Guidelines for Discharging Patients by liuqingyan


									              Guidelines for Discharging Patients
                                                                                             [Updated 1/7/08]

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

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

        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).

      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.


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.


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)



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]


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