: Within the next five (5) business days, please take the following action with the above-named patient Action Reason(s) 1. Non-Compliance: Patient Attendance guidelines Send First Notification (letter re: items, 1, 2 or 3) 2. Non-Compliance: Behavioral Send Second Notification (letter re: items 1 or 3) 3. Non-Compliance: Clinical/Medical Send Letter re: Discontinuation of Pain Management Tx. 4. Non-Compliance: Controlled Substances Agreement Send Letter re: Discharge from E/TFHC. 5. Other (please explain below) DETAILS I. DESCRIPTION of SITUATION: (if needed) Staff Member Site Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Reviewed By: Practice Supervisor Site Date Reviewed By: Director of Quality & Disease Management Site Date Action(s) Taken Request Approved. First / Second Letter re: sent on: Request Approved. Discontinuation of Pain Management Tx Letter sent on: Request Reviewed and Forwarded to Director of Quality & Disease Management on: Request Approved. Discharge Letter sent on: [Note: Please use back of form to note additional information; please attach any pertinent documentation] 3.
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