ORLANDO EMA HIV/AIDS RYAN WHITE Part A PROGRAM OUTPATIENT/AMBULATORY MEDICAL CARE SERVICE STANDARDS OF CARE Definition: The provision of professional diagnostic and therapeutic services rendered by a physician, physician s assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not outpatient settings. Services includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, education and counseling on health issues, well-baby care, continuing care and management of chronic conditions, and referral to and provision of specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the Public Health Service s guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. Eligibility: Consumers accessing Ambulatory Outpatient Medical Care must meet eligibility standards as described in the System-wide Standards of Care. August 4, 2009 Page 1 of 6
Standard #1 Agencies shall use the most current approved USPHS (United States Public Health Service) guidelines for treatment and support of HIV infected consumers. (1.1) Agency shall have written documentation of treatment protocols: Prevention of transmission Preservation of immune function Prophylaxis against opportunistic infection (OI), particularly CMV, PCP, and MAC Early diagnosis and prevention of OI Therapeutic provider-consumer relationship, close consumer followup, and attention to consumer education related to medication regimens and disease state Consumer-centered care optimizing quality of life (psycho-social, financial, and end of life issues) Consumer safety (drug-drug interactions, drug-nutrition interactions, suicide interventions) 1.1 Written protocols on file. Review of Protocols August 4, 2009 Page 2 of 6
(1.2) Consumer s medical care initial encounter and subsequent visit shall be in compliance with the current Florida Caribbean AETC Primary Care Guide (Chapter 4 Initial Encounters and subsequent visits). 1.2 Documentation reflects AETC recommendations for each visit. Review consumer medical record Standard #2 Appropriate specialty care services shall be provided as indicated. August 4, 2009 Page 3 of 6
(2.1) Agencies shall have a written policy for making Specialty care referrals. 2.1 Policies and procedures in place Review of policies and procedures (2.2) Agencies shall develop and maintain a relationship with specialty care providers. Copy of MOA on file Provider file Standard #3 Appropriate medical emergency care services shall be provided as indicated. (3.1) Agencies shall have written policies and procedures for emergency treatment and referrals. 3.1 Policies and procedures in place Review of policies and procedures August 4, 2009 Page 4 of 6
Standard #4 Agencies shall ensure that required documentation is obtained and maintained. (4.1) Consumer records shall include flow sheets, incorporating information as recommended by the Caribbean/Florida AIDS Education Training Center Medication sheet Problem list, Immunizations and screenings, Prevention/chronic disease flow sheet, Treatment and monitoring flow sheet, Controlled substance flow sheet X-ray and procedure log Anti-retroviral history HIV/Office visit/progress notes Health Maintenance Education 4.1 Appropriate documentation placed in consumer s record. Review consumer medical record August 4, 2009 Page 5 of 6
(4.2) Consumer medical record shall include documentation that an advance directive has been discussed, or a signed waiver of the directives. 4.2 Appropriate documentation placed in consumer s medical record. Review consumer medical record August 4, 2009 Page 6 of 6