Download 2014 Residency Policy Manual

Mission Statement
Last Revision & Review: 6/10/14
To Increase the Quality of Primary
Care for Arkansans by Training
Health Care Professionals
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Goals and Objectives for the Family Medicine Residency Program
Goal 1:
The overarching goal for our UAMS AHEC NE family
Medicine Residency is preparing family medicine residents to become
competent, independent family physicians capable of practicing current,
evidence based medicine for families in Northeast Arkansas, the state of
Arkansas, and beyond.
Objectives

Recruit excellent students to be a part of our program.

Begin recruitment in a “pipeline” fashion starting in high school,
continuing in college, and focusing on medical schools to assure good
applicants for our program.

The program will maintain close relationships with all graduates
through personal communication, e-mail, phone consults, and surveys.

The program will be knowledgeable of honors, board appointments,
leadership activities, and excellence of practice of our graduates.

The program will track achievements of Board certification of all
residents.
Goal 2:
Our program will provide a safe, excellent environment for
the teaching of Family Medicine.
Objectives







Faculty will not teach by intimidation or humiliation of students or
residents (UAMS Policy).
Faculty and staff will not tolerate harassment based on sex, age,
gender, religion or sexual preference.
The program will provide adequate salary, work space,
encouragement, and strict adherence to duty hours for all residents.
The program will provide excellent opportunities for education in all
areas of medicine that pertain to family medicine.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Goal 3:
Our program will provide excellent educational opportunities
for students, residents, and all learners involved in the program.
Objectives

The program will provide necessary IT equipment (i.e. computer,
printers, internet access, etc.) for residents, students, and faculty.

The program will provide libraries (clinic and comprehensive) with
pertinent books, journals and educational materials. It will have a full
time librarian and have the ability to get articles, provide searches, and
obtain other educational literature (monographs, CDs, books) for all
learners.

The program will strive to have a comfortable “family” relationship
including residents, faculty, administration, nursing staff, and business
office. This will be encouraged by daily contact at noon conferences
and daily report. Also with clinic staff meetings, meeting with hospital
administration, monthly combined meetings (residents, faculty, and
staff), with monthly Residency Director and Assistant Residency
Director and residents.
Goal 4:
Our program will provide excellent faculty with a variety of
skills and expertise to train our residents.
Objectives

The program will provide salary, vacation, CME, and encouragement
for our full and part time faculty.

The faculty will include diverse skills and training (MD, DO, PharmD D,
physician extenders, and other educators).

The program will provide opportunities both time and financial
resources to ensure faculty development on four levels.
1.
Individual activity
2.
Group (local) activity
3.
State wide
4.
National (AAFP, STFM, SMA, PDW, RPS).
1. The program will provide opportunity and facilitate research and
scholarly activity for all full-time faculty.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Scope of Practice for the Family Medicine Residency Program
Purpose: Quality graduate medical education can occur only in settings
characterized by the provision of quality medical care. Learners at the
UAMS AHEC Northeast Family Medicine will learn in an environment
epitomized by the highest standards of patient care.
Policy:
 The physician of record is responsible for the quality of all the clinical
services provided to his or her patients.
 All clinical services provided by the resident will be supervised
appropriately to maintain high standards of care, safeguard patient
safety, and ensure high quality education.
 The resident will be given graduate responsibility and will demonstrate
progression through the training program, demonstrating the capability
to practice independently prior to graduation.
 Supervision requirements for Family Medicine residents are specified
for invasive and non-invasive procedures at each PGY level.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Scope of Training: Goals and Objectives of the Residency Training Program
At the completion of training the graduate should be a family physician who will
be able to provide primary, continuing, comprehensive health care to all
members of families, regardless of age, gender or disease process, by gathering
essential and accurate information and combining it with up-to-date scientific
evidence to make decisions about diagnostic and therapeutic interventions. He or
she will accomplish this using medical information resources available in text and
online form as well as using available consultants. This will be monitored through
ongoing assessment throughout training and post graduation surveys.
At the conclusion of the Family Medicine Residency Program the graduate will
have been given the opportunity to:
1. Function as the physician of first contact, to be an expert in dealing with
undifferentiated problems, to be proficient in sensing medical problems, and
skillful in inductive medical problem-solving, and frugal in the use of resources
for diagnosis and treatment. This will include the use of “best practices”, and
functioning in the context of a larger health system and society. Evaluation:
the residents’ management of patients presented during the working day as
well as during after hours care.
2. Demonstrate competency in the diagnosis and management of common
types of medical problems and illnesses such as present in the ambulatory
setting. These include the most frequently seen illnesses in primary care, life
threatening diseases, and early recognition of high risk conditions and serious
illnesses needing more specialized care. Evaluation: ongoing chart review,
demonstrated use of existing protocols and best practices, daily assessment
by clinical faculty, and assessment of performance in the FMC.
3. Demonstrate the knowledge and ability to recognize causal relationships of
illnesses and the influence of lifestyle as well as the interaction of lifestyle and
genetics. The graduate will demonstrate proficiency in patient education and
counseling regarding lifestyle changes. Evaluation: daily practice assessment
and close clinical observation.
4. Manage the non-biomedical care of the patient with chronic illness. This care
will include counseling and assistance with lifestyle changes to minimize the
impact of harmful lifestyle choices on the disease state as well as dealing with
the end-of-life issues surrounding the terminal nature of certain chronic
diseases. Evaluation: daily practice assessment and close clinical
observation.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
5. Make informed decisions about diagnostic and therapeutic interventions
based on patient information and preferences, up-to-date scientific evidence,
and clinical judgment and develop and carry out patient management plans
appropriate to the patients disease process, need for preventive services, and
high risk behavior. Evaluation: daily practice assessment.
6. Apply epidemiological, clinical, and operational research to clinical decisionmaking. As part of their own practice they should be able to recognize and
define informational needs and implement change based on best available
evidence into their practice. Evaluation: preparation of an evidence-based
presentation in the third year and through ongoing chart review.
7. Demonstrate the fundamental qualities of professionalism: integrity, respect
for the patient, regard to the patient’s wishes, and responsiveness to the
needs of the patient that supersedes self-interest. This is to be done in a
manner that reflects sensitivity to the patient’s cultural background and
desires. Evaluation: This will be assessed throughout the training process as
a part of the longitudinal behavioral science curriculum. Direct observation of
patient interactions in clinic and in-patient setting, and review of information
presented at noon conferences.
8. Demonstrate competency in the use of the computer to manage information,
access online information, and support clinical care. Evaluation: one-on-one
demonstration of these proficiencies at various points during the training.
9. Develop and maintain that particular type of doctor/patient relationship
necessary in family medicine. This relationship is characterized by a
continuing, personal intense relationship in which the physician cares for the
patient as a person and member of a family system, and manages a broad
range of problems of concern to the patient in which the family physician acts
as a therapeutic agent. Evaluation: This ability will be assessed throughout
the training process as a part of the longitudinal behavioral science curriculum
and direct observation of interactions in clinic and in-patient settings.
10. Demonstrate skills in collecting and utilizing data on the family genetic
pedigree in managing the patient, family, and community. Evaluation: direct
measurements by the in-training exam as well as assessment of clinical
documentation, focused review on episodes of patient care where this is most
pertinent (such as prenatal visits, and counseling regarding cardiovascular
and cancer risk.
11. Function within the larger health system. This includes use of costeffectiveness and case management techniques, appropriate use of
diagnostic studies and therapeutic procedures, and ordering within the
constraints of the individual patients’ and society’s resources. Evaluation:
monitoring attitude and skills as documented throughout training as well as
participation in meetings, forums, and other venues as assigned.
12. Provide care as a family physician in the setting of his or her choice. The
graduate will demonstrate knowledge of the variety of practice situations
available and the risks and benefits involved with each. The graduate will
define personnel, legal and ethical issues which are common to a medical
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
practice regardless of the individual practice situation. Evaluation: resident
and post-graduation surveys.
13. Implement and provide for staff adherence to proper documentation of care
and storage/access to protected health information. This includes proper
charting for medical, reimbursement, and legal purposes, as well as
management of patient specific information, patient privacy and
confidentiality, and maintenance of quality. Evaluation: This will be monitored
throughout the residency through chart review, mentoring, directed feedback
and graduation and post-graduate surveys. The graduate will demonstrate
competency in using Electronic Health Records.
14. Function effectively in the broader practice community. These issues include
dealing with family and work related concerns, maintaining a doctor-patient
relationship while not being constantly available, working with physicians of
Family Medicine specialty as well as other specialties, and maintenance of
the clinical database and recertification. Evaluation: graduation surveys,
postgraduate surveys, and ongoing review and rotation feedback from
collaborating preceptors and faculty mentors
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Level of Care Which Can be Provided by Residents in their PGY- I Year
This encompasses the period of time from entrance into the program until
judged capable of performing at the level of PGY-II based on the
requirements of the AAFP, performance on rotations, and direct personal
observations of supervising residents and faculty.
Clinical Diagnosis Management
 Perform and documents history and physical
 Develop a differential diagnosis
 Develop and document diagnostic strategy
 Develop and document a treatment plan
 Order diagnostic test+
 Order medications+
 Order appropriate consults+
Clinical Non-Invasive Management
 Perform complete and focused physical exam
 Order and interpret blood tests
 Order and interpret imaging studies+
 Order invasive radiology studies
 NST/CST interpretation+
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Clinical Invasive

Repair simple laceration

Vent Management*

Skin Biopsy

Interpret EKG

Lumbar puncture*

Minor skin surgery*

Endotracheal
Intubation*

Remove foreign body from ear
and nose
Joint injection/aspiration*

Paracentesis*


I & D*

Vaginal exam*

Central line
placement*
Uncomplicated
pregnancy
management*
Induction of labor*

Sprain/fracture/dislocation
management*


Circumcision

Episiotomy repair+

Thoracentesis+
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Cryotherapy of
cervix*
Vasectomy+
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Endometrial biopsy+
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IUD Management+

Cervical biopsy+


Endocervical curette+

Chest tube
placement+
Frenulectomy of
Newborn+
OB Ultrasound+


st
1 assist at C-section+
Specific Settings for Evaluation and Management
Admission and/or management to regular floor
Evaluation and/or management in ED
Admission and/or management in Intensive care
Admission and/or management on Labor and Delivery+
Admission and/or management of uncomplicated newborn+
Evaluation and/or management in FMC+
*A faculty physician or qualified upper level must be present physically or immediately available during the key
portions of the procedure/surgery.
+Resident will gradually be awarded increasing independence from close supervision based in observation of
performance and completion of performance objectives.
Level of Care Which Can be Provided by Residents in their PGY- II and III
This encompasses the period of time from completion of the PGY-I
experience until judged capable of performing at the level of Board eligible
Family Physician based on the requirements of the AAFP, performance on
rotations, and direct personal observations of supervising residents and
faculty. Residents will be promoted to a PGY-III level when they have
completed the requirement of the PGY-II year as well as have
demonstrated increasing maturity and movement towards mastery of the
core attributes of a Family Physician as identified above.
Clinical Diagnosis Management
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Perform and document history and physical
Develop a differential diagnosis
Develop and document diagnostic strategy
Develop and document a treatment plan
Order diagnostic tests
Order medications
Order appropriate consults
Clinical Non-Invasive Management



Perform complete and focused physical exam
Order and interpret blood tests
Order and interpret imaging studies
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM

Order invasive radiology studies**
Clinical Invasive

Repair simple laceration

Vent Management+

Skin Biopsy

Minor skin surgery

Endotracheal
Intubation*

Interpret EKG

Lumbar puncture+

Remove foreign body from ear
and nose
Joint injection/aspiration

Paracentesis+


I & D*

Sprain/fracture/dislocation
management*


Vaginal exam*

Circumcision

Central line
placement+
Uncomplicated
pregnancy
management
Induction of labor**

Cryotherapy of cervix+

Colposcopy+

Episiotomy repair+

Thoracentesis+

Vasectomy+

Endometrial biopsy+

Chest tube placement+

IUD management+

Cervical biopsy+


Endocervical curette+

Frenulectomy of
Newborn+
OB Ultrasound+

1st assist at C-section+

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Tubal ligation+

Primary surgeon Csection+
Specific Settings for Evaluation and Management
Admission and/or management to regular floor
Evaluation and/or management in ED
Admission and/or management in Intensive care
Admission and/or management on Labor and Delivery**
Admission and/or management of uncomplicated newborn
Evaluation and/or management in FMC+
*A faculty physician or qualified upper level must be present physically or immediately available during the key
portions of the procedure/surgery.
**The resident will maintain close contact with the attending physician regarding patient’s clinical course.
Attending physician will be immediately available for consultation.
+Resident will gradually be awarded increasing independence from close supervision based in observation of
performance and completion of performance objectives.
Level of Care Which can be Provided by Graduates of Residency Program
Performance at this level of care is a minimum for all graduates of our
program. Additional skills may have been acquired during residency and
should this be the case additional documentation should be provided.
Clinical Diagnosis Management







Perform and document history and physical
Develop a differential diagnosis
Develop and document diagnostic strategy
Develop and document a treatment plan
Order diagnostic tests
Order medications
Order appropriate consults
Clinical Non-Invasive Management




Perform complete and focused physical exam
Order and interpret blood tests
Order and interpret imaging studies
Order invasive radiology studies**
10
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Clinical Invasive

Repair simple laceration

Vent Management

Skin Biopsy

Minor skin surgery

Interpret EKG

Lumbar puncture+

Endotracheal Intubation

Remove foreign body from ear
and nose
Joint injection/aspiration

Paracentesis

A-line placement+

Central line placement

I&D

Sprain/fracture/dislocation
management


Vaginal exam

Circumcision

Uncomplicated
pregnancy
management
Induction of labor

EGD+

Colposcopy

Colonoscopy+

Episiotomy repair

Thoracentesis+

Vasectomy+

Endometrial biopsy


Nasopharyngoscopy+

Cervical biopsy


D & C+

Endocervical curette

Chest tube
placement+
Frenulectomy of
Newborn
OB Ultrasound+
Primary surgeon Csection+

IUD Management+


st
1 assist at C-section

Specific Settings for Evaluation and Management
Admission and/or management to regular floor
Evaluation and/or management in ED
Admission and/or management in Intensive care
Admission and/or management on Labor and Delivery
Admission and/or management of uncomplicated newborn
Evaluation and/or management in FMC
+Graduate should show evidence of additional training
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Resident Administrative Responsibilities by Year
PGY-I
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Successfully complete USMLE Step II
Successfully complete NRP, ACLS and BLS before starting residency
Complete health work and provide paperwork necessary
Find out about all schedules, clinic, rotation, and call (prior to start of scheduled
rotations)
Appear for duties promptly and dressed appropriately
Request vacation time from appropriate rotations 4 weeks in advance.
Upkeep of charts in both clinic and hospital EMR systems
Cover call at St. Bernards Medical Center
Recruiting
Meet with Program Director three times during PGY I year
Provide any and all necessary duties to insure smooth operation of program, clinic,
call and hospital service
Participate in didactic lectures (in both attendance and giving presentations when
called upon to do so)
Log duty hours and procedures in New Innovations tracking system
PGY-II











Provide copies of all licensure information to residency office
Request vacation time from appropriate rotations 4 weeks in advance
Upkeep of charts in both clinic and hospital EMR systems
Find out about all schedules: clinic, rotation and call (prior to start of scheduled
rotation)
Appear for duties promptly and dressed appropriately
Cover call for SBRMC, NEA/Baptist, and after hours clinic phone calls
Recruiting
Meet with Program Director two times during PGY II year
Provide any and all necessary duties to insure smooth operation of program, clinic,
call and hospital service
Participate in didactic lectures (in both attendance and giving presentations when
called upon to do so)
Log duty hours and procedures in New Innovations tracking system
PGY-III







Complete Step III
Request vacation time from appropriate rotations 4 weeks in advance
Upkeep of paperwork and charts in both the clinic and hospital EMR systems
Secure rotations for elective months
Find about all schedules: clinic, rotation and call (prior to the start of scheduled
rotation)
Appear for duties promptly and dressed appropriately
Cover call for SBRMC, back up the Intern and PGY II as needed
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM




Recruiting
Meet with the Program Director three times during PGY III year including exit
interview
Provide any and all necessary duties to insure smooth operation of program, clinic.
Call and hospital service
Log duty hours and procedures in New Innovations tracking system
13
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
ADMINISTRATIVE – GENERAL INFORMATION
ADVISORS (FACULTY)
NUMBER:
REVISION:
I-0200
4/3/12
ADVISOR (FACULTY):
DATE: 7/1/99
PAGE: 1 of 1
Each resident will be assigned a Family Practice faculty member on a 6 month
rotating schedule for the purpose of defining rotation goals, supervision and discussion of in-and-out patient
experiences. In the first year, the assigned faculty mentor will meet once a month with the residents followed by
periodic meetings. The faculty advisor will discuss resident performance with the assigned preceptor as needed.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE - GENERAL INFORMATION
NUMBER:
REVISION:
I-0300
4/3/12
BENEFITS:
House staff group benefits are provided by the program and include:
BENEFITS
DATE: 7/1/99
PAGE: 1 of 1
Malpractice Insurance
Basic Life Insurance [1 x monthly salary]
Basic Long Term Disability Insurance [$1000.00 per month as defined in coverage.]
Medical Insurance Plan [Resident no cost; spouse/family coverage through payroll deduction]
Dental Insurance available
Supplemental Retirement Account – SRA [payroll deduction, no employer matching, tax-sheltered option, TIAACref funds]
ACLS registration
NRP registration
ATLS registration
PALS registration
CME allowance [$1,000/$2,000/$2,000]
Challenger Resident Education Program
Jackets with laundry service
On-call and conference meals
15 work days vacation/year (must be approved 4 weeks in advance)
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-0400
CHIEF RESIDENT
CHIEF RESIDENT:
DATE: 7/1/99
PAGE: 1 of 1
The Chief Resident(s) is/are the administrative representative(s) elected by the residents
to serve as intermediary between residents and faculty for all resident suggestions and complaints. The Chief
Resident(s) reports to the Program Director and assists with residency administrative and disciplinary tasks.
The Chief Resident(s) is/are elected in February and serves as Chief Elect beginning in April.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
GENERAL INFORMATION
NUMBER:
REVISION:
I-0550
4/3/12
DRESS CODE:
DRESS CODE
DATE: 7/1/99
PAGE: 1 of 1
Manner of dress is left to the resident’s discretion and is informal only to the point where
it becomes less than neat or well kept. Blue jeans are not acceptable working attire. Scrubs are also
discouraged as routine working attire particularly when seeing patients in the FAMILY MEDICINE CENTER. (Teeshirts, sandals, etc., are not acceptable at any time). In the hospital and during rounds with your attending,
attempt to honor their wish since you will be seeing their patients. As with all other appearances, facial hair,
beards and mustaches should be kept neat. Professional jackets in your size are available in the residents’ office.
These will be laundered for you.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-0600
HOLIDAYS:
The UAMS AHEC Northeast office observes the following holidays:
HOLIDAYS
DATE: 7/1/99
PAGE: 1 of 1
New Year’s Day
Martin Luther King’s Birthday
President’s Day
Memorial Day
Independence Day
Labor Day
Veteran’s Day
Thanksgiving
Christmas Eve
Christmas Day
Officially, as a resident under contract, you do not have guaranteed holidays; however, unless you are
responsible for call duty you may have the holiday off when the clinic is closed. You should always discuss your
assigned attending’s expectations since all medical offices may not observe several of these holidays.
The American Board of Family Practice states that a resident will not be allowed more than 30 days per year
away from the residency without making up that time to be eligible to take the Board exam.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-0700
HOSPITALIZATION INSURANCE
HOSPITALIZATION INSURANCE:
DATE: 7/1/99
PAGE: 1 of 1
Plan benefits are QualChoice, the UAMS self-insured group policy. All
participants must enroll and select a PCP. Resident premiums are paid. Family coverage is available through a
payroll deduction.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-0800
ILLNESSES:
Any illness which will cause you to miss work should be reported to the Chief Resident(s) or
ILLNESSES
4/3/12
DATE: 7/1/99
PAGE: 1 of 1
Family Practice Coordinator who will in turn notify the Family Practice Director (or Assistant Family Practice
Director) and to the attending physician on your rotation as soon as you know you will be absent.
If you are scheduled for call or clinic, it will be your responsibility to arrange coverage by one of your
colleagues.
Reporting an illness should be made by the resident rather than through an intermediary. [See Leave]
20
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-0900
10/21/00
LIBRARY:
The UAMS AHEC Northeast Library is located on the first floor of the Annex Building adjacent to
LIBRARY
the Family Medicine Center.
DATE: 7/1/99
PAGE: 1 of 1
The library offers an extensive collection of monographs, journals, textbooks,
internet access, as well as interlibrary loan services. The residents may use the resources of the library free.
Library hours are 8 AM – 5 PM, Monday through Friday with a full-time librarian on-duty during these hours. A
resource library is also located in the Family Practice teaching corridor with many of the most frequently used
manuals available for reference during your clinics. Recommendations for acquisitions for either the library or
clinic resource area should be given to the Chief Resident.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-01000
MAIL
DATE: 7/1/99
PAGE: 1 of 1
MAIL: All mail addressed to the resident will be placed in the mail tray on the individual’s desk. Incoming mail
related to FMC patients should be taken care of promptly, and routed internally for action or filing. Note: As a
general rule, a copy for our files is made of all patient related material.
All patient related report should be initialed and dated to indicate your review. You should follow-up urgent or
complicated reports yourself. When giving directives to the nursing staff or business office personnel do so
verbally. A “sticky” note with instructions on the face of the chart is not acceptable.
Social security disability claims may be given to the insurance clerk with a request that pertinent data from the
medical record be copied. The resident should review all requests for copies of a medical record and decide what
will be sent.
The Insurance Clerk will complete all insurance forms (personal, group, Medicare, Medicaid).
Death Certificates MUST be completed within 48 hours of receiving and routed to the funeral home or coroner’s
office.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-01100
MALPRACTICE INSURANCE
DATE: 7/1/99
PAGE: 1 of 1
4/3/12
MALPRACTICE INSURANCE:
The University of Arkansas provides malpractice insurance through First
Professional Insurance/Care providers of UAMS.
The residency program pays for this occurrence policy
coverage. This policy only covers activities performed while working directly for the residency and under the
supervision of an Attending physician. This policy does NOT cover any work performed outside the UAMS AHEC
Family Medicine Residency. (See Moonlighting)
23
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-01200
10/10/01, 6/10/14
MATERNITY/PATERNITY LEAVE
MATERNITY/ PATERNITY/ ADOPTION LEAVE:
DATE:
7/1/99
PAGE: 1 of 1
Residents may request paid leave based on the
guidelines established by the American Academy of Family Physicians. Residents will be expected to make up
call so that their colleagues are not disadvantaged. This program will work with each individual to design a leave
plan that meets their needs and minimizes time away from the program.
The American Board of Family Medicine states that a resident will not be allowed more than 30 days per year
away from the residency without making up that time to be eligible to take the Board exam.
24
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-01300
MEDICAL SCREEN
MEDICAL SCREEN:
DATE: 7/1/99
PAGE: 1 of 1
Each employee is required to have an initial medical examination at the time of hire. This
will include a review or update of immunizations, TB skin test, medical assessment, drug screen, and review of
ability to perform essential functions of job. An annual TB skin test is required thereafter. (See drug free work
place statement attached to contract.)
25
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-01400
PAGERS:
Teletouch display pagers are used for on-call PGY I and PGY II physicians and the PGY I
PAGERS
4/3/12
DATE: 7/1/99
PAGE: 1 of 1
physician assigned to OB. Even without the pager, residents can make themselves available by cell phone.
Teletouch pagers are activated by calling PCS Answering service (870)933-3828 and they will page resident for
resident to call them back for return call. The residents can also receive text pages.
PGY I residents take in-house calls.
PGY II residents take outside calls.
Each PGY I will hand off both pagers after each call. St. Bernard’s Healthcare Center will activate all in-house
codes and those codes are transmitted to both PGY I pagers.
The program uses an answering service for all after hours clinic calls. The answering service will contact resident
to return the patient’s number with call back code indicating urgent, routine, or personal to the resident on call.
Batteries for the pagers are available in the residency coordinator’s office.
26
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-01500
PARKING:
Each resident is given a parking card for the St. Bernard’s Regional Medical Center doctors’ lot
PARKING
4/3/12
DATE: 7/1/99
PAGE: 1 of 1
located off Matthews Street on the west side of the hospital. Rarely will you have to drive to an Attendings office
but when you do, convenient parking is available at all sites.
27
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION - GENERAL INFORMATION
NUMBER:
REVISION:
I-01600
PAYROLL:
Payroll checks are prepared at UAMS in Little Rock and electronically deposited via direct bank
PAYROLL
4/3/12
DATE: 7/1/99
PAGE: 1 of 1
deposit. An electronic pay stub will be available on-line. You will not receive any paper checks or pay stubs and
that option is not currently available at UAMS.
28
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATION – GENERAL INFORMATION
NUMBER:
REVISION:
I-01700
4-12-07
PRESCRIPTIONS
PRESCRIPTIONS:
DATE: 7/1/99
PAGE: 1 of 1
AHEC Northeast has been assigned an institutional DEA Number. All residents have a
unique identifier associated with this DEA number. For each resident their respective identifier is used on
prescriptions for controlled medications that are written for the management of UAMS AHEC Northeast patients.
29
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-01800
4-12-07, 5-4-12
RECRUITING
DATE: 7/1/99
PAGE: 1 of 1
RECRUITING: Each resident is expected to be actively involved in the program’s recruiting efforts. You may be
asked to represent the program at recruiting functions, entertain an applicant, write letters, etc., and your opinions
are important to the match selection process.
Expenses will be reimbursed by the program. This program is
committed to the ethical recruiting guidelines established by the NRMP and endorsed by the Association of
Family Practice Residency Directors. Many, if not all, of the cost associated with recruiting is covered by the
program. Prior approval must be obtained by the Program Director or his/her designee before reimbursement will
be approved (see reimbursement policy # I-01900).
RECRUITMENT DINNERS
Per each applicant, we will reimburse up to four meals. Two for the applicant and spouse if present plus two for
individuals that represent AHEC. If there is no applicant spouse or significant other then a total of three meals will
be reimbursed. AHEC representatives can be faculty, residents, staff and or spouses (spouses count as an AHEC
representative) but the ratio is two AHEC representative to one applicant.
The reimbursement total for each meal is limited to $50 each. Tax and gratuity is not counted in the $50 meal
limit. So it is basically $150 per evening meal per applicant limit – excluding tax and gratuity.
Receipts turned in that do not meet these guidelines will have the maximum allowed applied, the balance being
the hosts responsibility.
30
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-01900
REIMBURSEMENT (TRAVEL)
DATE: 7/1/99
PAGE: 1 of 1
The reimbursement process for travel expenditures is mandated by state regulations. It is a two phase process:
(1)
Before the trip, form EO1105 [request for authorization of travel expenses] must be completed with details
about the reason for travel, a copy of meeting brochure, and an estimate of cost for the trip. After
authorization signatures are obtained the form is sent to Little Rock where an authorization to travel
number is assigned. The form is then returned to us.
(2)
After the trip, a TR-1 [travel expense reimbursement form] must be completed with actual expenditures
listed and identified with the assigned authorization number. Proof of expenditures is required as follows:
(A)
Receipts required:
Hotel
Airline
Parking @ airport
Registration [cancelled check]***
Taxi or shuttle
***May be paid by purchase order request on your behalf if trip is planned early.
(B)
Receipts not required:
Meals receipts [per diem amount established by city visited]
Mileage receipts [based on atlas miles]
(C)
Non-reimbursed expenditures:
Rental car
Personal entertainment
Family expenses
Tips
Alcohol
Taxes: We suggest you keep receipts for non-reimbursed expenditures as you may be able to use as business
expense when filing taxes. Check with your accountant.
REMEMBER: You can not be reimbursed until we submit a request; so the sooner you bring your receipts to the
office after the trip the quicker you get your money. The paperwork process takes 14 – 21 working days.
31
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-02000
5-4-12
REPRESENTATIVE OF FAMILY PRACTICE
REPRESENTATIVE OF FAMILY PRACTICE:
DATE: 7/1/99
PAGE: 1 of 1
Up to one additional week (5 working days) away from the
program will be allowed for residents who are involved in a national Family Practice organization [i.e., American
Academy of Family Physicians] as an official representative of the organization. The resident will be responsible
for arranging call coverage if indicated. No additional monetary travel allowance is given. This does not count as
CME or vacation time. However, CME funds may be used towards travel expenses if so desired by the resident
once prior approval by the Program Director has been made.
32
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-02100
5-25-10, 4-5-12
RESIDENT TRAVEL (CME)
RESIDENT TRAVEL (CME):
DATE: 7/1/99
PAGE: 1 of 1
Residents are encouraged to attend medical meetings during their residency and
most of the expenses can be defrayed through a program travel allowance. Selected meeting and meeting site
should be cost effective in obtaining some skill, which you want to enlarge upon, and is not offered locally. The
Family Practice Director must approve CME meeting choice. Up to 5 days in each residency year is allowed for
CME. Vacation time-off restrictions apply to CME.
In the first year, up to $1,000.00 is available for one meeting with up to $2,000.00 available in years two and
three. Travel money can not be carried into the next year.
As with vacation time, arrangements for coverage of the hospital and/or critical functions have to be taken into
consideration. Travel plans should be made as early as possible so that required travel documents can be routed
through the University system for approval of expenditure. Information about the meeting (program brochure),
transportation cost, hotel cost, registration fees, etc., should be provided to the Family Practice Coordinator as
soon as your plans are made. AFTER your trip, receipts for travel, hotel, registrations, parking, shuttle services,
etc., should be given to the Residency Administrative Assistant to initiate reimbursement request. Your spouse’s
expenses cannot be reimbursed from your CME travel allowance. Residents will be asked to report on meeting
as a conference topic or as a brief presentation at daily report.
CME money may also be used to purchase books, computer software, etc. with a CME value.
The list of
approved items is ever changing and can be obtained from administration.
33
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-02200
10/21/00
SEXUAL HARASSMENT
SEXUAL HARASSMENT:
DATE: 7/1/99
PAGE: 1 of 1
AHEC Northeast and UAMS are committed to its mission of providing an
academic and employment environment that fosters excellence.
Sexual harassment violates the trust and
respect essential to the preservation of such an environment, and threatens the education, careers, and well
being of all employees. In both obvious, [i.e., touching or uninvited propositions] and subtle [i.e., sexist jokes]
ways, sexual harassment is destructive and will not be tolerated in this working environment. Any individual who
believes they have been sexually harassed should report it to their immediate supervisor who will proceed per
established UAMS policy, a copy is on file in the Coordinator’s office and attached to Resident contract. (See
UAMS Administrative Guide, 3.1.05)
34
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-2300
UAMS AFFILIATION
UAMS AFFILIATION:
DATE: 7/1/99
PAGE: 1 of 1
The UAMS AHEC programs are affiliated with the University of Arkansas for Medical
Sciences and is subject to their administrative guidelines. This includes travel requirements, purchasing supplies,
due process, and other areas as outlined in UAMS Administrative guides. Residents may not make purchase or
contractual obligations on behalf of the program. The AHEC Administrative office is responsible for all Northeast
purchases. [A copy of the UAMS Administrative guide is located in Residency Coordinator’s office.]
35
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I-02400
5/10/10, 5/22/12
VACATION
DATE: 7/1/99
PAGE: 1 of 1
VACATIONS: All residents will receive 15 working days/year of vacation. [10 of these days must be taken in
two separate five day blocks, 5 of these days may be taken in daily increments.]
Vacation requests are to be submitted on the appropriate form (may be found in Residency Coordinator’s office).
Requests should be completed by the resident and then given to the chief resident who will discuss with the
faculty member in charge of resident scheduling. While initial approval can be given by these individuals, the final
approval of all vacation requests is at the discretion of the residency director.
All vacations must be requested and approved at least 30 days in advance of time off. No vacation will be
approved for the first two weeks of July or the last two weeks of June. Vacations cannot be taken when the
resident is on the Family Practice Service or a two-week rotation.
Every attempt should be made to schedule your vacation at the start or the end of a block. Vacation records are
maintained in the coordinator’s office. It is your responsibility to notify your attending physician when you plan to
take vacation time. Before your vacation is approved it is also your responsibility to make arrangements for
coverage of any call days during your absence. You may also be required to swap clinics which cannot be
cancelled (i.e. work in or procedure clinics).
36
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400 - 018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 1 of 7
PHILOSOPHY STATEMENT: Substance abuse (drugs and/or alcohol) in the workplace presents a threat to the
safety and reputation of the UAMS AHEC Program, the welfare of patients and visitors, and the morale and safety
of employees. Studies show that even small amounts of alcohol or mood-altering drugs can impair an individual’s
cognitive ability, interpersonal skills, motor coordination and judgment.
The UAMS AHEC Program is committed to providing quality health care services and ensuring a safe work
environment for all employees. Therefore, the UAMS AHEC Program will not hire nor continue to employ
individuals who abuse drugs and/or alcohol.
POLICY GUIDELINES:
(A)
Unlawful, unauthorized or improper possession, distribution, manufacture, sale or use of a controlled
substance or the misuse of any substance, prescription or non-prescription, on or off UAMS AHEC
premises while in the pursuit of UAMS AHEC duties is considered grounds for termination.
(B)
For purpose of this policy, controlled substances include all chemical substances or drugs listed in any
controlled substance acts or regulations applicable under any federal, state, or local laws, and any other
substance which impairs an employee’s ability to perform his/her job. This list includes but is not limited
to the following:
Amphetamines
Methaqualone
Methadone
PCP/Phencyclidine
Barbiturates
Benzodiazepines
Propoxyphene
Cannabinoids
Cocaine
Opiates
Derivatives of any of the above
(C)
For purpose of this policy, in addition to performing normal duties on AHEC premises, all employees are
considered to be on the job in the following circumstances:
1.
2.
3.
Driving or riding as a passenger in a state vehicle
Conducting AHEC business off AHEC property
Assigned to on-call status, required to remain available by telephone or pocket pager, in order to
be paged into work.
(D)
Off the job illegal drug use or abuse which could threaten the reputation and integrity of UAMS AHEC
Northeast may result in disciplinary action up to and including discharge.
(E)
In the interest of protecting the health and safety of patients and employees, employees suspected of
reporting to work under the influence, to have brought illegal drugs or alcohol onto AHEC premises, or to
have consumed substances while on duty will be required to undergo an investigation which includes a
substance abuse test. Failure to cooperate in the investigation will result in termination of employment.
37
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400 - 018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 2 of 7
PREEMPLOYMENT:
(A)
Procedures and Guidelines for Testing
All applicants selected for offer of employment will be tested as part of the employment opportunity.
New employees will not be placed on the payroll until completion of the required drug screening.
(B)
Actions Resulting From a Positive Drug Test Result
Applicants will be notified that they have failed to pass the pre-employment process and will not be employed.
As a condition of employment, all new employees must agree to submit to random drug/alcohol testing and/or
reasonable suspicion drug/alcohol testing.
CURRENT PROCEDURE:
Applicants who receive positive drug screen results will be informed by the AHEC
Director that they have failed the employment process (i.e. the drug screen) and cannot be employed.
Should the applicant inform the AHEC Director that positive results occurred because a medication was
inadvertently left off the applicant’s list of current medications; then,
The AHEC Director shall instruct the applicant to provide the following documentation:
(A)
A copy of the prescription and/or the medication container which indicates the medication was
prescribed to the applicant before the drug screen date.
(B)
A copy of the physician’s progress notes or a letter/note from the physician indicating the
medication was prescribed before the drug screen date.
The AHEC Director shall review both pieces of documentation provided by the applicant. If it is determined that
the applicant was approved for the medication and the omission was an oversight, then the applicant can be
employed.
38
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400 - 018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 3 of 7
CURRENT EMPLOYEES:
(A)
Procedures and Guidelines for Testing
(1)
Reasonable Suspicion Testing Current Employees
Circumstances which may form the basis of reasonable suspicion for testing of current employees include but are
not limited to the following:

Documented or observed impairment of job performance which could reasonably be attributed to the use of
drugs or alcohol. For example, severe and/or prolonged reduction in productivity or carelessness.

A pattern of abnormal conduct or erratic behavior. For example, leaving the AHEC premises for breaks/lunch
and returning with personality changes (irritability, withdrawn, excitability, defensiveness, and antisocial
behavior); frequent disappearances from the work areas.

The employee’s attendance record-habitual absenteeism and tardiness.

Direct observation, by management or supervisor, of drug abuse or possession of illegal drugs during working
hours or while on AHEC premises.

Workplace accidents or accidents involving state vehicles or equipment.

Physical symptoms indicative of drug use, for example, slurred speech, tremors, drowsiness, pupils dilated or
constricted, irritability, hyperactive, general motor impairment, disoriented, and alcohol on breath.

Evidence that drugs have been tampered with and/or missing from designated areas.

Arrest or conviction for drug-related offense, or the identification of an employee as the focus of a criminal
investigation into illegal drug possession, use, or trafficking.

Newly discovered evidence that the employee has tampered with a previous drug test.

Any other aberrant behavior on the part of any employee, which could reasonably be attributed to the use of
drugs or alcohol.
Employees who meet any of the above criteria may be asked to submit to a urine drug screen and/or a blood
alcohol test. Refusal or failure to submit to such testing will result in termination of employment.
39
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400 - 018
10/15/99
(2)
DRUG SCREENING
DATE: 6/1/99
PAGE: 4 of 7
True Random Screening
All current employees are subject to random drug screening at the direction of UAMS.
The proper collection procedure is followed. (See “Procedure for Collection and Analysis – Drug Screening.”)
After collection, the selected employee will return to his/her assigned work area.
(B)
Actions Resulting from a Positive Drug Test Result
Prior to employees being randomly selected for testing, employees with substance abuse problems will be given
the opportunity to voluntarily report such behavior to the AHEC Director. Every effort will be made to assist these
employees in rehabilitation, and to maintain confidentiality. Referrals to the Employee Assistance Program will be
made as appropriate. Employees who voluntarily report substance abuse but who do not successfully stop
abusing drugs and/or alcohol will be terminated.
Employees who do not voluntarily report substance abuse and who test positive for drugs or alcohol during a
random drug screen will be terminated.
In the event that the employee who tests positive for drugs or alcohol challenges the result, he/she has the option
of having the original specimen forwarded to an independent certified drug testing laboratory of the employee’s
choice for testing. Such testing will be at the employee’s expense. The employee will be temporarily suspended
without pay pending the result of the independent testing procedure. In the event that the test result from the
independent laboratory is positive, the employee will be terminated. In the event that the result from the
independent laboratory is negative, the employee may be asked to submit another test sample if the testing
laboratory deems such action is warranted.
40
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400 - 018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 5 of 7
RE-EMPLOYMENT OF POSITIVE TESTED EMPLOYEES:
An employee who tests positive for drugs or alcohol may submit an application for re-employment only after
providing proof of successful completion of a rehabilitation program. Consideration for re-employment is at the
sole discretion of UAMS management. As a condition of re-employment, all such employees must consent in
writing to random drug/alcohol testing and monitoring at any time deemed warranted by AHEC Northeast.
MAINTENANCE OF RECORDS:
Testing results will be maintained solely by UAMS.
CONFIDENTIALITY OF TEST RESULTS:
Confidentiality of test results will be adhered to as stringently as possible. Laboratory results may be disclosed
only to those individuals whose duties necessitate review of the test results. Initial positive results will not be
disclosed until a confirmatory test has been run. All records and information of the personnel actions taken on
employees and verified positive test results should be forwarded to UAMS Human Resources Department. Such
information will remain confidential.
IMPLEMENTATION:
Area Health Education Center Northeast will be responsible for administering this program.
concerning policies and procedures should be directed to the UAMS human resource department.
All questions
Responsibility for the Chain of Custody and Laboratory Quality Control rests with the Testing Laboratory.
41
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400-018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 6 of 7
AHEC PROGRAM
Procedure For Collection and Analysis – Drug Screening

UAMS AHEC Northeast will contact Occupational Health Partners
42
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
ADMINISTRATIVE – GENERAL INFORMATION
NUMBER:
REVISION:
I: 400-018
10/15/99
DRUG SCREENING
DATE: 6/1/99
PAGE: 7 of 7
Use this form for all applicants. This form will become a permanent part of the employees’ personnel file for successful
employment candidates.
I,
, as a condition of potential employment at AHEC Northeast, hereby consent to
drug and/or alcohol testing. I understand that I will be required to give a urine and/or blood sample for testing by
a laboratory selected by AHEC Northeast. As an AHEC Northeast employee of 50% or greater time, I understand
that random and for cause drug and alcohol testing are conditions of employment.
I understand that if the test result is positive due to medications which have been prescribed to me by an
accredited physician for treatment of a current condition, AHEC Northeast will verify the circumstances with the
doctor prior to any off of employment or continued employment.
I understand that if the test result is positive for drugs or alcohol that are not part of a currently prescribed medical
treatment program, my conditional offer of employment will be revoked and I will not be hired. As an AHEC
Northeast employee, positive drug results will mean termination of employment.
I understand that if I refuse to participate in this drug and/or alcohol test and/or do not authorize AHEC Northeast
and my personal physician to discuss any medications that I may be taking, I will not be hired or continued
employment status will be reviewed.
I authorize the testing laboratory to release the drug and/or alcohol test results to AHEC Northeast for evaluation
of my employment status.
I understand that a controlled substance includes all chemical substances or drugs listed in any controlled
substances acts or regulations applicable under federal, state, or local laws, and any other substance which
impairs an employee’s ability to perform his/her job. This list includes but is not limited to the following:
Amphetamines
Methaqualone
Methadone
PCP/Phencyclidine
Barbiturates
Benzodiazepines
Propoxyphene
Cannabinoids
Cocaine
Opiates
Derivatives of any of the above.
I have read this form and have had AHEC Northeast’s drug and alcohol policy, including the provisions for this
and future tests, fully explained to me.
APPLICANT’S/EMPLOYEE SIGNATURE:
DATE:
WITNESS’ SIGNATURE:
DATE:
Check this space if the applicant refuses to sign the form. Explain the ramifications of his/her
refusal to sign the form. Have another employee witness his/her verbal refusal. Two witnesses to the candidate’s
refusal to sign form must sign and date the form in the spaces below. File the form with the candidate’s
application.
43
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
NUMBER:
REVISION:
FAMILY MEDICINE CENTER
TELEPHONE SYSTEM
DATE:
10/25/00, 4/12/07, 4-5-12
PAGE: 1 of 1
TELEPHONE SYSTEM: The Family Medicine Center has twenty three (23) incoming lines that ring off a rotary
system on 972-0063. This is the only number patients should be given to call the clinic. After office hours,
weekends, and holidays an answering service is used for emergency calls, which are relayed to the resident on
call. This option is available by dialing the same clinic number, 972-0063.
The number to administration is 972-9603 and should not be used by the residents. The residency coordinator’s
number is 931-9137. All of your personal business, long distance calls should be billed to your home number.
There are two SBRMC hospital lines, 4532 and 4554 (dial 5, 0), which may be used to call departments in the
hospital or to call the Family Medicine Center from the hospital. Internally, each phone has a station identification
number. Each station has a button to access the overhead clinic wide paging system. It is accessed by pushing
the assigned button and then pressing one (1) to activate the speakers. To limit unwarranted interruptions of your
clinic, specialty rotations or conferences, the clinic staff will take telephone messages on most calls. These
messages will be given to your nurse so that she can contact you about follow-up as indicated. You should also
develop the habit of checking with your team nurse on a daily basis to avoid unwanted interruptions when you are
on other services. All patient calls should be returned in a timely manner with a note made in the patient’s chart
of verbal instructions.
44
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0100
4/12/07, 4-5-12
INTRODUCTION
INTRODUCTION:
DATE: 7/1/99
PAGE: 1 of 1
The residents are expected to be interested and available in the care of their patients in
the Family Medicine Center and on their specialty rotations. Your demonstrated interest in the performance of
assigned tasks will help in gaining the respect of the attending physicians and enhance the learning experience.
In a private hospital setting, as we have in Jonesboro, your availability and interest will be the major factor in
determining how much you benefit from your rotations. In short, you get out of it what you put into it. Time spent
with your preceptors, even on seemingly mundane tasks, will produce many opportunities for you to enhance your
own skills, knowledge, and aid in your continued development as a well rounded family physician.
45
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0200
4-5-12
AVAILABILITY
AVAILABILITY:
DATE: 7/1/99
PAGE: 1 of 1
If you have not already realized it, medicine is not an 8:00 am – 5:00 pm, Monday
through Friday profession. ALL family practice residents are expected to be conscientious about their attendance
on specialty blocks and within easy availability to the Family Medicine Center. Some blocks may have atypical
scheduling that is required so that you gain the full experience.
With that, we ask that you take personal
responsibility and be mindful of the ACGME duty hours and expect that you will never exceed them. The majority
of your assigned blocks will require morning and afternoon rounds with the attending, patient work-ups as
assigned, and attendance in their office clinics. Do not ask the assigned preceptor to call you when “something
interesting” presents – be available so you do not miss the “pearls”. In addition, since the UAMS AHEC program
has a substantial degree of physician resources, there may be times that we are called on to aid our local
hospitals and community that are unexpected (i.e. local or regional disasters, periods of increased hospital surge,
etc.)
46
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0300
10/10/01;4/13/07; 5-4-12
CALL/RESIDENT RESPONSIBILITES
DATE: 7/1/99
PAGE: 1 of 2
PGY I: Call/Responsibilities
A.
PGY I residents are responsible for in-house call at St. Bernard’s Hospital.
B.
Respond to all hospital cardiac arrests.
C.
After clinic hours, responsible for all in-house AHEC patients at St. Bernard’s.
D.
When a patient is admitted after hours, it will be the on-call resident’s responsibility to write the initial
orders, do a complete history and physical, and other required work-up in consultation with immediate
back-up (either PGY II or PGY III).
E.
The PGY I will be responsible for AHEC Family Medicine Center OB patients who present in labor to the
hospital after office hours. The on call resident will assess the patient and write chart notes. The back-up
resident (PGY III) will be called on all laboring patients. The Family Practice faculty will be called and will
be present for all deliveries.
F.
The on-call PGY I resident will contact his back-up on every admission and the back-up resident is
expected to come in for these admissions. Every admission requires the back-up resident to physically
assess the patient and write an admission progress note. Those patients requiring admission to the ICU
or those patients that deemed a pediatric admission will require evaluation and a note by the PGY III
resident. All non-ICU and non-pediatric admissions will require evaluation and note written by the PG II
resident. The back-up will contact the on-call Family Practice Faculty attending on every transfer and ICU
admission and as indicated.
G.
The PGY I on-call is not responsible for the patients of private physicians but may be contacted by the
physician to pronounce a death. This is offered as a courtesy to the medical staff. The physician (not a
nurse) should make the request so that relevant information regarding the patient and family members is
available to the PGY I on-call. The patient’s physician will complete the death certificate.
H.
When the resident completes their call, he/she should check out to the incoming PGY I on-call (on the
weekend) or the on-coming FPS and OB residents with information on patients admitted during the call
period and the status of in-house patients. Other pertinent call information may be shared during daily
report.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
NUMBER:
REVISION:
RESIDENT PERFORMANCE
CALL/RESIDENT RESPOSIBILITIES
II-0300
4-5-12
DATE: 7/1/99
PAGE: 2 of 2
PGY II Call/Responsibilities:
1.
PGY II residents on call are responsible for covering medicine admissions at the
NEA/Baptist hospital and providing backup for non-ICU medicine and nonpediatric patients at St. Bernard’s hospital.
2.
PGY II residents are required to evaluate and write back notes on non-ICU
medicine and non-pediatric patients at St. Bernard’s hospital.
3.
PGY II residents are required to evaluate and admit medicine patients at
NEA/Baptist hospital as dictated.
4.
PGY II residents on their OB/Peds rotation will act as the primary back up
resident for the designated PGY I residents on their OB and pediatric rotations.
The PGY II resident will oversee the PGY I as they coordinate care and
management of patients on the obstetrics floor, pediatric inpatient, and NICU.
5.
During the month of July, the PGY II resident will remain in-house with the new
PGY I residents to provide immediate oversight and input into patient care issues
that arise.
PGY III Call/Responsibilities:
1.
PGY III residents will be responsible for immediate back-up to the PGY II
residents on-call. The PGY III resident will be available for questions arising from
admissions to either NEA/Baptist or St. Bernard’s hospitals.
2.
PGY III residents will provide backup for the PGY I residents on ICU medicine
and pediatric patients at St. Bernard’s hospital.
The PGY III will physically
assess the patient with an admission progress noted recorded on medical record.
The PGY III will determine the assignment area for in-house residents. When
volume warrants PGY III will call in PGY II and direct assignment of care
responsibilities whether ER, OB, unit, etc.
3.
PGY III residents will be in-house with laboring patients through delivery and
stabilization of the neonate.
4.
During the weekdays, the first two weeks of July, the PGY III will assume
responsibility as immediate backup to all new PGY I residents.
5.
PGY III residents will round with in-house colleagues and faculty attending on
weekends and holidays.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Attending Call/Responsibilities Schedule:
1. An AHEC Faculty member is on call for the residency program at all times. There is no time that there is
not a UAMS AHEC attending physician available for the residents.
2. The immediate back-up will contact the faculty as patient care requirements indicate. For example, when
there is an ICU admission at the St. Bernard’s hospital, the PGY I resident will evaluate the patient and
notify the PGY III resident. Once the PGY III resident has evaluated the patient the AHEC Attending will
be notified.
3. During the weekends and holidays, the AHEC faculty will round with the on-call PGY I, PGY II, and PGY
III residents on all AHEC patients that are admitted to the St. Bernard’s hospital and the NEA/Baptist
hospital. Faculty attending will be notified of all laboring patients. The Family Practice Faculty supervises
all hospitalized patients and is present for laboring patients and deliveries.
49
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0301
5/29/12
RESIDENT SCHEDULE/DUTIES
DATE: 8/14/06
PAGE: 1 of 1
INTERN CALL RULES:
- Call Schedule
o The call schedule is created each year in the late spring for the following academic
year (July-June). Unfortunately, due to the critical nature of the medical profession,
the call, rotation, and clinic schedules are fairly rigid (that is not to say that
adjustments cannot be made in times of need). Changes must be carefully
evaluated to make sure they comply with ACGME and UAMS AHEC Northeast
requirements and policies. Call, clinic, or rotation changes cannot be made without
approval of the Chief Resident and Program Director (or designated faculty
member).
o Intern Call
 The schedule below represents the first week of call for a given
month. In general, call rotates each week.
 Medicine Service Intern # 1 (60 hr)
o Works Monday through Friday from 0700 to 1900
o Rotates the next week and works Monday through Friday from
0500 to 1700
 Medicine Service Intern # 2 (60 hr)
o Works Monday through Friday from 0500 to 1700
o Rotates the next week and works Monday through Friday from
0700 to 1900
 Medicine Service Intern # 3 (Night Float) (72 hr)
o Works Monday through Thursday from 1700 to 0700
o Works Friday from 1700 to Saturday 0900
 Saturday
o Intern # 1 (Medicine Service Intern) (15 hr)
 Comes in at 0500 and works until 2000
o Intern # 4 (Any one of the non-medicine service interns) (16
hr)
 Comes in at 1700 and works until Sunday 0900
 Sunday
o Intern # 2 (Medicine Service Intern) (15 hr)
 Comes in at 0500 and works until 2000
o Intern # 5 (Any one of the non-medicine service interns) (14
hr)
 Comes in at 1700 and works until Monday 0700
o The intern who works until 0700 Monday goes home and does
not return until Tuesday in time for their rotation.
o Weekly Work Hours
 Interns # 1 and # 2 alternate weeks and one of them will rotate to Night Float
depending on the schedule.

Total hours per week are 75 hrs.
 Intern # 3 works Night Float for 2 weeks then rotates to the Medicine service
during the day or on to a new rotation.
50
AHEC NORTHEAST FAMILY MEDICINE PROGRAM






Total hours per week are 72 hrs.
Intern # 4, typically an OB intern (M-F, 12 hr/day = 60 hrs)(16 hrs on call).
 Works Monday through Friday from 0500 to 1700 (60 hrs.)
 Rotates the next week and works Monday through Friday from 0700
to 1900 (60 hrs.)
 Rotates through call on the weekend.
 Total hours per week are 76 hrs.
Intern # 5, typically an OB intern (M-F, 12 hr/day = 60 hrs)(14 hrs on call)..
 Works Tuesday through Friday from 0800 to 2000
 Rotates the next week and works Monday through Friday from 0500
to 1700
 Rotates through call on the weekend.
 Total hours per week are 76 hrs.
Intern # 6 (Inpatient Pediatrics)
 Works Monday through Friday from 0700 to 1700 (50 hrs)
 Rotates through weekend call schedule (Sat/Sun 2nd shifts) (14 hrs)
 Total hours per week are 64 hrs.
Intern # 7
 Generally works from 0800 to 1700 depending on the given rotation
they are on.
 Rotates through weekend call schedule (Sat/Sun 2nd shifts)
 Total hours per week are approx 61 hrs.
Intern # 8
 Generally works from 0800 to 1700 depending on the given rotation
they are on.
 Rotates through weekend call schedule (Sat/Sun 2nd shifts)
 Total hours per week are approx 61 hrs.
o
2nd Year Resident Call
 Medicine Service Resident takes call on Saturday from 0800 to 0800 on
Sunday
 OB/Peds Service Resident takes call on Friday from 1700 to 0800 on
Saturday
 Total hours per week are approx 69 hrs.
 Nine hours per day x five days = 45 hrs.
 Call = 15-24 hrs.
o
3rd Year Resident Call
 Medicine Service Resident takes call on Saturday from 0800 to 0800 on
Sunday
 Total hours per week are approx 61 hrs.
o
July Orientation Call
 With new interns, new 2nd year, and new 3rd year residents all starting in July,
the July schedule is different than any other month of the year. There must
be a transition system in place to ensure patient and resident safety.
 Intern Call
o Primary Call
 1600-0800 (Everyday) (16 hr)
 One intern takes primary call each night. That intern
does not come in until 1600 when his/her shift starts.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM


After working the 16 hr shift the intern goes home and
returns on the following day.
o Secondary Call
 0700-2100 (M-F) (14 hr)
 0600-2000 (Sat. & Sun.) (14 hr)
 Two interns take secondary call each day. They come
in at 0700 and work until 2100. When they go home at
2100, they are expected to return to work at 0700 the
next day. On the weekends the interns come in at
0600 and work until 2000.
o Non-call Interns
 All non-call interns report to work at 0700 and begin
their daily rounds. They are expected to be at work
until 1700.
2nd Year Call
o In-House Call
 The second year will take in-house call the entire
month of July. While on call, the 2nd year will not leave
the hospital unless they are called to assess a patient
at the NEA/Baptist Hospital.
3rd Year Call
o The month of July is no different than any other month for 3rd
year residents. Their responsibilities include but are not
limited to:
 Being in the hospital when a patient is in active labor
(defined as cervical dilation of 4 cm with
consistent/regular contractions).
 Evaluating every ICU admission or transfer.
 Evaluating every pediatric (under 18 years of age)
admission.
 Due to the 3rd year residents level of experience they
are expected to assist the intern and 2nd year resident
and function in the capacity of a junior Attending
physician. In that role they will delegate (and
sometimes share in) responsibilities as needed in times
of peak call activity (i.e. codes, admissions, floor
situations).
The above schedules ensure that a minimum of ten (10) hours free of all responsibilities
between duty periods is met.
52
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0400
4/12/07, 5-8-12
Introduction:
Residents at all levels are encouraged to discuss interesting findings with colleagues and faculty
RESEARCH/SCHOLARLY ACTIVITES
DATE: 7/1/99
PAGE: 1 of 2
as opportunities present themselves so that all can learn from each other’s experiences. At the first year level,
residents should present the majority of their patients to the clinic attending and at levels II and III present to
attending as needed. Additionally, the UAMS AHEC Family Medicine Residency requires that each resident
participate in formal research and scholarly activities.
Monthly Perinatal/Pediatric/OB Conference
This conference is scheduled the 2nd Wednesday each month in Family Medicine Center Conference
Room (FMMC). The resident assigned to AHEC in-patient Pediatrics for the month is responsible for researching
and presenting an interesting case that is specific to the practice of pediatrics, neonatology, or obstetrics.
Practice topics will alternate from month to month (i.e. one month Perinatal/Peds topic, the next month
Perinatal/OB topic). The resident should take care to include current evidence based and clinically relevant
information in the presentation including but not limited to: general overview of the disease, causes, risk factors,
and genetics, pathologic basis for the disease, pertinent physical and clinical findings, criteria for making the
diagnosis, current evidence based treatment, prognosis, and prevention/screening measures if applicable. The
resident will include all resources and citations in the presentation. Those residents assigned to obstetrics for the
month will be charged with reviewing and researching selected patient cases from the preceding month which will
be assigned to them by the chief resident. These cases will be reviewed at the conference as well.
Chest Conference
This conference is scheduled the 2nd Tuesday each month in Family Medicine Center Conference Room
(FMMC). The 2nd year on FPS II from the preceding month is responsible for researching, developing and
presenting an interesting chest case. The resident should take care to include current evidence based and
clinically relevant information in the presentation including but not limited to: general overview of the disease,
causes, risk factors, and genetics, pathologic basis for the disease, pertinent physical and clinical findings, criteria
for making the diagnosis, current evidence based treatment, prognosis, and prevention/screening measures if
applicable. The resident will include all resources and citations in the presentation. Ideally, this case will come
from the month of inpatient hospital medicine service they just completed the prior month.
Interesting Case Conference
This conference is scheduled the 4th Tuesday each month in Family Medicine Center Conference Room
(FMMC). The three intern residents that were on FPS I from the preceding month are responsible for researching,
developing and presenting an interesting case from the pool of hospital patients they managed the previous
month. The residents should take care to include current evidence based and clinically relevant information in the
presentation including but not limited to: general overview of the disease, causes, risk factors, and genetics,
pathologic basis for the disease, pertinent physical and clinical findings, criteria for making the diagnosis, current
evidence based treatment, prognosis, and prevention/screening measures if applicable.
Emergency Medicine Conference
This conference is scheduled monthly in Family Medicine Center Conference Room (FMMC). The
resident that is on their emergency medicine rotation will research, develop and present an interesting ER topic.
The resident should take care to include current evidence based and clinically relevant information in the
presentation including but not limited to: general overview of the disease, causes, risk factors, and genetics,
pathologic basis for the disease, pertinent physical and clinical findings, criteria for making the diagnosis, current
evidence based treatment, prognosis, and prevention/screening measures if applicable. The resident will include
all resources and citations in the presentation.
53
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Grand Rounds Conference
Every PGY III resident will be required to develop and present an interesting medical topic of their
choosing. The resident should take care to include current evidence based and clinically relevant information in
the presentation including but not limited to: general overview of the disease, causes, risk factors, and genetics,
pathologic basis for the disease, pertinent physical and clinical findings, criteria for making the diagnosis, current
evidence based treatment, prognosis, and prevention/screening measures if applicable. The presentation will be
given to the entire St. Bernard’s medical staff at a scheduled Grand Rounds conference based on available dates.
Guidelines on the presentation are as follows::
(1)
Topics to be addressed should include current issues pertinent to the practice of family medicine; a case
study from the resident’s practice would be desirable.
(2)
Topics should include current studies (not review articles) and should preferably revolve around a
controversial or unresolved issue (ex. Should a post-menopausal female receive estrogen?)
(3)
Topic should be discussed with faculty mentor prior to presentation development.
(4)
Handouts which include an outline of the talk and other pertinent information should be provided to the
audience.
(5)
Audiovisuals should be utilized to enhance the presentation (powerpoint.)
(6)
Presentations should last a minimum of 30 minutes, allowing time for a questions and answer period.
Residents are expected to prepare and present cases that are interesting or that are necessary for use at
teaching or curriculum conferences. Generally, this will be a patient that you are familiar with; however, a staff
member or the Program Director may request that you simply examine a case or subject and prepare it for use at
a conference even though you may not have seen the patient in the past or be well-versed on the subject.
54
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0500
4/13/07, 5-8-12
CONFERENCES
DATE: 7/1/99
PAGE: 1 of 1
DAILY CONFERENCES: Daily noon conferences are structured to enhance the curriculum and are a required a
part of program accreditation.
Attendance at noon teaching conferences (Monday – Friday) is mandatory.
There may occasionally be reasons for excused absences (imminent delivery, critical patient, etc.) but you must
contact the Family Practice Director, FMC faculty, or coordinator to explain the absence. Non-emergent work
requirements (i.e. patient rounds on the service, completing charts, etc.) are not reasons to miss conferences and
such request will not be excused. Attendance records are kept on each required conference by the residency
coordinator.
Additionally, residents will have at least one monthly support group meeting with the Chief Resident(s) to discuss
pertinent resident concerns and facilitate positive change for the residency. There is also a separate monthly
meeting with the Program Director where information regarding program and organizational changes are relayed.
This is also a forum for the residents to voice questions, concerns, or issues to the Program Director about
different aspects of the Program or organization.
Residents are expected to attend the St. Bernard’s hospital’s Family Practice Department Meeting on the 3rd
Monday of each quarter. This is a medical staff meeting where insight into real world practice issues can be
obtained and is often useful for the residents when looking ahead at their practice after residency.
Residents are also encouraged to attend meetings of the Craighead-Poinsett County Medical Society where
insight can be gained on the political aspects of medicine on a state and local level.
55
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0600
4/13/07, 5-8-12
CORE CONTENT REVIEW
CORE CONTENT REVIEW:
DATE: 7/1/99
PAGE: 1 of 1
The program subscribes to a seven-test review of family practice for each
resident. The content is reviewed in detail at monthly noon conferences. Each resident is expected to complete
the required reading prior to the conference and participate in the discussion. This is a specific area of medical
education that prepares the resident for successful completion of the ABFM Family Medicine Board Exam.
56
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0700
March 30, 2007
CORRECTIVE ACTION
CORRECTIVE ACTION:
DATE: 7/1/99
PAGE: 1 of 1
Each resident is expected to be conscientious and self-motivated toward
residency expectations. Disciplinary action will center on an expected outcome to correct bad habits or improve
care and time management skills. In general, bringing to the attention of the resident an unmet expectation by the
chief resident, a faculty member, or the program director should result in changed behavior. If behavior is not
corrected, the faculty and/or program director will exercise one of several options:
(a) Invite resident into a faculty meeting to discuss problem area.
(b) Place resident on in-house call first available date.
(c) Place resident on “temporary working” vacation or deduct vacation or CME time as deemed
appropriate.
(d) Extra time in residency to complete requirements. Repeated unacceptable performance may result in
dismissal from the program.
57
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0800
4/13/07, 5-8-12
DAILY REPORT
DAILY REPORT:
DATE: 7/1/99
PAGE: 1 of 1
All residents are expected to attend Daily Report in the FMC conference room from 1:00
p.m. to 2:00 p.m., Monday through Friday (excluding holidays and days the clinic is closed). The PGY I, PGY II,
and PGY III residents on the Family Practice services will present all hospitalized patients from both St. Bernard’s
and NEA/Baptist hospitals.
Residents assigned to OB will present all AHEC OB patients.
Residents assigned to Inpatient Pediatrics will present all AHEC nursery patients as well as any admitted pediatric
patients.
Upper level residents will present continuity-of-care hospitalized patients.
The faculty attending on FPS I will insure report format and discussion contributes to education process.
A Resident not presenting patients who has clinic responsibilities may leave report if it runs overly long and they
have other obligations (rotation, clinic, etc).
58
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0900
DUE PROCESS/GRIEVANCE
DUE PROCESS:
DATE: 10/13/00
PAGE: 1 of 1
Residents are appointed for educational training purposes one year at a time.
Responsibility for the scheduling, supervision and evaluation of resident performance is with the program director
or his/her designate. Non-reappointment at the end of the contract, non-promotion to the next level of training, or
dismissal during the course of the academic year will be made by the program director. A due process document
is included with the residency contract. Specifically, should we have a resident who performs poorly due process
actions will be: (1) Verbal corrective action will be given in a meeting with the resident to discuss the identified
problem and expected resolution with Program Director.
period.
(2) A written warning with an identified probationary
(3) If no resolution is made the Resident will meet with committee consisting of: Faculty members
appointed by the Program Director. (4) If the problem is not resolved the Resident will meet with the Program
Director and the AHEC Director. (5) If problem is still not resolved the Resident may go through the AHEC GMEC
Due Process as specified in the Policy and Procedure Manual
(6) Termination from the Family Practice
Residency Program or non-renewal of contract for subsequent training year(s) may result if satisfactory resolution
is not achieved.
GRIEVANCE:
(1) A Resident having a grievance, a complaint or a question concerning a condition of
his/her residency will take the matter up first with his/her Program Director. It is the duty of the Program Director
to give an impartial consideration of the grievance, to make a reasonable investigation and, if possible, promptly
to arrive at an answer or settlement which is mutually agreeable. (2) If a mutually agreeable settlement is not
reached with ten (10) days after the presentation of a grievance to the Program Director, the Resident may then
submit his/her grievance in writing to the Program Director and AHEC Director. (3) Within ten (10) days after
receipt of a written complaint and a mutually agreement is still not resolved the Resident may then submit his/her
grievance in writing to the AHEC GMEC. (4) Within ten (10) days after receipt of a written complaint and a
mutually agreement is still not resolved the Resident may then submit his/her grievance in writing to the Vice
Chancellor of Regional Programs (5) Within ten (10) days after a written complaint and a mutually agreement is
not still not resolved the Resident may then submit his/her grievance in writing to the Chancellor of the University
of Arkansas for Medical Sciences after informing the Program Director he or she is doing so. The decision made
by the Chancellor will be final and binding and shall not be subject to further appeal.
Copy in Coordinator’s office.
59
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0950
10/2007, 7/27/2012
CRITERIA FOR ADVANCEMENT/PROMOTION OF RESIDENTS
DATE: 10/13/00
PAGE: 1 of 7
PGY1 to PGY2
PATIENT CARE
 Identifies purpose of patient visit in presentation to faculty or preceptor
 Gathers complete and reliable history, addressing the onset and persistence of illness in
the context of the patient’ life
 Develops an appropriately ordered, reasonable differential diagnosis for presenting
problem
 Documentation is legible, concise, complete for each problem, and with an updated
problem list for each patient.
 Considers the ramifications of treatment (medications, IV fluids, radiologic procedures,
surgery, activity levels, etc.) including interactions, side effects, and potential
complications
 Prescribes medications appropriately
 Appropriately secures assistance from PGY2 or PGY3, or faculty member so that
patient care is not delayed or jeopardized
 Documents all procedures performed during PGY1
 Demonstrates competence in all First Year Resident Physical Examination skills
 Appropriately manage 6 patients in a four-hour clinic schedule
MEDICAL KNOWLEDGE
 Orders appropriate labs/tests for the presenting problem
 Interprets EKG, CXR, NST systematically and accurately
 Specifies the guidelines (or is able to find and interpret them) for diabetes, hypertension,
hyperlipidemia, asthma
 Performs every aspect of the general physical examination, so that any abnormality in
any part of the body can be recognized
 Specifies the need for Special examinations to evaluate physical abnormalities
 Develops an appropriate assessment and plan for common presenting problems in
Family Medicine
 Identifies the most common and most urgent diagnosis in a differential
 Demonstrates competence in managing common problems via chart review or didactic
discussion
 Identifies normal and abnormal results of diagnostic tests
 Devises appropriate management and follow-up depending on results of diagnostic
tests
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM

Generates hypotheses regarding patients and their problems
PRACTICE-BASED LEARNING AND IMPROVEMENT
 Evaluates own performance and decision-making
 Considers means for improving patient care practices
 Tests hypotheses through thorough literature review, laboratory tests, physical
examination, history, and consultation.
 Uses instructional technology to determine best medical evidence
 Begins to evaluate the literature for presentations to peers and faculty
 Receives an evaluation and feedback for each outside rotation during PGY1
INTERPERSONAL AND COMMUNICATION SKILLS
 Creates a therapeutic working relationship with patients
 Appropriately presents working diagnosis to patient/family
 Educates patient/family about prescribed medications
 Identifies the patient’s needs, concerns and agenda(s) in coming to the office (patient’s
purpose for visit)
 Specifies the impact of patient’s SES, age, family life, culture, literacy and motivation on
acceptance of medical plan of care
 Effectively communicates to patient and family relevant information about the patient’s
clinical problem, condition and management plan
 Works collaboratively with other health professionals to facilitate patient care
PROFESSIONALISM
 Introduces self to patient/family and addresses patient/family appropriately
 Presents a patient case in a clear, organized, thorough manner
 Demonstrates a commitment to carrying out professional responsibilities
 Accepts feedback on performance and uses it to improve performance
 Demonstrates sensitivity to a diverse patient population
 Consistently demonstrates that patients’ needs supersede resident’s personal needs
 Attends at least 70% of all noon conferences
 Meets expected behaviors and can reliably use the content in the PGY1 Resident
Manual
SYSTEMS-BASED PRACTICE
 For each patient, discusses appropriate follow-up and/or discharge planning
 Health maintenance information is consistently updated, including medicine/allergy list
and problem list
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM







Documents appropriately, using the EHR
Participates in coding/billing of clinic/hospital visits
Utilizes insurance company formularies to choose covered medications
Refers patients to subspecialists that are covered by their insurance
With minimal guidance, writes diagnoses on all laboratory orders
Coordinates discharge of inpatients with hospital case manager
Coordinates care with team nurse and PGY II and III residents as appropriate
62
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Promotion Criteria
PGY2 to PGY3
PATIENT CARE
 Effectively narrows focus of encounter to manageable list of problems based on
patient’s symptoms, time available, and urgency of need.
 Addresses sensitive issues appropriately such as mental health or risky behaviors
 Incorporates health maintenance and preventative care where appropriate
 Arranges appropriate medical and ancillary referrals
 Functions effectively as an upper level resident
 Responds appropriately in emergent/urgent situations
 Documents all procedures performed during PGY2
 Addresses continuity of care issues in all visits where appropriate
 Addresses relevant family issues in office visits
MEDICAL KNOWLEDGE
 Demonstrates a clear method for evaluation of physical abnormalities, including ability
to identify need for and perform specialty examinations
 Reliably identifies an acute MI on EKG
 Consistently diagnosis common abnormalities on chest X-ray
 Orders appropriate pediatric and adult immunizations
 Demonstrates proficiency in using most common medications appropriately and safely,
including making dosage adjustments for renal or hepatic status, pregnancy & lactation,
comorbidities, and other drug therapies
 Consistently interprets diagnostic tests
 Consistently follows-up on results of diagnostic tests in a timely manner
PRACTICE-BASED LEARNING AND IMPROVEMENT
 Manages clinic duties efficiently
 Teaches students and interns in clinic and on hospital service
 Receives an evaluation and feedback for each outside rotation during PGY2
 Critically evaluates relevant literature during clinical and research presentations
 Consistently accesses online clinical resources to answer clinical questions
INTERPERSONAL AND COMMUNICATION SKILLS
 Implements a negotiated management plan with patient
 Discusses with patients end-of-life issues appropriately and with sensitivity to personal
and cultural norms
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM







Works with nonphysician professionals in a way that garners mutual respect and
excellent patient care
Demonstrates the ability to obtain special histories in a sensitive and nonjudgmental
manner [e.g., sexual practices, mental status, suicide risk, substance use/abuse,
domestic violence, child and elder abuse]
Communicates effectively with patients and families in challenging clinical situations
[giving bad news, discussing errors, inquiring about advance directives, recommending
Nursing Home care or retirement, altercations among patient and/or family members]
Appropriately intervene and/or report abuse, coercion, and unethical behavior of other
providers
Demonstrate consistent application of principles and skills that allow patients to make
informed decisions about their care
Consistently makes referrals to specialists that specify a clear question, and provide for
appropriate information exchange.
Consistently provide oral and written patient education appropriate to the visit
PROFESSIONALISM
 Identifies ethical issues in patient care
 Consistently demonstrates respect for patient autonomy
 Addresses chronic problems during office visit when appropriate
 Attends at least 70% of all noon conferences
 Meets expected behaviors and for upper level resident
SYSTEMS-BASED PRACTICE
 Complete and assist in billing for clinic/hospital visits
 Utilizes appropriate systems when ordering outpatient testing
 Consistently enters appropriate diagnoses on all laboratory orders
 Makes appropriate referrals to long-term care facilities and hospice
 Demonstrates consideration of patient and system costs in making referrals
 Advocates for patient care quality in both inpatient and outpatient settings
 When indicated, participates in root cause analysis on system errors
 When indicated, recommends interventions to prevent errors in the future
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Criteria for Graduation from the Program
PGY3
PATIENT CARE
 Consistently works with patient and family to develop a collaborative relationship and
management plan that includes care of acute and chronic issues, health maintenance,
disease prevention, and continuity of care
 Actively manages clinic
 Functions as a “Junior Faculty” in clinic and on hospital services
 Documents all procedures performed during PGY3
MEDICAL KNOWLEDGE
 Independently develops assessment and plan for patients’ problems, including plan to
address areas of uncertainty or knowledge deficits
 Apply appropriate, up-to-date practice guidelines, and be able to discuss and critique
the appropriateness of the guideline to each patient
 Demonstrate expertise in managing the 20 most common Family Medicine problems via
chart review or didactic discussion
 Demonstrate proficiency in appropriately prescribing/maintaining/discontinuing
medications, including risk/benefit analysis, management of side effects and adverse
reactions
 Passes USMLE Step III
PRACTICE-BASED LEARNING AND IMPROVEMENT
 Receives an evaluation and feedback for each outside rotation during PGY3
 Consistently critically evaluates relevant literature during formal presentations and
clinical discussions
 Presents a Grand Rounds Presentation to the Residency Hospital Staff
 Interprets relevant literature to answer clinical questions
 Facilitates the learning of staff, colleagues, and students, including identification of
learner needs
INTERPERSONAL AND COMMUNICATION SKILLS
 Works respectfully with and motivates clinical and hospital staff to promote safe,
effective, and efficient patient care
 Works respectfully with physician colleagues to promote excellent patient care
 Demonstrates ability to conduct a family meeting to address patient care issues
 Uses effective counseling skills to modify health risk behaviors
 With minimal assistance, coordinates care among consultant physicians and other
health care team members to achieve patient care goals
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM

Modifies case presentations to meet the learning needs of the audience
PROFESSIONALISM
 Completes all patient care tasks in a timely, organized and professional manner
(charting, flow sheets, phone calls and evaluation/disposition of laboratory data and
diagnostic reports)
 Consistently demonstrates respect, reliability, honesty, responsibility and compassion in
the fulfillment of professional responsibilities [with patients, families, colleagues and
other professionals]
 Advocates for high quality care for all patients in the Family Medicine Center
 Attends at least 70% of all noon conferences
 Consistently meets expected behaviors and reliably uses the content in PGY3 Resident
Manual
SYSTEMS-BASED PRACTICE
 Consistently submits accurate billing codes for patient encounters
 Consistently follows proper procedures (legal and insurance-required) in ordering
testing and referrals
 Independently makes appropriate referrals to hospice care
 Participates on hospital or clinic committees that review and improve systems that have
an impact on patient care and safety
SUMMATIVE CRITERIA THAT INCLUDES ALL 6 CORE COMPETENCIES (Patient Care,
Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and
Communication Skills, Professionalism, and Systems-Based Practice)
 Meets all six core competency requirements and receives documentation to verify
accomplishment
 Practices competently and independently in the field of Family Medicine
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0950.1
RESIDENT REMEDIATION
DATE: 5/8/12
PAGE: 1 of 2
At the UAMS AHEC Northeast Family Medicine Program we strive to provide a well rounded family
medicine education to residents at all levels. Recognizing that the practice of family medicine is multi-faceted and
that graduates of our program are successful in obtaining positions as hospitalists, emergency room physicians,
urgent care physicians, and family medicine with obstetrics in addition to a traditional family medicine position, we
work to maintain a high level competency from our residents. To that , we recognize that our residents come from
different educational backgrounds and enter our program with different levels of knowledge. We attempt to
challenge every resident and motivate them to achieve their full potential. When it becomes evident through
evaluations, faculty and preceptor input, and in-training exam scores that a particular resident appears to be
falling behind and is not achieving the expected threshold of competence the Program Director may elect to take
several steps to aid the resident in gaining the needed knowledge to become a successful family physician.
Typically, the following would occur in a step-wise manner, but in certain circumstances the Program
Director may elect to progress in a non-step-wise manner.
The approach to the resident with academic deficiencies is as follows:
1. The resident will completed assigned Challenger Modules as dictated by the Curriculum Director
which will include successful passing of the exams associated with each module.
2. The resident will meet weekly with his/her faculty advisor where high yield topics in family
medicine will be discussed. The resident will be assigned specific reading topics to be discussed.
3. The resident will give weekly lectures to faculty and fellow residents on topics assigned by the
faculty mentor and Curriculum Director.
We recognize that at times it may be necessary to review basic principles of medicine and physiology to
ensure each resident has a better foundation from which to build his/her medical knowledge and continue to be
successful within our program. As a result, we have developed a remediation rotation to aid our residents in
developing and maintaining the knowledge critical to providing good overall healthcare.
Course Length:
1 month; takes the place of an elective rotation; vacation is not allowed during this
rotation. Clinics will be scheduled on Tuesdays or Thursdays.
Course Preceptor:
Course Lecturers:
Curriculum Director
Designated AHEC Northeast faculty, PharmD staff, and guest staff physicians.
Course description:
The purpose of this rotation is to take a step back and review basic anatomy, physiology,
pathology, and pharmacology. The rotation will take a systems based approach and
consists of didactic lectures, assigned reading, and on-line tutorials. The course will also
contain pre and post examinations to determine competency. The month is broken
down into didactic and self study days. Didactic days are generally on Mondays,
Wednesdays, and Fridays. Each didactic day will cover a specific body system. The day
will start with a review of anatomy and physiology that covers the specified system. As
the day progresses high yield pathophysiology and pharmacology will be discussed as it
pertains to that body system. Tuesdays and Thursdays are designated as self study
days and are to be used by the resident to review information that was covered in
previous didactic lectures or prepare for upcoming lectures. Tuesdays and Thursdays
are also times when clinics will be scheduled. At the end of the rotation, there will be a
final exam covering major points that were covered during the month. The resident is
expected to score at least a 70% on the exam to prove competence in the material that
was covered. Those resident’s scoring less than 70% will meet with the Program
Director and may be required to repeat the rotation.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Required Texts:
Pathophysiology of Disease, An Introduction to Clinical Medicine, McPhee, Ganong, 5th
Ed, Lange
Textbook of Family Medicine. Rakel, Rakel, 8th Ed, Elsevier
Course Outline:
Week #1
Day #1 – Cell Physiology
Day #2 – Self Study
Day #3 – Cardiovascular System
Day #4 – Self Study
Day #5 – Pulmonary System
Week #2
Day #1 – Nervous System
Day #2 – Self Study
Day #3 – Endocrine System
Day #4 – Self Study
Day #5 – Renal System
Week #3
Day #1 – Immune System
Day #2 – Self Study
Day #3 – Gastrointestinal System
Day #4 – Self Study
Day #5 – Reproductive System
Week #4
Day #1 – Urinary System
Day #2 – Integumentary System
Day #3 – Review
Day #4 – Self Study
Day #5 – Exams
Copy in Coordinator’s office.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01200, 01400, 01600
4/13/07, 5/9/12
SPECIALTY ROTATIONS / PRECEPTORS
SPECIALTY ROTATIONS:
DATE: 7/1/99
PAGE: 1 of 1
The Family Medicine Center is your primary training site but a significant part of
your time will be spent in the hospital on specialty rotations and your assigned attending’s office. Each attending
is aware that family practice residents have obligations in the Family Medicine Center which require them to be
absent periodically throughout the week. To avoid scheduling difficulties and misunderstandings, each resident
should contact his/her attending before beginning the service and discuss the attending’s expectations. This will
confirm the rotation notification letter sent to the assigned preceptor from the program before each block.
PRECEPTORS:
On specialty rotations, your faculty attending will be assigned from the voluntary staff.
Preceptors hold adjunct clinical faculty appointments through UAMS and have demonstrated an interest in
teaching residents and medical students. Prior to the assigned block, the preceptor is notified with information
about your FMC obligations, approved time off, curriculum requirements goals and objectives, and evaluation
perimeters.
Non-service rotations are vital to your medical education. These preceptors are volunteering their time to
enhance your education. To that, you are required to be readily available to your preceptor’s service for A.M.
and P.M. rounds, clinics, admissions, procedures, etc. Your goal for each block will be to expand your medical
knowledge and patient management skills, as well as, learn the art of practicing medicine from assigned
preceptor. When your assigned preceptor is on vacation you should work with another physician in the group or
discuss alternatives with Program Director or Residency Coordinator.
A concerted effort will be made to provide you with a non-intimidating learning experience in each of the required
rotations. However, should a personality conflict with an assigned attending become apparent, you are urged to
exercise restraint and inform the Residency Director of the problem at the earliest opportunity.
ROTATION NOTIFICATIONS:
A week before a new rotation begins, you, your assigned preceptor and
faculty advisor will receive a notification of scheduled rotation. This information will include clinic assignments
and other approved time away from the service, a curriculum outline with preceptor round expectations, goals and
objectives, and an evaluation form. These should be reviewed prior to each rotation.
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SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01000
EVALUATIONS
EVALUATIONS:
DATE: 7/1/99
PAGE: 1 of 1
This program attempts to provide immediate performance feedback, both constructive
and critical, to maximize learning opportunities that can develop each resident’s potential. The most meaningful
evaluation, if honestly done, is self-evaluation and you are encouraged to do this throughout your training.
However, in order to have standardized resident performance evaluations the
The following methods are:
(1)
Director (or another faculty member) will directly observe a patient interview in the office setting
periodically.
(2)
The attending physician for your rotation will evaluate performance for that period of time spent on his
service.
There will be a reciprocal evaluation of that rotation by the family practice resident at the
conclusion of each block. Preceptor evaluation forms will be routed to the faculty advisor and resident for
review.
(3)
Each resident is evaluated by their faculty advisor and the clinic’s nursing supervisor, on a regular
schedule. All evaluations will be used by the Program Director for scheduled evaluation conferences. In
the first year, a monthly evaluation conference will be conducted by faculty advisor followed by
evaluations in September, February and June with the program director.
Second year resident’s
evaluation with the program director will be scheduled in October and March.
In the third year,
evaluations with the program director will be August and January with an exit session in June. Final
resident evaluations are sent to AHEC Central Office for resident’s permanent file.
(4)
All residents will participate in the American Board of Family Practice’s In-Training Assessment Exam
each November. These results are used to identify individual weaknesses and strengths as well as those
of the program’s curriculum.
(5)
The program subscribes yearly to the Core Content Review (a seven-test series) for each resident yearly
as another assessment tool.
(6)
Faculty assessments for clinical procedure check-off.
(7)
Faculty mentor’s follow-up with assigned preceptor.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01100
4/19/12
MOONLIGHTING
MOONLIGHTING:
DATE: 7/1/99
PAGE: 1 of 1
The official policy of this family practice program and the University of Arkansas for
Medical Sciences is that residents are free in their off-duty time to pursue whatever outside interest they have.
Should those outside interests interfere in any way with the obligations to the Family Practice Residency program,
they are grounds for immediate disciplinary action. (See contract)
At AHEC Northeast, moonlighting is prohibited during PGY I year. In the PGY II and PGY III years, any
moonlighting cannot interfere with the defined ACGME resident work hours. A copy of your moonlighting
schedule will be turned in to the Program Coordinator and Program Director at the beginning of each month. It
will be assumed if you have not obtained approval for the month that you are not working.
Your residency malpractice insurance will not cover your moonlighting activities. “Rider” policies are available
from several insurance carriers. (Reminder: Set aside a reasonable percentage of your moonlighting income for
taxes.)
Moonlighting commitments are not to interfere with performance in the Family Medicine Center, on specialty
rotations or any other residency responsibilities. An obligation for moonlighting should never be used as an
excuse to leave your attending’s service or you FAMILY MEDICINE CENTER. Negotiate flexibility with sites
where you plan to moonlight so that coverage is provided when you are detained. NOTE: Moonlighting is not a
priority of this residency training program.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01300
PUBLIC RELATIONS
PUBLIC RELATIONS:
DATE: 7/1/99
PAGE: 1 of 1
In the hospital and community you represent the Family Practice Program,
UAMS AHEC Northeast, as well as the medical community. Your performance as a resident is our most effective
means of developing good public relations in this community training setting. Your professionalism will be
reflected in the way you interact with patients, staff, colleagues and the community in general.
As part of the longitudinal community medicine curriculum requirement, you will be asked to participate in direct
public relations projects such as assisting with community related activities, i.e., physical exams for sports teams
or health issue talks in the public schools. You may also be asked to discuss health topics for radio, television, or
newspaper spots. It is important that you gain this experience as it will be likely that you will also participate in
community health events in your practice after residency.
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SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01500
5/22/12
ROUNDS:
FPS I teaching rounds are conducted with the faculty attending, PGY I, PGY III, and students at a
ROUNDS
DATE: 7/1/99
PAGE: 1 of 1
time and location designated by the faculty attending.
PGY I residents should be prepared to discuss pertinent subjective and objective findings with the rounding
team. Teaching rounds are not to be used as “working” rounds.
PGY II and PGY III residents will round on their FMC patient admissions daily around scheduled block
assignment. After rounds the PGY II or PGY III resident will discuss each patient with their respective faculty
attending.
ALL residents are expected to make hospital rounds while on specialty rotations in accordance with their specialty
preceptor.
ALL residents will make once per month rounds on their assigned nursing home patients. These rounds are
generally held on Wednesday afternoons with the designated nursing home faculty attending. Please see policy
number III-02300 for further details regarding NH Rounds.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-01700
7/1/07, 6/11/10, 4/19/12
DUTY HOURS
DATE: 8/23/05
PAGE: 1 of 1
DUTY HOURS: The ACGME lays out specific requirements for residents in terms of duty hours. The
UAMS AHEC Northeast Family Medicine residency program mandates strict adherence to these duty hours.
At no time should a resident ever violate the ACGME duty hours. If it appears that a resident will violate the
requirements, then it is the duty of that resident to notify his/her chief resident and/or attending physician so
that arrangements can be made to prevent a work hours violation from occurring and that additional coverage
of duties may be provided as needed. Further, the ACGME requires that duty hours be reported for all
residents of residency programs. All residents of the UAMS AHEC Northeast Family Medicine Residency
Program are required to log their duty hours in New Innovations software program at https://www.newinnov.com
Each resident will be given a login, password, and trained on how to use New Innovations
Software during orientation. The Residency Coordinator will monitor duty hours and you will be penalized a
vacation day if your duty hours are more than two weeks delinquent. You are allowed to be away from the
residency program 30 days during a fiscal year, if you run out of vacation time then that time will be added on
to the end of your residency.
The above schedules ensure that a minimum of ten (10) hours free of all responsibilities
between duty periods is met.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
RESIDENT PERFORMANCE
NUMBER:
REVISION:
II-0100
4/12/07
INTRODUCTION
INTRODUCTION:
DATE: 7/1/99
PAGE: 1 of 1
The residents are expected to be interested and available in the care of their patients in
the Family Medicine Center and on their specialty rotations. Your demonstrated interest in the performance of
assigned tasks will help in gaining the respect of the attending physicians and enhance the learning experience.
In a private hospital setting, as we have in Jonesboro, your availability and interest will be the major factor in
determining how much you benefit from your rotations. Time spent with your preceptors, even on mundane tasks,
will produce many opportunities for you to enhance your own skills and knowledge.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III: 0200
01/10/02; 4/13/07; 5/10/12
Administrative Structure
DATE: 07/01/99
PAGE: 1 of 1
Administrative Structure: As within any organization, new ideas for improving the overall operations are
welcomed and encouraged. However, change within the Family Medicine Center must be in the best interest of
all aspects of the training program and furthering the goals set for AHEC Northeast. To maintain good lines of
communication and insure that the right individuals are involved in problem solutions and new ideas, an
administrative chain of command is in place to facilitate efficiency in clinic management.
The nursing and lab staff report to Nursing Supervisor.
The Nursing Supervisor reports to the Residency Director.
The business office staff reports to Business Office Supervisor.
The Business Office Supervisor reports to the Administrative Director.
The Residency Coordinator reports to the Residency Director.
Residents report to the Chief Resident(s).
The Chief Resident(s) report to the Residency Director.
The Assistant Residency Director reports to the Residency Director.
Identified problems or improvement opportunities should be brought to the attention of the appropriate
administrator.
The Assistant Residency Director works closely with the Residency Director and functions as the Residency
Director in his/her absence.
Management goals are developed and facilitated through a series of Meetings including departmental, clinic
management, faculty, and AHEC administrative staff. The Chief Resident represents residents at many of these
meetings.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0250
8/7/2008
PATIENTS’ RIGHTS
PATIENTS’ RIGHTS:
DATE: 10/23/00
PAGE: 1 of 1
Access to Care: Individuals shall be accorded impartial access to treatment or
accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, or
sources of payment of care. Respect and Dignity: The patient has the right to considerate, respectful care at all
times and under all circumstances, with recognition of his/her personal dignity. Privacy and Confidentiality:
The patient has the right, within the law, to personal and informational privacy, and to assume that all
communication and records read only by individuals directly involved in treatment or in the monitoring of its
quality. Personal Safety: The patient has the right to expect reasonable safety insofar as the clinic practices and
environment are concerned. Identity: The patient has the right to know the identity and professional status of
individuals providing service to him/her and to know which physician or other practitioner is primarily responsible
for his/her care. Ethical Issues: All patients have the right to participate in discussions of ethical issues regarding
their care. All patients are entitled and encouraged to voice their ethical concerns with their attending physician or
their primary nurse. Information: The patient has the right to obtain, from the practitioner responsible for
coordinating care, complete and current information concerning his/her diagnosis (to the degree known),
treatment, and any known prognosis in understandable terminology. When it is not medically advisable to give
such information should be made available to a legally authorized individual. Communication: The patient has
the right to access to people outside the clinic by means of visitors and by verbal and written communication.
When the patient does not speak or understand the predominant language of the community, he/she should have
access to an interpreter. Consent: The patient has the right: To reasonable informed participation in decisions
involving his/her health care. Not to be subjected to any procedure without his/her voluntary, competent, and
understanding consent or the consent of his/her legally authorized representative. To know who is responsible for
authorizing and performing the procedures or treatment. To be informed of, and voluntarily give or refuse consent
to participation in, any human experimentation or other research/educational projects affecting his/her care or
treatment. Consultation: The patient, at his/her own request and expense, has the right to consult with a
specialist. Refusal of Treatment: The patient may refuse treatment to the extent permitted by law. When refusal
of treatment by the patient or his/her legally authorized representative prevents the provision of appropriate care
in accordance with professional standards, the relationship with the patient may be terminated upon reasonable
notice. Patients presenting to the clinic under the influence of drugs and/or alcohol: If any patient presents
to the clinic and you suspect they are under the influence of drugs and/or alcohol, then inform the patient that it is
our clinic policy to either:
1. Call them a taxi and escort them to the taxi.
2. Make sure they have a family member who will be driving them home.
3. If they are uncooperative with either 1 or 2 then we will call the Jonesboro Police Department to report
them as being publicly intoxicated.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0300
4/13/07, 5/10/12
ADMISSIONS
DATE: 7/1/99
PAGE: 1 of 1
ADMISSIONS: When a patient is admitted to the hospital from clinic, the PCP will write admission orders that
include H & P.
(1)
PGY II and PGY III will admit and manage their own patients from the FMC and nursing home.
(2)
PGY I residents will admit their patients from the FMC and nursing home to the FPS.
(3)
Faculty patients that are admitted to the hospital will be rounded on by the residents assigned to the
medicine service. The faculty may elect to round with the resident on the patient.
All patients admitted to the hospital should be included on daily census.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0400
AFTER HOURS CLINIC USE
DATE: 7/1/99
PAGE: 1 of 1
AFTER HOURS CLINIC USE: The Family Medicine Center will not be used for after hours treatment unless it is
for an immediate family member but even this is discouraged. If you do want to use the clinic after hours for
anyone other than a family member, approval must be obtained from the Program Director or Assistant Director.
This is to avoid any “problems” that an unsupervised exam might incur for you or the FMC.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0500
10/10/01, 7/18/12
APPOINTMENTS
APPOINTMENTS:
DATE: 7/1/99
PAGE: 1 of 1
Every effort is made within the Family Practice Center to work from a patient appointment
schedule. A combination of open access and routine scheduling is used to try and provide our patients with
several options. The goal is to allow our patients to schedule their appointments around their personal schedule
and enable them the freedom to see their physician when it is convenient.
In terms of patients scheduled into a resident clinic, there are maximum numbers of 8 for PGY I, 10 for PGY II,
and 12 for PGY III have been established with an acute care protocol when these numbers must be exceeded.
When all clinic slots are scheduled at maximum number and a patient must be seen, the business office staff will
screen, take pertinent information and present it directly to a senior resident in the clinic for decision on course of
action including overriding maximum numbers. Acute presentations are a part of Family Practice and must be
worked into every clinic. There is an established “work-in” clinic where the vast majority of these types of patients
are scheduled. On occasion, residents in regular clinics may be asked to see overflow work-in patients based on
the volume of patients seeking care.
All patients are to be seen in a timely manner whether appointed or work-in. Patients will not be refused
service or rescheduled unless approved by the clinic Attending physician or the Residency Director.
It will be your responsibility to inform the receptionist and your nurse of any appointments you make for a patient,
whether through a telephone conversation, ER encounter, or hospital discharge.
Any conflicts, complaints, or concerns about appointment schedules should be addressed with the Assistant
Residency Director or Residency Director at the conclusion of clinic. Under no circumstances should the
resident leave patients in the clinic to confront the front office about problems with scheduling.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0600
4/13/07, 5/21/12
ATTENDING
ATTENDING:
DATE: 7/1/99
PAGE: 1 of 1
Instruction and supervision of residents in the Family Practice Center is provided by
identified full and part-time faculty members. A faculty member in the teaching area or in their respective office
will be available for case discussions, supervision of procedures, reviewing chart notes, and resolving immediate
problems involving residents, staff, or patients. A monthly schedule of faculty teaching corridor assignments is
posted in several areas including the hall message board.
Attending duties:
(1)
Review, critique, and sign residents’ notes in the EMR.
(2)
Encourage resident questions and interaction.
(3)
Staff office procedures.
(4)
Evaluate and provide input on all Medicare patients.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0650
5/21/12
MEANS OF RESIDENT GUIDANCE FROM FACULTY
DATE: 10/23/00
PAGE: 1 of 1
There are several ways in which the residents receive guidance from the faculty including:
1.
Use of the team system with the faculty as the team leader to provide guidance for resident team
members on medicine and OB/Peds services.
2.
If the designated faculty team leader is not immediately available, other faculty members assume
coverage and duties of guidance for resident team members.
3.
During the time of a resident’s annual review, the designated faculty mentor provides guidance on future
practice plans, areas needing improvement, etc.
4.
Resident supervision and guidance by the faculty is given in the clinic, hospital, nursing home and in all
other outpatient settings during patient care encounters.
5.
There is an open door policy with the program director and all faculty members for residents seeking
advice.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0700
4/13/07
CHART REVIEW
CHART REVIEW:
DATE: 7/1/99
PAGE: 1 of 1
The designated clinic attending will review all resident EMR notes. The review may result
in a question regarding the course of action taken, provide guidance for further management; or sharing a
“practice pearl”. Follow-up with the faculty as indicated by note.
Charts are also reviewed randomly as part of QA process.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0800
5/22/12
CLINIC ASSIGNMENTS
CLINIC ASSIGNMENTS:
training.
DATE: 7/1/99
PAGE: 1 of 1
Clinics with an appropriate panel of patients are a required part of residency
Your clinics are coordinated [when possible] around your preceptor’s stated preference, service
requirements, and your team’s schedule. Your clinic assignments will vary with each rotation but you will be
informed through the rotation notification and published clinic schedules.
PGY I: Two one-half days per week with the number is reduced to one one-half day per week while on FPS I
service)
PGY II: Three one-half days per week with the number reduced to two one-half day clinic while on FPSII and
OB/Peds Backup rotations. (NOTE: one of the one-half day clinics while on FPS II service is at the
Church Health Clinic.)
PGY III: Three one-half days per week. While on FPS III service, the PGYIII resident is kept out of scheduled
clinics due to their significantly increased responsibility as the PGYIII team member on the FPS service.
The resident is expected to staff all assigned clinics. Asking a colleague to cover your assigned clinic is not
acceptable except in the rarest of circumstances, i.e.; family emergency or attendance at patient’s bedside. In
these instances, all changes must be approved by the chief resident and/or designated faculty member in charge
of resident scheduling.
Residents are may be asked to perform extra clinics as patient volume warrants (i.e. seasonal illnesses,
pandemics, community needs, etc).
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-0900
CLINIC-CHURCH HEALTH
CHURCH HEALTH CLINIC:
DATE: 7/1/99
PAGE: 1 of 2
In PGY II, the resident on Family Medicine Service is assigned to the Church
Health Clinic as a required clinic. Resident assignment will be a one-half day block on Thursday from 1:30 P.M. –
4:30 P.M. Clinic notice is provided on rotation notification. Please remember that patients are scheduled into this
clinic and except in case of emergency this clinic cannot be cancelled. The resident is held to the same
accountability as in the FAMILY MEDICINE CENTER and is required to attend.
Located at the corner of Washington and Kitchen Streets, this clinic is staffed by a full-time RNP and volunteer
physicians. The clinic offers care to uninsured and underinsured individuals.
This responsibility is also credited to your community medicine requirements.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-01000
CONTINUITY OF CARE
CONTINUITY OF CARE:
DATE: 7/1/99
PAGE: 1 of 1
Family Medicine is grounded in the concept of a physician providing continuity of
care to a patient. As the patient’s health care advocate you are expected to develop long-term relationships that
promote optimal management outcomes, compliance, rapport, and professional satisfaction in the specialty you
have chosen. In the Family Medicine Center, continuity of care is fostered through patient enrollment with you
and an identified team.
Your patients seen by a colleague in the clinic, ER, or hospital will be referred back to your clinic for on-going
care.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-01100
DEATH CERTIFICATES
DEATH CERTIFICATES:
DATE: 7/1/99
PAGE: 1 of 1
Death Certificates on your patients should be completed and mailed in a timely
manner. Arkansas law states the certificate should be completed, signed, and returned to the funeral director
within 48 hours of death. The funeral home must record the death certificate with the state within 10 days. As
the physician, you are responsible for completing: section 23, parts 1 and 2 including the interval between onset
and death; sections 24 through 35; sections 38 through 40.
[Seek guidance from the faculty or an upper level resident if you have questions.]
A complete guideline is available in the Coordinator’s office.
Occasionally, you may receive a death certificate on a patient you pronounced while on call in the hospital.
These should be forwarded to the patient’s primary care physician (information can be obtained from the
hospital’s medical records department).
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-01200
EMPLOYEE MEDICAL CARE
EMPLOYEE MEDICAL CARE:
DATE: 7/1/99
PAGE: 1 of 1
Employees of the FPC and SBRMC may seek you out for medical care
or advice for themselves or their family members. “Hallway” care is never acceptable. [AHEC Northeast has an
employee policy that addresses these issues specifically and each employee has a copy of the policy.] Patient
records should be reviewed, an encounter form prepared, and history/exam conducted in an exam room. A note
should be entered in the EMR (including any samples dispensed) and the encounter form completed with
appropriate charge level. You should encourage the employee to establish care with one identified physician and
that care should be rendered within the standards set for any of our patients.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-01400
FINANCIAL COUNSELING
FINANCIAL COUNSELING:
DATE: 7/1/99
PAGE: 1 of 1
The FPC has established procedures for helping each patient manage their
account. These policies may and do change without notice. Any questions regarding financial requirements or
expectations should be directed to our financial counselors. Some of these policies include determining eligibility
for OB Medicaid coverage, providing information and referrals to appropriate assistance agencies and setting up
monthly payment plans when necessary. Qualified individuals may apply for a FPC discount through a sliding fee
scale based on income. This discount with be honored by our outside lab so it is in the best financial interest for
the patient to be approved.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY MEDICINE CENTER
NUMBER:
REVISION:
III-01500
FIRING PATIENTS
FIRING PATIENTS:
DATE: 7/1/99
PAGE: 1 of 1
Periodically, resident physicians identify a patient in the clinic or hospital that he/she does
not want to follow in their panel of patients. The resident should give colleagues an opportunity to follow patient
and if no one elects to do so, present the patient to the Program Director for approval to dismiss patient from
practice.
Please include reasons for dismissal. A notification letter under the signature of the resident and
program director will be sent to the patient and clinic records noted accordingly.
We must continue to see the patient for 30 days (for emergency problems only).
DO NOT ask the front office staff to fire a patient or dictate a letter firing a patient.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-01600
HOURS:
The clinic is open from 8:00 A.M. – 5:00 P.M., Monday through Friday.
HOURS
DATE: 7/1/99
PAGE: 1 of 1
You are expected to be on time for the beginning of your assigned clinic. If you are detained for any reason and
cannot be in the clinic at the designated time, it is your responsibility to let your clinic nurse know about the delay
and when you will be available. Residents should be available in the clinic or resident’s office until the end of
assigned clinic time.
Occasionally, your clinic may extend beyond 12:00 or 5:00 P.M. due to unforeseen patient care requirements.
This is an expected part of family medicine.
If daily report is overly long and you are scheduled for clinic, you should leave report if you are not presenting a
patient.
A resident CANNOT cancel a clinic. These requests should be through the Chief Resident(s), Residency
Coordinator, and Program Director.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-01700
HOUSE CALLS
HOUSE CALLS:
DATE: 7/1/99
PAGE: 1 of 1
House calls on certain patients are required and encouraged since it often helps to
develop a management plan appropriate to the patient’s home environment. Each resident is required to make at
least 2 home visits during his/her 3 years of residency. These visits must be entered in the EMR and signed by
faculty. Patients enrolled in Hospice are a good opportunity for home visits. A FM faculty member will be
available for consultation. A resident is NEVER to perform a home visit alone, they must be accompanied by a
faculty member or the Nurse Manager.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-01750
INCIDENT REPORTS
INCIDENT REPORTS:
DATE: 7/1/99
PAGE: 1 of 1
Occasionally, a patient (or family member) is dissatisfied with the medical care
provided, our professionalism, billing, etc., and may voice these complaints to a staff member, resident, or faculty.
Each of these contacts must be treated as a potential problem area and should be followed up in an appropriate
manner. An incident report form is available to document pertinent details. Always discuss any threatened
litigation with the Program Director. Any threat by a patient of bodily harm will not be tolerated and is to be
reported IMMEDIATELY to the Program Director.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-01800
4/16/07
LAB:
LAB
DATE: 7/1/99
PAGE: 1 of 1
Limited lab services are available in the FPC with additional services sent to Quest Diagnostics. Lab
reports are sent to you via EMR for your review. Residents are encouraged to seek guidance from the clinic
attending to decide appropriate action on abnormal reports.
A number of insurance plans, especially Medicaid and Medicare, have restrictions or special requirements to
cover certain lab studies. All non-paid services should be discussed with patient prior to ordering. Each lab
orders must include either a diagnosis or symptom to justify request. Insurance companies deny payment on lab
which is not tied to a specific, diagnosis or symptom. When a diagnosis or symptom can not be determined seek
guidance from a faculty or the lab tech.
Cost effective use of lab studies is an important part of patient
management.
All residents are encouraged to learn basic lab procedures by availing themselves of the expertise of lab tech.
LAB FOLLOW-UP:
Patients are concerned about any lab and/or x-ray studies that were done and have a
right to know the results of these studies. Good patient/physician communication is essential to the practice of
medicine and you should inform your patient during the office visit of a follow-up method to expect. A.) A letter to
the patient is sent on all normal labs. B.) Schedule the patient for a specific follow-up visit to discuss lab/x-ray
findings particularly after an extensive work-up. Note: allow time for results from independent labs to be returned
to office.
It is never a good idea to ask the nursing staff to contact your patient about abnormal lab findings. Patients may
need reassurance and information, which the nursing staff may not be able to provide.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-01900
MANAGED CARE PLANS
MANAGED CARE PLANS:
DATE: 7/1/99
PAGE: 1 of 1
The FPC participates in several managed care plans. You will automatically be
enrolled as a provider in plans the FPC accepts. The specifics of these plans may vary but all are designed
around the concept of primary care physicians supervising patient care through direct management or appropriate
referral to other specialist. Specific coverage information for each plan is available in the clinic.
Residents may not independently enter into a contract on behalf of the FPC.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02000
MEDICAID:
The managed care plan of Medicaid requires recipients to identify one physician as provider. You
MEDICAID
DATE: 7/1/99
PAGE: 1 of 1
are enrolled as a provider in this plan. The Medicaid program is restrictive with specific guidelines for the number
of outpatient visits, lab test and procedures that are covered. Since the UAMS AHEC Northeast family medicine
clinic is a Medicaid provider many times a patient may present with a Medicaid ID card that lists AHEC Northeast
as their PCP even though they have not established an actual doctor/patient relationship with us. The UAMS
AHEC Northeast family medicine clinic is required to care for all Medicaid patients that have us listed as their
Medicaid provider.
Prescriptions are restricted to a covered formulary.
Seek guidance from faculty or staff on specific requirements.
96
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02100
4/16/07
MEDICARE PATIENTS
MEDICARE PATIENTS:
DATE: 7/1/99
PAGE: 1 of 1
Medicare has restrictive coverage guidelines on certain lab, out-patient studies
and procedures. When a service is not covered, the patient must sign a release advanced beneficiary notice
acknowledging their financial responsibility. Standardized forms are available in FPC. Example: Patient states “I
want a chest x-ray” and there is no diagnosis or reason for an x-ray.
CMS sets certain stipulations on residents seeing Medicare patients in a training program. Faculty must see all
patients with a PGY I for the first 6 months of training. After the first six months, residents may independently see
patients for service codes 99201, 202, 203, 211, 212, and 213. Patients must be reviewed with the attending and
documented in the medical record. All residents must have the clinic attending see higher service level patients
(99204, 99205).
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02200
4/16/07, 6/4/12
MEDICATIONS AND SAMPLES
DATE: 7/1/99
PAGE: 1 of 1
MEDICATIONS AND SAMPLES:
The UAMS AHEC Northeast Family Medicine Clinic has a policy of NOT keeping sample medications except
insulin’s. Most of these medications are name branded and more expensive than generic alternatives.
Pharmaceutical representatives are still allowed to set up in a specific area and can be used to gain insight into
new medications and treatments.
Many pharmaceutical companies have indigent care resources, which can be requested for your patient. The
Pharm. D. faculty can provide information on these.
Medical supplies and stock purchased for the clinic should not be given to the patients nor taken for personal use.
98
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02300
6/9/2009, 5/22/12
NURSING HOMES
NURSING HOME:
DATE: 4/19/01
PAGE: 1 of 1
The FP program is responsible for a group of patients at Craighead Nursing Center (5101
Harrisburg Road; Jonesboro, AR 72401). Dr. McGrath is the attending designated to oversee nursing home
rounds.
All residents are assigned to care for a panel of patients at Craighead Nursing Center during their training.
Residents are required to round on each of their patients at least once monthly. Protected time is built into each
resident’s schedule to allow rounding with the nursing home attending on Wednesday afternoon (Red team on 1 st
Wednesday, Yellow team on 2nd Wednesday, Green team on 3rd Wednesday, Purple team on 4th Wednesday). If
a resident is unable to be present at the nursing home on their designated week, they are required to discuss an
alternative time for rounding with the nursing home attending.
In addition to monthly rounds, resident physicians are expected to address, in a timely manner, all issues
pertaining to their nursing home patients which are made known to them via the office flagging system or phone
message.
DEATH PRONOUNCEMENT IN NURSING HOME:
Based on AR Code Annotated 20-18-601/604 and 1212-315, the body of a person who expires in a nursing home may be sent directly to the funeral home without a
physician pronouncing death. The nursing home will contact the patient’s physician or the ROC to obtain an order
for the disposition of the body. The secondary back-up should be notified and pronounce the patient if there are
family members present or the death was unexpected.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02400
5/22/12
OB CONTINUITY OF CARE
OB CONTINUITY OF CARE:
DATE: 7/1/99
PAGE: 1 of 1
We prefer that obstetrical care will be provided by one assigned resident from
initial work-up through all prenatal visits. It is understood that due to the difficulty of scheduling this may not
always be the case. It is expected that a team member will follow the patient when the primary physician is on
vacation or away for CME or other requirements. At times a physician other than the primary or physician on the
primary’s team may deliver care. Delivery presentation will be managed per on-call assignments unless the PCP
is willing and available for the delivery.
Per current ACGME guidelines, PGY II and PGY III residents are required to deliver ten patients from their panel
with the option for others to be delivered by the on-call or OB service residents.
The continuity Physician should see both mother and baby (if to be followed in our clinic) after delivery and followup in their clinic.
C-SECTION:
Patients needing cesarean section are scheduled with a UAMS AHEC Northeast Attending that
has hospital privileges to perform this procedure. The resident will refer the patient to an attending capable of
performing cesarean section by 32 weeks gestation.
HIGH RISK OB:
The UAMS AHEC Family Medicine Northeast clinic provides high risk obstetrics care through
the use of a high risk APN (Lisa Harmon) and tele-video visits with the maternal-fetal medicine physicians at
UAMS. In some cases it may be appropriate that the patient deliver here at St. Bernard’s. This will be decided
per patient and discussed with the AHEC OB attending at that time
Vaginal Delivery After Cesarean section (VBAC): Unfortunately, not all attending physicians at this program
have the ability to perform a cesarean section if needed. The UAMS AHEC Northeast Family Medicine clinic
does NOT support VBAC deliveries. Patients refusing repeat cesarean section and wishing to have a VBAC must
be recognized early in the pregnancy and every attempt must be made to get them referred to another OB
provider. If a patient presents to the OB floor refusing cesarean section and requesting VBAC then the OB on-call
will be consulted to manage the case.
ULTRA-SOUNDS:
The FPC has faculty trained in ultrasonography. US are by appointment with protocols
established on when these should be obtained. Residents on OB will have US instructional time in FPC.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02500
OSHA/UNIVERSAL PRECAUTIONS
OSHA/UNIVERSAL PRECAUTIONS:
DATE: 7/1/99
PAGE: 1 of 1
Federal regulations through the Occupational Safety and Health
Administration (OSHA) requires certain standards be in place in the work environment. The AHEC office and the
Family Practice Center adhere to these guidelines and require all employees to be oriented yearly on these
measures which include universal precautions in handling body fluids and waste disposal.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02600
6/5/12
PATIENT BILLING & COLLECTIONS
DATE: 7/1/99
PAGE: 1 of 1
PATIENT BILLING: The AHEC Family Practice Center is not a free clinic. All services provided to patients in the
FPC, hospital and nursing home will be charged to the patient’s account with payment expected. The clinic
accepts Medicaid, Medicare, and other insurance.
In the FPC, clinic and lab charges are posted from the encounter form. Each physician is responsible for
completing the encounter form attached to the patient’s chart with all patient visit data: level of service,
procedures performed, lab tests and x-rays ordered, diagnosis and when return appointment should be
scheduled.
Hospital charges are obtained through information at daily report and direct communication from residents
providing care to billing staff.
Below are copies of handouts of what our patients get regarding their financial responsibility:
ALL BALANCES ARE DUE UPON RECEIPT UNLESS PRIOR ARRANGEMENTS HAVE BEEN MADE
1. Thirty (30) days from the date of the first statement your account will be considered past due if we have not
received payment in full or payment per agreement.
2. If you are unable to pay your outstanding balances in full please call our Financial Counselor at 870-972-0063,
extension 299.
3. If your outstanding balance becomes 90 days past due, the balance may be transferred to the collection
agency listed below. You can contact them at:
Professional Credit Management
Post Office Box 4037
Jonesboro, AR 72403
Phone (870) 932-7030
It is your responsibility to provide UAMS Family Medical Center-Jonesboro with your current insurance
information at each visit. If you continue to receive a statement that shows no insurance payments or
adjustments, please contact our Insurance Billing Office at 870-972-0063, extension 247 or extension 257.
Insurance companies have a time limit to send in claims. Once that time limit has been reached, UAMS
Family Medical Center-Jonesboro can no longer file your claim with your insurance plan and the balance
becomes the patient's responsibility.
Please remember to present your insurance card to the check-in person at each visit.
Having your correct insurance information will help prevent future claim problems and potential collection issues.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
Patient Financial Responsibility
Information Form
A. Insurance: We participate in most, but not all insurance plans, including Medicare and Medicaid. If you
are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured
by a plan we do business with, but don’t have an up-to-date insurance card, payment in full for each visit is
required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please
contact your insurance company with any question you may have regarding your coverage. UAMS FMCJONESBORO is a residency program, therefore; charges are billed under the attending physician, which
changes every day. If we bill under an attending physician that is not in network with your insurance, the
balance, after filing, will be the patients’ responsibility.
B. Uninsured patients: We require that a $125 deposit be made by new patients with no payer source before
being seen by a physician. We require that a $75 payment be made by established patients with no payer
source before being seen by a physician. All self-pay hospital follow-up visits will be referred to ARcare, an
alternative local service, or to the hospital social worker for assistance in securing follow-up care after a
hospital admission.
C. Co-payments and deductibles: All co-payments and deductibles must be paid at the time of service.
This arrangement is part of your contract with your insurance company. Failure on our part to collect copayments and deductibles from patients can be considered fraud. Failure on your part to pay 3 or more copayments could result in termination of coverage. Please help us in upholding the law by paying your copayment at each visit.
D. Non-covered services: Please be aware that some – and perhaps all – of the services you receive may
be noncovered or not considered reasonable or necessary by Medicare, Medicaid or other insurers. You
must pay for these services in full at the time of visit.
E. Proof of insurance: All patients must complete our patient information form before seeing the doctor. We
must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you
fail to provide us with the correct insurance information in a timely manner, you will be responsible for the
balance of a claim.
F. Claim submission: We will submit your claims and assist you in any way we reasonably can to help get
your claims paid. Your insurance company may need you to supply certain information directly. It is your
responsibility to comply with their request. Please be aware that the balance of your claim is your
responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract
between you and your insurance company; we are not party to that contract.
G. Coverage changes: If your insurance changes, please notify us before your next visit so we can make the
appropriate changes to help you receive your maximum benefits. If your insurance company does not pay
your claim in 45 days, the balance will automatically be billed to you.
H. Nonpayment: If your account is over 60 days past due, you will receive a letter stating that you have 10
days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please
be aware that if a balance remains unpaid, we will refer your account to a collection agency and you and
your immediate family members may be discharged from this practice. If this occurs you will be notified by
regular or certified mail that you have 30 days to find alternative medical care. During that 30-day period,
our physician will only be able to treat you on an emergency basis.
I.
Missed appointments and late cancellations: Appointments not kept represent a cost to us, to you
and to other patients who could have been seen in the time set aside for you. Cancellations require a 24
hour notification prior to the appointment. We charge your account $20 for missed or late-canceled
appointments. Abuse of scheduled appointments may result in discharge from this practice. Please help
us serve you better by keeping your scheduled appointments.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
J.
Motor vehicle accidents: UAMS FMC-JONESBORO does not file claims due to motor vehicle accidents.
If you are seen due to motor vehicle accident, you will be considered a self pay patient and the charges will
be your responsibility.
Our practice is committed to providing the best treatment to our patients. Our prices are representative of the
usual and customary charges for our area. Please let us know if you have any questions or concerns.
Rev 12/08/2011
Self-Pay Policy and Procedure
Non OB & Pediatric patients:
 All new and established self-pay patients requesting an appointment will be notified of our self-pay
financial policy before the appointment is scheduled. If the patient is unwilling or unable to meet those
guidelines, the patient will be rescheduled or referred to alternative local services 1.
 All new self-pay patients presenting for their first appointment must pay $125.00 up front. Those new
patients presenting for care who are unable to pay the $125.00 co-pay will be rescheduled or referred to
alternative local services.
 All co-pays, deductibles and co-insurance amounts are due at time of check-in.
 An established patient with no insurance coverage will be expected to pay the $75 co-pay per visit. The
co-pay is in addition to any payment arrangements made by the established patient. If the established
patient is unable to make the co-payment, patient will be rescheduled or referred to alternative local
services.
Emergent and Urgent Situations:
 An emergency situation (potentially life threatening) occurring at our check-in area or clinical services
area will require the attention of the most available physician in our clinic. Medical staff will stabilize the
patient until hospital ER or EMT personnel arrive to assume patient responsibility.
 Urgent is not an immediately life threatening situation but one where medical attention is necessary. Selfpay patients (new or established) presenting with an urgent complaint will be screened by a triage nurse
to determine the status of the patient’s condition and determine if there is an urgent need for medical
attention. Patients not meeting the financial requirements, but deemed urgent by a triage nurse in
consultation with a provider will be seen. Normal charges will be assessed for that visit. The patient
account will be flagged that an urgent situation occurred requiring immediate attention.
o Front desk responsibilities are to: 1) inform patient of our financial policy and patient’s payment
responsibility; 2) collect payments; 3) check for previous “urgent” visits; and 4) notify triage
nurse for screening, in consultation with a provider, of all patients presenting for non-healthcare
maintenance complaints and of previous “urgent” visits.
o Triage nurse responsibilities are to: 1) screen the patient in consultation with a provider to
determine if an urgent visit is required; 2) document the need for the urgent visit and notify the
registration staff that the patient will be seen; and 3) refer the patient to the financial counselor
for financial follow-up. If an urgent visit is not warranted, the patient will be directed to other local
providers.
o Financial counselor responsibilities are to: 1) make payment arrangements for the visit; and 2)
advise the patient of any outstanding balances.
Hospital Follow-up visits:
 All self-pay patient hospital follow-up visits will be referred to an alternative local service 1 or hospital
social worker for assistance in securing follow-up care.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
OB and Pediatric Self pay patients:
 Once care is established for an OB patient, the patient will be followed through delivery and the requisite
post partum visits. All self-pay OB patients must be referred to the financial counselor who will follow-up
with the Medicaid Case Worker to expedite the application process for Medicaid coverage and should see
the financial counselor before each visit for financial follow-up. Once the global fee is charged at delivery
and the patient has completed the requisite post-partum visits, any pre-payments made by the patient
before delivery will be credited and the remaining balance will be transferred to Debt Offset following
attempt to collect. All self-pay OB patients must pay $75 co-pay for each ante-partum visit. The $75 will
be carried as a credit balance until delivery. At delivery, the credit will be transferred to the global fee. In
the event that the patient is not delivered by an AHEC physician, the global fee will not be charged and
the ante-partum visits will be posted and the credit applied to those visits.
 OB patients with pending Medicaid coverage will convert to self-pay status after 75 days on pending
status. Once Medicaid is denied or coverage is not established, the above applies. The financial
counselor will work closely with each patient with pending Medicaid until coverage is obtained or denied.
 Self-pay pediatric patients will be referred by the financial counselor for application to the AR Kids First
program. All new pediatric patients will be seen but those not qualifying for AR Kids or parents failing to
follow through with the application process will be referred after the first visit to alternative local services.
General Guidelines:
 Pay plans for patients can last no longer than six months from date of service. Balances in excess of the
pay-plan will be transferred to debt offset immediately. For example: patient has incurred a visit balance
of $700.00 and agrees to pay $50 per month for the next six months. The balance after pay plan is $
400.00 which would immediately be transferred to Debt Offset leaving a balance of $300 on the patient’s
account to be paid out in installments. If the patient misses a payment or is unable to make full payment
in any month, the remainder will be transferred to Debt Offset immediately.
 A discount of 20% may be offered to any self-pay patient paying a balance over $100.00 in full. This also
applies to any self-pay balance after all insurance and other third party payers have paid.
1 Alternative
local service is ARcare (six locations), The Church Health Center or other services as directed by
patient.
BILLING AND PAYMENT POLICY
IF YOU ARE COVERED BY INSURANCE:
Our office is currently participating in Medicaid, Medicare as well as many local, state and federal insurance
programs. You must present your insurance identification card at the time of each visit. We will file your claims for
you. However, you are responsible for the annual deductible and co-payment as required by your insurance plan.
WE WILL REQUIRE THAT YOU PAY THE CO-PAYMENT AND ANNUAL DEDUCTIBLE PRIOR TO YOUR
OFFICE VISIT. If you do not have your insurance card with you at the time of your visit, you will be considered a
cash pay patient.
IF YOU ARE NOT COVERED BY INSURANCE:
We understand that many patients may not be covered by any type of medical insurance. In order for this clinic to
keep costs reasonable while giving you excellent health care, if you are an established patient or a new or
established OB patient, a co-payment of $75.00 is required at the time of service for each visit and prior
arrangements made for outstanding balances. For your convenience we take major credit cards, credit/debit
cards, checks and cash. There is a $35 fee for all returned checks. If a check is returned for non- sufficient funds
more than once by a patient/guarantor, payment will only be accepted by cash or credit card. If you are a new
patient, a $125.00 co-payment will be required prior to service with the balance due within 90 days.
CREDIT & COLLECTION POLICY:
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
At this time, we require that payment be made at the time of service unless prior arrangements have been made.
We will do our utmost in keeping you informed of your health care costs as services are rendered. If there is
balance on your account after your insurance carrier has been billed, you will be responsible for payment on your
account in a timely manner. Balances not paid after 90 days are subject to collection and legal services and
health services from this clinic may be denied until the account is no longer delinquent.
By signing below, I am confirming that I understand the information above.
____________________________________ ______________________
Patient Name (Print)
(Date)
____________________________________ ______________________
Signature Relationship to Patient
(Date)
Rev: 03/21/12
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02700
PATIENT ACCOUNT REVIEW
DATE: 7/1/99
PAGE: 1 of 1
PATIENT ACCOUNT REVIEW: Every attempt is made to collect patient accounts through established FPC
policies. When necessary, accounts are reviewed and turned over to a collection agency for further action.
You may be asked to review bad debt accounts on your patients. This review should include your personal
knowledge of patient, problems, or conflicts that might be inflamed by additional collection efforts. When in doubt,
discuss with a faculty member.
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SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02800
6/5/12
PATIENT DISCOUNTS
DATE: 7/1/99
PAGE: 1 of 1
PATIENT DISCOUNTS: Residents should not develop the habit of giving away their services through “no charge”
or “Discounts to insurance”. Discount to insurance is deemed a fraudulent practice. You should learn to charge
appropriately for the level of services rendered.
The FPC has an established sliding fee scale for qualified individuals who have difficulty paying for medical care.
Through established clinic procedures, the Financial Counselor will work with uninsured or underinsured patients
to identify resources available to them. When a patient expresses a concern about their ability to pay, refer them
to the Financial Counselor to discuss their account.
PATIENT DISCOUNT POLICY GUIDELINES
Dear Patient:
We are glad that you have inquired about the discount program at AHEC NE. To find out if you can take
advantage of this program, we will need some things from you right away. Enclosed in this packet you will find an
application form.
Complete the form in this way:
1.
2.
3.
4.
Make sure all spaces are complete even if the answer is “none” or “does not apply.”
Use full legal name for all patients listed. (For example, use “Robert” not “Bob”)
Gross income or salary means the money you make before any taxes or other deductions are made.
If you have more information that won’t fit the space on the form, attach it to the form.
In addition to the completed application, additional information will be needed. Please provide the following:
**PLEASE NOTE – CURRENT INFORMATION IS MANDATORY**
1. Denial of Medicaid application.
2. Proof of total household income from the past two months. (If you are paid weekly, we will need 8 current pay
stubs. If you are paid bi-weekly, we will need 4 current pay stubs. If you have a new job, bring a letter from
your employer stating the date you began work, the number of hours expected to work, and your hourly
wage.) for everyone 18 years or older.
3. Self-employment verification. (income tax forms, bank statements)
4. Current documentation reflecting benefit amount (V.A., Social Security, Disability, Unemployment,
Retirement, etc.)
5. Proof of any financial assistance you might receive. (Housing Assistance, Food Stamps, Utility Assistance,
Child support...etc.)
6. If you are unemployed, bring 2 statements from non-family individuals stating your living conditions and how
your living means are met.
It is important that we have this information in our office as early as possible. Once you have been given the
application, you have 30 days to return all information to the Financial Counselor. Failure to comply with request
of this letter will result in your application for financial assistance being denied. Approved discounts will not apply
to any bills that are older than two months on the date you apply. Making sure we have all the correct information
108
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
is very important. Once all the required information is received, we will begin to process your application and you
will receive notification of your eligibility from our office.

If you are approved, we will continue your discount for six months. In order to continue on the discount
program you must re-apply 30 days prior to the expiration date. If you do not re-apply, your discount will be
terminated.
The discount program will cover services in our office only. Anything that is elective or not considered medically
necessary will not be covered. The physician will determine whether it is medically necessary. The following
services will not be covered:






Elective studies (e.g. Depo Provera, other forms of birth control)
Prescriptions
Accounts already at collections
Accounts with an attorney at the time you apply
Motor vehicle accidents where liability and/or medical insurance exists for the patient and/or the party at fault
Lab tests (It is the patient’s responsibility to apply for the discount program through Quest
Laboratories)
If you have any questions about the application or need assistance, please contact our office at (870) 972-0063
ext 417.
Financial Counselor
Collections Department
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02900
5/23/12
PHARMACEUTICAL REPRESENTATIVES AND OTHER PROFESSIONAL
VISITORS
DATE: 7/1/99
PAGE: 1 of 1
PHARMACEUTICAL REPRESENTATIVES AND OTHER PROFESSIONAL VISITORS: An office policy exists
for pharmaceutical representatives to set up displays on a scheduled basis. This policy restricts access to the
approved area only.
The resident’s area is for your use but be conscientious about inviting visitors into the area that might infringe
upon the time and space of your colleagues. If a private area is needed to meet with visitors there is usually a
faculty office vacant.
Pharmaceutical reps are not to be invited in to the clinic teaching corridor.
Most private physician offices have medication samples (“sample closets”) that sample medications can be
dispensed out of. Unfortunately, most if not all of these medications can be costly and are usually prohibitive to
our patient population when compared to generic medications. To that, the UAMS AHEC Northeast does not
accept or keep sample medications.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03000
4/16/07
PRE-AUTHORIZATIONS
PRE-AUTHORIZATIONS:
DATE: 7/1/99
PAGE: 1 of 1
Health care plans that require designation of a primary care physician (PCP)
have defined guidelines to access scope of coverage through a process of pre-authorizations for certain labs,
procedures, referrals, and hospitalization. The patient’s encounter form and chart will reflect how the patient is
covered to assist you and the staff with identifying insurance plans.
As a PCP you should be involved in referrals to other specialty areas and should not be authorizing referred
request after the fact.
Non-covered and non-authorized services are at the patient’s expense and they must be so informed before the
service is rendered.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03100
4/16/07, 5/23/12
PROCEDURES AND CONSULT REQUEST
PROCEDURES AND CONSULT REQUEST:
DATE: 7/1/99
PAGE: 1 of 1
Clinic patients should not be referred to another specialty area
for a procedure or consult without discussing findings and reason with faculty attending. If there is any doubt in
your mind about the course of action to follow, the Program Director should be contacted.
PROCEDURES DOCUMENTATION/PROFICIENCY:
Supervision by a faculty member to determine procedure
proficiency is required until competency is achieved. As a rule, during the first year all procedures will be
supervised by one of the faculty members or a third year resident. This serves as a good stimulus for
faculty/resident discussion and permits direct assessment of the resident’s problem solving techniques.
It can be difficult to perform procedures in a resident clinic, because of that there is a designated Procedure Clinic
where office procedures can be scheduled into. This clinic occurs every Friday afternoon and residents are
assigned to and rotate through the clinic.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
NUMBER:
REVISION:
FPC - General
PROFESSIONAL CONDUCT
4/16/07
DATE: 7/1/99
PAGE: 1 of 2
PROFESSIONAL CONDUCT: All patients will be treated with deference in a nondiscriminatory manner
regardless of their social, economic or ethnic background. The sensitivity of all patients will be respected and
each will be examined in an atmosphere of respect for individual sensibilities. These standards of professional
conduct are expected of ALL Family Practice Center staff members.

Proper draping of every examinee is expected, whether male or female.

If the examination requires uncovering for effectiveness, only essential exposure will be made, preceded
by an explanation to the patient of such necessity.

In the management of patients by male professionals, all sensitive examinations of female patients will be
performed with a member of the nursing staff present. The presence of another person, male or female
(relative, friend, spouse, etc.) does not obviate this rule. All sensitive examinations of male patients will
be performed, if possible, with the nurse absent. If the professional is female, all sensitive examinations
of male or female patients will be performed with the nurse present.

All patients will be allowed to disrobe and gown in privacy.

All patients will be allowed to dress in privacy.

Third parties, except for FPC staff, will remain with the patients during interviews and examinations of the
patient only with the expressed permission of the patient, except for pediatric patients.

Noisy, boisterous behavior is inappropriate in the professional setting, either in the examining room,
hallway, or adjacent rooms. Loud voices, frenetic music, etc., have a negative impact on patients and
their perceptions of professionalism.

During clinic hours all exam room doors will be closed – when occupied by a patient.

NO ONE should enter any closed door in the Family Practice Center without knocking.

Interruption of professional conversations should occur only if an emergency exists.

Casual conversations, coffee drinking, eating, etc., should be outside the view and hearing of the patient.

Respect, courtesy, and dignity are expected in all professional relationships, whether with patients, peers,
faculty, or staff during clinic hours.

All discussions, whether or not patient centered, will be conducted in such a manner that they will not
invade the privacy of: (a) the subject of the discussion and; (b) the nearby uninvolved patients or staff
members.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
NUMBER:
REVISION:
FPC - General
PROFESSIONAL CONDUCT
4/16/07
DATE: 7/1/99
PAGE: 2 of 2

All information derived in the process of patient care is confidential and privileged information. Sharing of
such information for casual purposes, either within or outside the clinic, is unethical. Such sharing of
information must be done only to provide better care for the patient, and to further the resident’s
education.

ALL STAFF MEMBERS of this program are expected, without exception, to abide by these rules of
conduct. Patient care in settings other than the Family Practice Center does not change this level of
expected conduct.

HIPPA training will be a part of orientation.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03300
PROFESSIONAL COURTESY
PROFESSIONAL COURTESY:
DATE: 7/1/99
PAGE: 1 of 1
Residents at all levels of this training environment will extend
professional courtesy to each other. When you need a colleague to see one of your patients, you should discuss
the reason for request and any recent findings in the same way you would a partner or an attending not through
an intermediary. Patient “dumping” between residents is not allowed.
115
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03400
4/16/07, 5/22/12
RECORDS:
Appropriate documentation of care utilizing the problem oriented medical record system is essential and an
RECORDS
DATE: 7/1/99
PAGE: 1 of 1
entry will be made for each clinic patient encounter. Patient notes be entered in the EMR, reviewed by a faculty attending.

Subjective (clinical history)

Objective (clinical findings)

Assessment

Plan for care (the plan should include, when appropriate: medications, including frequency and dosage; specific
instructions for follow-up; informed consent; education, when appropriate, indicating patient participation.
The SOAP method should be used and most EMR templates follow this outline.
The documentation should reflect the complexity of the patient evaluation and treatment and support the reason for the
encounter, the severity of the problem, the findings of the examination, and the billing level.
X-rays, lab test, and other
ancillary study results should be addressed with the reason for the studies documented in the record. All FPC x-rays and
EKGs must be reviewed with an attending and the interpretation documented in the record along with the name of the
attending that reviewed.
Relevant risk factors should be identified.
Patient referrals and consultations should be documented.
Referral: Care is transferred to another physician who assumes management of the care, which precipitated
the referral.
Consultation:
The primary physician retains responsibility for the patient.
There is always some temptation to shortcut histories and physicals and be less than compulsive about record-keeping;
however, this is not acceptable and will be viewed as unsatisfactory performance. A patient’s health record should include
sufficient information to: a) assess the previous treatment; b) ensure continuity of care, c) ensure necessary and appropriate
testing and/or therapy, and d) support the level of care billing code. Notes should be made in the patient’s chart on all
telephone instructions or prescription refills. You are responsible for updating this information as indicated.
Copies of charts, patient visits, and all patient information must be treated as extremely sensitive. Do not leave these where
others can see. Any above records must be placed in document shredder box if they are not intended to be included as part of
the patient’s permanent medical record.
116
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03401
6/9/09, 5/22/12
MEDICAL RECORDS
DATE: 1/05/04
PAGE: 1 of 1
Medical records in the hospital and clinic must be completed in a timely manner.
Our policy is complete all your records within 10 working days. This gives the faculty time to review and co-sign
your records.
Every Wednesday a list of charts by resident that are incomplete for 10 days or more will be generated. You will
have until 0800 Monday to complete those records. Failure to complete these documents by the deadline of 0800
Monday will result in loss of vacation or CME time for each day past the deadline that charts go undone. This
does not mean you are on vacation. Your regular duties will continue. If you have no more vacation or CME
days, time will be added to your current residency year and you will not be permitted to successfully pass into the
next residency year until that time is made up. If you are a PGY III and have no vacation/CME days, this penalty
will be added on to your residency time. This policy will be for residents and faculty.
If you are on vacation or CME, it is your responsibility to make sure your charts (clinic, both hospitals) are up to
date prior to leaving for vacation.
When the residency coordinator (or faculty member responsible for monitoring chart completion) is notified via
phone, fax, or email that you have incomplete/delinquent charts, you will be notified that day of delinquency
status. These charts must also be completed by the specified deadline and are held to the same policy regarding
assessment of vacation/CME day.
This policy has been reviewed and approved by: Dr. Scott Dickson (Residency Director).
117
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03500
5/22/12
RESIDENT TEAMS
RESIDENT TEAMS:
DATE: 7/1/99
PAGE: 1 of 1
Each resident is assigned to a team composed of residents from each level, a nurse, and
a faculty advisor. The team has a group practice structure to insure continuity of patient care among a selected
group of providers with knowledge of problems while limiting the number of involved physicians. Patient records
are identified with their primary physician.
It is required that resident physicians keep an open line of communication with their team nurse to ensure that all
patient manners are addressed in a timely fashion.
When a resident is away from the office (vacation, CME, etc.), messages, reports, records, etc., will be handled
by a team member (typically the senior-most members). It is helpful, as well as professional courtesy, to discuss
any “expected problems” with colleagues before leaving town.
118
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03700
4/16/07
STANDARD OF CARE
STANDARD OF CARE:
DATE: 7/1/99
PAGE: 1 of 1
Each resident is responsible for providing good medical care to presenting
patients under the guidance and supervision of the faculty attendings. This expectation includes adherence to
protocols developed within the FPC and professionally accepted health-screen protocols and standards of care.
Quality reviews are in varying stages of development and are developed in an on-going process. Residents are
encouraged to be active participants in quality initiatives.
119
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03800
2/12/01
STUDENTS:
The Family Practice Center serves as a learning laboratory for students interested in a health
STUDENTS
DATE: 7/1/99
PAGE: 1 of 1
science career. These may be students from nursing, pharmacy, social work, pre-med, and all levels of medical
school. Everyone associated with the Family Practice Center is expected to encourage the students in a friendly,
approachable manner.
Routinely, student instruction will be through upper level residents and faculty who will encourage students to see
patients in the clinic. Under no circumstances, however, should a student see a new patient on an initial visit.
Likewise, patients should never leave the clinic without being seen by their appointed caregiver. Periodically,
junior medical students will take in-house call with PGY I where they may see ER or OB patients.
Regarding students other than UAMS medical students who are doing rotations in AHEC’s:
This comes out of a meeting with AHEC Residency Directors, Dr. Steven Strode and Kumel Kutait by Interactive
Video on February 12, 2001.

It was the consensus that students from other institutions should have malpractice insurance that
follows them to the new site which should be ascertained before the rotation takes place. The
amount of coverage should coincide with the requirements of the individual institution where the
student will be studying.
This is in no way to imply that the students will practice medicine alone or unsupervised. It is to make
clear what avenues of malpractice support should be followed in case there was litigation involving
the student.
120
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-03900
TEACHING CORRIDOR
TEACHING CORRIDOR:
DATE: 7/1/99
PAGE: 1 of 1
The majority of clinic exam rooms have been constructed around a teaching
corridor that permits private interaction between residents and faculty. ALL individuals in the teaching corridor are
expected to conduct themselves in a professional manner and respect the confidentiality of patients. Exam room
doors into the teaching corridor should always be closed even when you expect to return in a few minutes.
Individuals not assigned to the clinic should avoid visiting and/or congregating in the teaching corridor.
121
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02300
Use of Clinic DEA Numbers
DATE: 9/02
PAGE: 1 of 2
Purpose:
To define the policy and procedures for using the DEA number of AHEC Northeast.
Definition
The term “patient” refers to persons with whom a resident has established a physician-patient relationship as
documented in the medical record.
Policy
1. Residents may use a clinic’s specific DEA number only to prescribe controlled substances to patients (as
described above).
2. Residents shall not prescribe excessive amounts of controlled substances to any patient, including the writing
of an excessive number of prescriptions for an addicting or potentially harmful drug (Arkansas State Medical
Board, Regulation 2).
3. Residents shall not prescribe controlled substances for their own use or for use by members of their family
(Arkansas Medical Board, Regulation 2).
4. Residents may prescribe controlled substances only when the resident has a physician-patient relationship
with that patient. This physician-patient relationship shall be clearly documented in the patient’s medical
record. The reason (i.e., diagnosis and plan of treatment) each prescription of a controlled substance shall be
documented in the medical record.
Each resident at AHEC Northeast is assigned unique identification codes composed of several numbered digits.
The identification codes are described below and, where indicated, a specific code must be attached as a suffix
when using a hospital’s DEA number.
A unique 4-digit identification code is assigned to each resident. The 4-digit identification code must be attached
as a suffix when using the DEA number of AHEC-NE.
Prescription Writing:
In accordance with the Arkansas Department of Health Rules and Regulations Pertaining to Controlled
Substances, when writing a prescription for a controlled drug, the resident must issue the prescription for
legitimate medical purposes. The prescription must bear the:
1. full name and address of the patient
2. the drug name, strength, dosage form, quantity prescribed, and directions for use
3. resident’s last name printed as well as the signature of the resident
4. Clinic DEA number and the resident’s specific identification code or the resident’s DEA number.
5. date
Moonlighting Activities:
If a resident practice outside the UAMS system, the resident must obtain and use his/her own private DEA
number.
122
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
FAMILY PRACTICE CLINIC
NUMBER:
REVISION:
III-02300
Use of Clinic DEA Numbers
DATE: 9/02
PAGE: 2 of 2
Misuse of the DEA numbers:
Misuse of the DEA numbers includes, but it not limited to:
1. using the clinic’s specific DEA number to prescribe controlled substances to patients not followed within that
hospital’s system.
2. prescribing excessive amounts of controlled substances to any patient, including the writing of an excessive
number of prescriptions for an addicting or potentially harmful drug to a patient,
3. prescribing controlled substances by a resident for his/her use or for the use of his/her immediate family.
4. prescribing controlled substances by a resident for peers, nursing or hospital staff, or friends without clear
documentation of a physician-patient relationship in the medical record.
5. Any violations of the provisions of this policy.
Misuse of any DEA number will be reported directly to the residency director and could result in disciplinary action
up to and including dismissal from the training program. Individuals found misusing these DEA numbers must
undergo a “for cause” drug screen, and if indicated, a diagnostic and/or therapeutic intervention and subsequent
indicated drug screens during the training program.
123
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0100
4/16/07
INTRODUCTION
INTRODUCTION:
DATE: 7/1/99
PAGE: 1 of 1
A significant part of residency training is in our affiliated hospital, St. Bernard’s Medical
Center and NEA/Baptist Medical Center. All residents are expected to comply with the affiliated hospital’s staff
guidelines and maintain good standing. This includes keeping all records up to date as dictated by hospital
policy.
124
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0200
4/17/07
ADMISSIONS
ADMISSIONS:
DATE: 7/1/99
PAGE: 1 of 1
PGY II and PGY III residents will manage their admissions from the FPC and nursing
home panel. The resident on the service should be notified by the PGY I when a decision is made to admit a
patient from their FPC patient panel.
Patients admitted through the Emergency Room at SBRMC without an identified physician (service patients) will
be assigned to FPS I. The goal for the number of patients/resident will be 10 plus.
Unassigned patients admitted through the Emergency Room at Regional Hospital of NEA will be assigned to the
FPS II.
When an admission occurs after hours, the resident on call will handle the admission including history and
physical, admission orders and appropriate notes until he/she can transfer care to the appropriate primary
resident or FPS. The appropriate back-up resident will write a note of agreement at the time of admission.
Residents are expected to do admission history and physical on the specialty service of their attending. These
admissions will be in the name of that rotation attending.
ADMISSIONS DENIALS:
Audits of admissions will periodically generate Medicare and/or Medicaid
admission denials. Whenever you receive a notice, please respond in a timely manner. Most denials are
reversed when appealed by the doctor. Failure to respond may result in all admissions being reviewed and/or
recoupment or payments to the physician and hospital. All notices received must be discussed with the Program
Director and the identified faculty attending. Don’t hesitate to seek advice --- these do not mean you used poor
medical judgment.
OBSERVATION ADMISSIONS:
Most of admissions may start as observation when uncertain if full
admission is warranted. The patient can be monitored for a period up to 24 hours and the status can always be
changed to inpatient admission.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0300
CALL DUTIES:
CALL DUTIES
DATE: 7/1/99
PAGE: 1 of 1
The PGY I in-house resident (s) has specific responsibilities while on call. Primarily, the
resident will cover the AHEC Family Practice Center patients for emergency medical care, obstetrics, and any
crisis that develops with AHEC FPS. . [See Resident Performance – Call]
The resident is not responsible for the patient care needs of other medical staff admissions. As a courtesy, the
resident may be asked by a primary physician to pronounce a death.
The resident is a part of the SBMC code team and will respond accordingly. [See Resident Performance – Call]
CALL ROOM:
Resident call rooms are provided at St. Bernard’s Medical. The in-house call resident will
have first priority for its use. A secondary call room is available for PGY III back-up resident monitoring laboring
patients.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0400
CONSULTS
CONSULTS:
DATE: 7/1/99
PAGE: 1 of 1
Occasionally, AHEC is asked to consult on an in-house patient admitted by a sub-
specialty physician. These requests are handled the same as admissions by the FPS I during regular work hours
or ROC after hours.
127
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0600
4/17/07
HOSPITAL PRIVILEGES
HOSPITAL PRIVILEGES:
DATE: 7/1/99
PAGE: 1 of 1
Residents will have privileges at St. Bernard’s Medical Center and NEA/Baptist
Medical Center that meet the needs of the training curriculum. All hospital in-patient care will be supervised by
either a Family Practice faculty member or an assigned specialty preceptor.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0700
5/23/12
MEALS:
Meals are provided by SBMC for the resident on call through the cafeteria services. The cafeteria
MEALS
DATE: 7/1/99
PAGE: 1 of 1
lines open at 6 AM for breakfast, 11:30 for lunch and dinner is from 4 PM to 6:30 PM. When the resident enters
the checkout line in the cafeteria he/she needs to let the cashier know they are an AHEC resident. They will be
asked to sign a book with the amount of the meal noted.
In the physician dining lounge residents are also allowed to eat without paying (thanks to the persistent work of
Dr. Speights). There is a sign-in sheet located to the right when entering the dining area. The resident should
find their name on the list and initial beside it.
Meals are also provided at the NEA/Baptist hospital cafeteria at no expense to the resident.
Meals are provided at all required conferences.
Having meals provided to the residency is a privilege that the hospitals have allowed and should not be
abused. There may be times where a spouse or significant other may want to join an on-call resident for a meal
in the cafeteria. This is generally permitted. It is not appropriate for a resident to take additional meals home.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0800
MEDICARE ADMISSIONS
MEDICARE ADMISSIONS:
DATE: 7/1/99
PAGE: 1 of 1
HCFA’s teaching presence regulation requires that the faculty attending see
patients for all billable services. These patient admissions will be brought to the attention of faculty attending.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-0900
NEEDLE STICK
NEEDLE STICK:
DATE: 7/1/99
PAGE: 1 of 1
The hospital’s incident manual guidelines should be followed. This will include preparing
an incident report giving information about the occurrence; presenting to ER for tetanus, hepatitis and/or IGG if
negative. Prophylactic treatment may be started. Reports will be sent to the Infectious Disease Department for
follow-up with patient HIV screens and further monitoring as indicated.
131
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01000
OBSTETRICS [LABOR & DELIVERY]
DATE: 7/1/99
PAGE: 1 of 1
The Family Practice Residents are responsible for their patients who present to the OB
Department at St. Bernards or service patients whom care is turned over to them by the
obstetrician on call. The care rendered to AHEC OB patients by the Family Practice residents
will use the standards established by ACOG and the UAMS Angels network, under the
supervision of the AHEC Faculty Attending Physician.
In order to satisfy the curriculum requirements for the Family Practice Residency Program
(ACGME requirements) while meeting the requirements of SBMC OB Department, the
following policies are established:
1. The AHEC OB service will be covered on a 24-hour basis by the Family Practice
Residents as scheduled:
a. Each month two specific interns and second year resident are assigned to
the AHEC OB Service and are responsible for AHEC patients who present
to the OB floor..
b. The intern on-call and the third year on-call are responsible for patients
that present to the OB floor after hours including AHEC holidays, and on
Saturdays and Sundays.
2. The intern responsible for the AHEC OB Service will round on all patients on a
daily basis and monitor all AHEC OB patients in labor.
3. The intern responsible for the OB Service will be supervised by an upper-level
resident and AHEC Family Practice Faculty as outlined below:
a. Second year resident assigned to OB 0800 to 1700, Monday through
Friday excluding AHEC holidays.
b. Third year resident on-call: From 1700 to 0800, Monday through Friday
including AHEC holidays and on Saturdays and Sundays.
c. A full-time Family Practice Faculty Member supervises the AHEC OB
Service every month and is available 0800 to 1700, Monday through
Friday excluding AHEC holidays. A Family Practice Faculty Member is
on-call and supervises after hours, on weekends, and on holidays.
Therefore, a Family Practice Faculty Member is available 24 hours a day,
seven days a week for assistance and supervision.
4. The Chain of Command for the OB Service should progress as follows:
a. First Year Resident (Intern)
b. Second Year Resident on the OB Service or Third Year Resident on-call
c. Family Practice Faculty Attending
5. The residents are responsible for AHEC OB patients, service OB patients and
AHEC Faculty patients as needed. Residents are not to be called to give routine
orders on another physician’s patients. In emergency situations it may be
necessary for the resident or Faculty Attending to aid in the management or
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
delivery of a private physician’s patient in their absence. In that case care will be
immediately returned to the private physician upon their arrival.
6. The AHEC Family Medicine Resident will respond to any resuscitation on the
labor and delivery floor involving either adult or newborn. If the patient is being
cared for by a private physician the resident will render emergency care until that
physician or his/her colleague arrives to assume care. AHEC residents will use
ACLS and NRP protocols and guidelines.
7. A “Service Patient” is defined as an obstetric patient that presents to the labor
and delivery floor that has not established and continued care by a local
obstetrician or family medicine physician with obstetrics privileges. All service
patients will be triaged by a registered nurse on the labor and delivery floor and
report called to the designated obstetrician on-call. The obstetrician on-call may
elect to transfer care of the patient to the AHEC Family Medicine OB Service.
Once the AHEC OB Service accepts care of a patient they will fully manage the
patient and order consultations as needed.
8. Obstetric consultations will be obtained as deemed necessary by the AHEC
faculty except in cases where emergent obstetrical care is indicated. Emergent
obstetrical consult is indicated when any obstetrical complication could result in
immediate fetal loss or where immediate intervention is deemed necessary to
prevent significant fetal and/or maternal morbidity and mortality.
133
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01100
4/17/07
PATIENT BILLING
PATIENT BILLING:
DATE: 7/1/99
PAGE: 1 of 1
You should provide charge levels for hospitalized patients at Daily Report or to the
bookkeeper for posting to the patient’s account. Other billable services include prolonged unit care time, newborn
services, and procedures.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01200
Revised 6/24/09
PROCEDURES DOCUMENTATION
PROCEDURES DOCUMENTATION:
DATE: 7/1/99
PAGE: 1 of 1
To obtain privileges when you complete your residency training, we must
document all in-house procedures that you assist your attending with or perform yourself under their supervision.
Documentation should be updated by resident in New innovations Software: https://www.new-innov.com/Login
REMEMBER: Documentation is essential to future hospital privilege appointments.
135
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01300
3/23/04, 5/22/12
RECORDS:
All medical records will be kept up-to-date. Histories and physicals are to be completed at
MEDICAL RECORDS
DATE: 7/1/99
PAGE: 1 of 1
admission. Ideally, discharge summaries will be done on the day they occur due to the number of signatures that
may be required to complete an AHEC patient chart.
To assist transcriptions in the hospital, identify yourself at the beginning of your dictation as a Family Practice
resident and give the name of your attending physician. The hospital’s dictation system will be explained during
orientation.
St. Bernard’s Medical Center requires a discharge summary from a regular admission when a patient is
transferred to TCF. On TCF an updated progress note can be used as H & P but an additional discharge
summary is required when the patient leaves TCF.
Charts are considered delinquent by the hospitals if everything is not completed within two weeks. When the
residency coordinator (or faculty member responsible for monitoring chart completion) is notified via phone, fax,
or email that you have incomplete/delinquent charts, you will be notified that day of delinquency status. These
charts must also be completed by the specified deadline and are held to the same policy regarding assessment of
vacation/CME day.
If you are on vacation or CME, it is your responsibility to make sure your charts (clinic, both hospitals) are up to
date prior to leaving for vacation. It is also your responsibility to notify medical records the dates during which you
will be away.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01400
6/1/09
SERVICE RESPONSIBILITIES
SERVICE PROTOCOLS:
DATE: 7/1/99
PAGE: 1 of 4
FPS I, with assistance from FPS III, will track admission distribution between in-
house services. Between 8 AM and 5 PM, FPS I will usually answer the ER pages, and see patients.
SERVICE RESPONSIBILITIES: Residents are expected to be interested, attentive, and available for all services
involving direct patient care responsibilities.
FAMILY PRACTICE SERVICE I:

PGY I assisted by PGY III has responsibility for in-house patients.

FPS inpatient care decisions are the responsibility of the assigned first year resident. Decisions should
be discussed with assigned PGY III resident then, as appropriate, with service attending, Pharm. D., or
consultants. All major procedures and all consultations should be discussed with the PGY III before they
are done.

A physical exam should be performed by the FPS I on every FPS patient regardless of who admitted the
patient.

Rounds will be made daily on all patients. At least one round each day should be with the FPS III
resident.

Notes should be present on all charts, Monday through Friday. The daily note should include a complete
problem list, with any changes in medications or other treatment discussed in the plan.

FPS I should be available for discussion of care with patients and their families including code status.

FPS I will present patients in daily report including all pertinent information on lab and x-ray studies.

FPS I will be available and prepared for scheduled FPS attending rounds, Monday PM, Wednesday AM,
and Friday AM. FPS Attending will establish time.

FPS I identify x-rays to be viewed.

Provide updated hospital list information to FPC business office each morning.

Provide FPC bookkeeper with levels of service and procedures performed for billing patient account.
137
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01400
6/1/09

SERVICE RESPONSIBILITIES
DATE: 7/1/99
PAGE: 2 of 4
Prepare case for presentation at Interesting Case Conference on 4 th Tuesday of each month following
service month. May also be asked by attending to prepare other cases for presentation.

Check out daily to ROC prior to departure from hospital including admission status for each in-house
service.

Complete hospital medical record per established hospital guidelines.

Additional responsibilities include Family Practice Clinics; attendance at scheduled conferences, and
monthly nursing home rounds.
FAMILY PRACTICE SERVICE II/PEDS:

Accept all pediatric admissions. (Peds resident)

Accept admissions to the teaching service at NEA Medical Center per established protocol.

Responsible for all patients care decisions on assigned patients with supervision provided by assigned
faculty attending. Prior approval for consults or referrals should be obtained from the faculty attending.

Rounds, Monday – Friday, with appropriate chart note.
The daily note should include updated
problem/medicine list with plan.

Present assigned patients in daily report.

Rounds with faculty attending on a regular mutually agreed upon schedule.

Provide updated hospital list information to FP business office each morning.

Discuss levels of service and procedures performed with FPC bookkeeper for billing to patient account.

Complete medical record per established hospital requirements.

Check out daily to ROC prior to leaving hospital.

Check out to PGY II back up for NEA Medical Center patients.

Prepare cases for presentation at conferences as requested by attending.

Additional responsibilities: up to one-half day FM clinic [includes 1 at local church health clinic];
attendance at scheduled conferences, and monthly nursing home rounds.

Prepare case for presentation at Chest Conference the second Tuesday of each month. May also be
asked by attending to prepare other cases for presentation.
138
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01400
6/1/09
SERVICE RESPONSIBILITIES
DATE: 7/1/99
PAGE: 3 of 4
FAMILY PRACTICE SERVICE III:

Be available 8 A.M. – 5 P.M. to provide immediate supervision to FPS I as patient care plans are
formulated, procedures performed, or consultations are sought.

Make work rounds daily with FPS on every patient with an appropriate note. [FPS I should have ultimate
responsibility for care of assigned patients including notes, orders, lab, etc., but FPS III should be equally
familiar with each patient on service.

Manage FPS problems when FPS I in clinic including patient admissions and ER presentations. Provide
FPS coverage when FPS I is scheduled for nursing home rounds.

Be available and prepared for FPS attending rounds, Monday PM, Wednesday AM, and Friday AM.
Answer FPS I beeper calls during rounds and cover or coordinate management of ER presentations with
ROC.

Insure that the intent of patient admission protocols is followed by ROC, FPC I and FPS II.

Additional responsibilities: Family Practice clinics as assigned, rounds on private FPC patients,
attendance at scheduled conferences, and monthly nursing home rounds. As service obligations permit,
be available as an instructor in the teaching corridor of the FPC.
OB SERVICE:

Admit and monitor progression of labor in conjunction with PGY I per established protocols with
appropriate chart notes.

Assess and manage care of newborn including circumcision if required.

Discharge instructions to mother including care of the newborn.

Complete medical record per established hospital guidelines.

Provide updated hospital list information to FP business office.

Discuss levels of care and procedures performed with FPC bookkeeper for billing to patient account.

Round with faculty attending on a regular, mutually agreed upon schedule.

Present patients in daily report.

Check out daily to ROC prior to departure from hospital.
139
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01400

SERVICE RESPONSIBILITIES
DATE: 7/1/99
PAGE: 4 of 4
Additional responsibilities include Family Practice clinics, attendance at scheduled conferences, and
monthly nursing home rounds.

All residents at PGY II and III levels must provide pre-natal through delivery Continuity of care to a
minimum of 10 OB patients each year. Faculty supervision must be present during delivery.
SERVICE ROUNDS:
FPS I and FPS III will meet faculty attending in the FPCCR for rounds Monday @ 1:30
PM, Wednesday @ 9:00 AM, and Friday @ 9:00 AM unless otherwise instructed. FPS I, with assistance of FPS
III, should in advance have pertinent x-rays and studies identified in PACS, be prepared to discuss changes in
known patients, and present new admissions. Formal presentations are expected on new admissions and should
include CC, HPI, PMH, Meds, pertinent Family history, social history, ROS, pertinent physical findings, lab,
assessment or problem list, and plan.
Follow-up on earlier admissions should be brief with only pertinent
additions. Presentations should generally be made from memory with references to charts or notes allowed.
Attending may examine new patients admitted since last rounds and complicated patients from earlier
admissions. Work rounds should be completed prior to attending rounds. FPS III will answer beeper and code
calls during rounds.
SPECIALTY BLOCKS:

AM and PM rounds with assigned preceptors.
Admission H and P’s, chart notes, procedures, and
discharge summaries per attending’s instructions.

Additional responsibilities: Family Practice clinics, attendance at scheduled conferences, and monthly
conferences, and monthly nursing home rounds.
140
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01450
7/19/12
TRANSFER OF CARE/HAND OFF OF PATIENTS
DATE: 7/19/12
PAGE: 1 of 2
INTRODUCTION

As in any medical environment where patient care is paramount, a proper and detailed transfer of
information regarding each patient admitted to the hospital is not only an expectation, but a requirement.
At the UAMS AHEC Northeast Family Medicine Program we have a specific protocol to address the
complexity and importance of patient care hand off. This protocol bridges the critical information gap that
occurs at change of shift and is required of all residents and Attendings.
FAMILY PRACTICE SERVICE PATEINT CARE TRANSFER

PGY I Resident Responsibilities
o
In the morning the oncoming medicine service intern(s) will physically meet with the off-going
intern and discuss changes in patient status from the previous night as well as new admissions to
the service. Each patient will be discussed with pertinent details that include but are not limited
to: admitting diagnosis, pertinent lab and radiologic findings, consults, code status and plan of
care.
o
In the morning the oncoming obstetrics intern(s) will physically meet with the off-going intern and
discuss changes in patient status from the previous night as well as new admissions to the OB
service. Each patient will be discussed with pertinent details that include but are not limited to:
Gravida, Para, gestational age, GBS status, cervical status, admitting diagnosis, pertinent lab and
radiologic findings, consults, and plan of care.
o
In the morning the oncoming pediatric intern(s) will physically meet with the off-going intern and
discuss changes in patient status from the previous night as well as new admissions to the
Pediatric service. Each patient will be discussed with pertinent details that include but are not
limited to: admitting diagnosis, pertinent lab and radiologic findings, consults and plan of care.
o
In the evening the oncoming night intern will physically meet with the off going medicine, OB, and
pediatric interns to discuss changes in patient status from the day as well as new admissions to
the specific service. Each patient will be discussed.

PGY II Resident Responsibilities
o
In the morning the oncoming PGY II resident will physically meet with the off-going PGY II
resident and discuss changes in patient status from the previous night as well as new admissions
to the 2nd Medicine service. Each patient will be discussed with pertinent details that include but
are not limited to: admitting diagnosis, pertinent lab and radiologic findings, consults, code status
and plan of care.

PGY III Resident Responsibilities
141
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
o
In the morning the oncoming PGY III resident will call the off-going PGY III resident and discuss
high priority (those admitted to the intensive care unit, pediatric patients, OB patients, and NICU
patients) from the previous night.

Attending Physician Responsibilities
o
When circumstances dictate, the off-going Attending will call the oncoming Attending and relay
pertinent information regarding specific patients that were managed during the call period.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01500
02/10/2010, 7/15/12
UNASSIGNED PATIENTS AND TRANSFERS
UNASSIGNED PATIENTS:
DATE: 7/1/99
PAGE: 1 of 1
Frequently, patients present to the emergency room at St. Bernard’s Medical
Center or NEA Baptist Hospital without an identified physician. These individuals are assessed by the ER
physician and if an admission is indicated, the unassigned on-call physician will be contacted. This “back-door
physician” can request that the patient be given to AHEC. We willingly accept these admissions to the FPS as
long as our own patient volume is not already at capacity. [Note: Resident may screen to determine if there is a
local PCP that was not notified or if there are available slots on the 1st service]
The on-call or FPS resident will complete the admission orders and manage the patient.
When an admission is not indicated, the ER physician may refer the patient to the FPC for follow-up in one of our
regular clinics. All payment policies will still apply. [The ER physician’ s assessment and pertinent lab or x-ray
will be faxed to the office prior to RMC follow-up visit.] This will avoid unnecessary interruptions in the on-call
duties.
Policy Regarding Unassigned St. Bernard’s ER Patients:
The AHEC residency will admit unassigned medicine patients (18 yoa or older) up to a certain level on the
medicine service (twenty-two patients from Sunday at 1800 to Friday at 1300 and eighteen patients from Friday at
1300 to Sunday at 1800). The AHEC residency will also admit unassigned pediatric patients up to a certain level
(six patients) on the pediatric service. After the AHEC service has been “closed” to adult medicine patients the
unassigned medicine physician on-call as dictated by the Unassigned Medicine call list (located in the SBRMC
ER) will be responsible for any other unassigned admissions. After the AHEC service has been “closed” to
pediatric patients any additional unassigned pediatric admissions will go to the St. Bernard’s Adult/Pediatric
Hospitalist physician on-call. The AHEC service will of course continue to admit established (previously admitted
or previously seen in clinic as per St. Bernard’s policy) AHEC patients.
If the unassigned physician in the ER is an AHEC attending, then the Intern on-call will admit the patient to the
AHEC service and that patient will be managed by the AHEC service.
Transfer Policy:
The AHEC service will frequently be contacted regarding transfer of a patient from another hospital due to the
availability of higher level of care or at patients request if we are their PCP’s. This policy addresses the procedure
which should be followed:
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM

Phone inquiry is directed by answering service or clinic to the FPS III resident during business hours or to the
PGY III resident on call after hours.

The upper level resident will determine if the AHEC service is open to accept unassigned patients, and will
obtain information regarding the patient which may need transfer. Information includes, but is not limited to:
stability of patient, HPI pertinent information, reason transfer is requested, pertinent patient indentifying
information.

Resident will then identify faculty member on call or, covering service to give information regarding transfer.
Acceptance of transfer is at the discretion of faculty member.

If patient is accepted, the resident on call contacts bed assignment at appropriate hospital facility, to
determine if bed is available. They then contact the facility requesting transfer to advise of patient disposition.

Patients who have a PCP that follows patients at SBMC or NEA, should not be accepted for that MD. The
resident on call should encourage MD requesting transfer to contact patients PCP to promote continuity of
care.
“Who Counts”: The FPS I service caps its number of patients at 22 on Sunday 1800 – Friday 1300, and 18 on
Friday 1300 – Sunday 1800 and holidays. Above that point only, AHEC patients are accepted for the FPS I. The
number of patients on the AHEC FPS I service is defined by the following criteria: counted at all times; adult
patients followed by FPS I, private patients of AHEC residents, private patients of AHEC Attendings, TCF
patients, ICU patients, and pediatric patients.
Additionally, from 1700 – 0800 Monday thru Thursday, and 1300 Friday – Sunday 1800, pediatric patients and
peripartum patients (not admitted for delivery or triage), are included in this number as they are managed by
ROC.
144
AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01550
4/17/07
AFFILIATED HOSPITAL AUTOPSY POLICY
AFFILIATED HOSPITAL AUTOPSY POLICY:
DATE: 10/23/00
PAGE: 1 of 2
NEA Medical Center out source their autopsies.
St. Bernards Medical Center: see below copied from their policy manual.
Rule Twenty: Autopsies
Page(s): 20A – 20B
a) The attending physician will review autopsy criteria with every death, and request an autopsy when the
death meets autopsy criteria. These discussions with family shall be documented in the medical record.
An autopsy may be performed only with written consent, signed in accordance with state law.
b) Under the following circumstances the County Coroner will be notified.
a. The death appears to be caused by violence or appears to be the result of a homicide or suicide or
to be accidental;
b. The death appears to be the result of the presence of drugs or poisons in the body;
c. The death appears to be a result of a motor vehicle accident, or the body was found in or near a
roadway or railroad;
d. The death appears to be a result of a motor vehicle accident, and there is no obvious trauma to the
body;
e. The death occurs while the person is in a state mental institution or hospital and there is not previous
medical history to explain the death, or while the person is in police custody, a jail, or penal
institution;
f. The death appears to be the result of a fire or explosion;
g. The death of a minor child appears to indicate child abuse prior to death;
h. The death appears to be the result of drowning;
i. The death is of an infant or minor child in cases where there is no previous medical history to explain
the death;
j. The manner of death appears to be other than natural;
k. The death is sudden and unexplained;
l. The death occurs at a work site;
m. The death is due to a criminal abortion;
n. The death is of a person where a physician was not in attendance within thirty-six (36) hours
preceding death, or in pre-diagnosed terminal or bedfast cases, within thirty (30) days;
o. A person is admitted to a hospital emergency room unconscious and is unresponsive, with
cardiopulmonary resuscitative measures being performed, and dies within twenty-four (24) hours of
admission without regaining consciousness or responsiveness, unless a physician was in
attendance within thirty-six (36) hours preceding presentation to the hospital, or in cases in which the
decedent had a pre-diagnosed terminal or bedfast condition, unless a physician was in attendance
within thirty (30) days preceding presentation to the hospital;
p. The death occurs in the home;
q. Unidentified or unclaimed bodies;
r. All residents in long term care facilities (this includes TCF);
s. All patients who were residents of a long term facility that die within 5 days of admission.
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AHEC NORTHEAST FAMILY MEDICINE PROGRAM
SECTION:
SUBJECT:
HOSPITAL
NUMBER:
REVISION:
IV-01550
4/17/07
AFFILIATED HOSPITAL AUTOPSY POLICY
DATE: 10/23/00
PAGE: 2 of 2
AFFILIATED HOSPITAL AUTOPSY POLICY:
St. Bernards Medical Center: see below copied from their policy manual.
Rule Twenty: Autopsies
Page(s): 20A – 20B
c) The Medical Staff, with other appropriate hospital staff will develop autopsy criteria. The Medical Staff
Executive Committee will approve autopsy criteria. Those criteria will be disseminated to the medical
staff.
d) The medical staff, and specifically the attending practitioner, shall be notified when an autopsy is being
performed.
e) All autopsies shall be performed by pathologists, who are members of St. Bernards Regional Medical
Center Staff, (or by a house-officer delegated
responsibility and supervised by the attending pathologist). Provisional anatomic diagnoses shall be
recorded on the medical record within 48 hours, and the complete protocol should be made a part of the
record within thirty (30) days (uncomplicated autopsies).
f)
It is the responsibility of the patient's attending physician to assure that the family is informed of the
autopsy findings.
g) Autopsy criteria are:
o Unexplained or unexpected death during hospitalization that cannot be explained on clinical
grounds
o Patient sustained or apparently sustained injury while in hospital
o Death unexpected or unexplained following procedure
o Death was obstetrics death
o Death of neonate or pediatric patient when cause of death is unknown
146