TFUC Rule Book

CODE OF ETHICS DATE JANUARY 07, 2020 PROPOSED BY DEVISION MARKETING CORE, LLC

DATE JANUARY 07, 2020 PROPOSED BY DEVISION MARKETING CORE, LLC CLINIC TOTAL FAMILY URGENT CARE

TABLE OF 3 INTRODUCTION 5 VISION-MISSION CONTENTS 6 EXPECTATIONS SUMMARY 16 SAMPLE SCENARIOS 18 ROLES & RESPONSIBILITIES 20 TRAINING SCHEDULE 22 CHECKLIST

TOTAL FAMILY URGENT CARE INTRODUCTION Due to the requirements requested by Studies indicate that collaboration the Department of Health and the among these providers and a team Affordable Care Act, there has been a approach has proven very powerful and major shift in the health care paradigm comprises an effective approach to good from clinics main focus on improving the management skills and communication health, improving healthcare system and skills. Developing a strong, effective lowering costs to a more dynamic focus integrated roles and responsibilities for on team-based care focused on the the team is vital and requires a clear patient and patient satisfaction. This kind understanding of the essential elements of innovative team approach is an that are necessary to incorporate to your example of integration of primary care daily habits in order to implement the and behavioral health. The goal of this change. The study identifies four procedure changes is to foster successful essential elements for effective teamcare collaboration that leads to a shared and provides a roadmap for the treatment approach beneficial for the organization foundation. patient and the physician experience. QUALITY IS THE BEST BUSINESS PLAN. Our primary goal and vision here at Total Family Urgent Care is to make sure we provide quality and efficient care for our patients. We focus on teamwork to collaborate and work together with one purpose in mind: the health and wellbeing of our patients. We believe that quality is the best business plan, not quantity. PAGE 03

LEADERSHIP AND TEAM PROCESS: ORGANIZATIONAL COMMITMENT: Team Process: One of the most essential aspects of team-based care is effective There is a vital importance of senior communication among the staff and leadership and organizational commitment providers. Integrated care teams describe to the philosophy of integrated care. The using three types of communication: clinical clear vision and commitment to an case review, daily operational innovative model of care was foundational communication, and process of for the team to develop. Specific leadership communication. In addition, the teams qualities noted include the ability to span describe the importance of continued boundaries, buffer teams from stressors and reassessment of their team-based care escalation, take risks, have a clear vision to procedures to improve the process. The act create a clear vision, and focus on providing of stepping back and making sure that the the right care at the right time, taking care and process are occurring as designed is everyone’s best interest at heart. an important aspect of delivering team- based treatment and maintaining a team. TEAM DEVELOPMENT: TEAM OUTCOMES: The real work of fostering an integrated team is done through both formal and Team Outcomes: Effective integrated care informal team development. We will teams identify clear patient outcomes that provide all the assistance and guidance to they work to achieve. Teams identify train the team to reach this potential. The outcomes as key to guiding a shared initial stages of team development include treatment approach as well as reducing creating a shared vision and developing conflict among providers. team values such as embracing a nonhierarchical team structure. Formal team development addresses concepts such as fostering strong team relationships, hiring the right providers, creating clear roles and responsibilities, and cross-training providers. TOTAL FAMILY URGENT CARE PAGE 4

MISSION STATEMENT Our mission is to collaborate as a team to provide the highest quality of healthcare to our patients and reach their health and wellness goals. COLLABORATION, TEAMWORK, AND COMMUNICATION LEAD TO SUCCESS AND PROVE HIGHER SATISFACTION RATES AMONGST PATIENTS AND PROVIDERS. TOTAL FAMILY URGENT CARE PAGE 5

VISION TFUC strives to provide a comfortable environments where our patients and staff feel safe and reassured they came to the right place. Our vision is to define roles and responsibilities amongst the provider to be able to most efficiently work together and provide the best healthcare for our patients. GOAL Our goal is to make sure our patients leave satisfied with our services provided at the clinic. We want to be able to obtain reviews and referrals from our patients due to their pleasant and remarkable healing experience. The main goal of TFUC is to establish a good health trusting relationship with our patients. TOTAL FAMILY URGENT CARE PAGE 6

EXPECTATIONS PAGE 7 SUMMARY Good Behaviors, Great Words  Communication with patient and other providers Do's and Don'ts  Clinical boundries and limitations to what should and should not be said Team Values Our team approach and agreement for team structure and commitment Training Modules Formal training modules to complete to advance learning habits and improve delivery methods. Team Communication Communication is the key to providing good and effective healthcare. TOTAL FAMILY URGENT CARE

5 SCRIPTS FOR GREAT HAND-OFFS Handing off patients from one staff The patient-centered health home member to another gives staff a chance model, which emphasizes the inter- to assure continuity of service and help relation of all members of the team, clients feel secure and clear about what supports positive transitions at all levels.  is happening.  There are many Primary care and behavioral health opportunities in a primary care clinic providers who regularly engage, attend to assure a warm handoff between joint staff meetings or training sessions, providers – whether it is a nurse and agree with systems that have been introducing a patient to their doctor, a put into place to improve collaboration, physician referring a patient to a are more likely to demonstrate smooth mental health provider, or a medical transitions.  Support staff who know and assistant linking a patient with a billing work well with administrative staff are clerk to help with insurance.  A also more likely to be able to convey a transition that goes smoothly can sense of teamwork to their patients increase the patient’s feeling of during a transition. This collaborative security and being well taken care of. spirit will again give the patient a greater One the other hand, if not done well, sense of satisfaction.Last but not least, the patient might feel as if they are what is the best way to say goodbye? As being passed from one provider to one writer says, “The close of a medical another (aka “dumped”) without visit is much like the gymnast’s anyone really caring or taking dismount.  It influences the patient’s responsibility. Clear, friendly judgment of the physician and the health transitions between clinic departments care he or she has provided” (ME Lutton, will result in greater patient (2004, Sticking the landing, Family satisfaction and better care.Warm Practice Management).  The provider handoffs depend in large part on good summarizing the care plan and asking the teamwork within the clinic.  patient if he or she has any additional questions are effective ways to wrap things up.  A good ending to the visit will increase adherence to treatment as well as patient satisfaction. TOTAL FAMILY URGENT CARE PAGE 8

GOOD BEHAVIORS 5 SCRIPTS FOR GREAT HAND-OFFS NURSE – HANDING OFF PATIENT AND COMPANION TO PHYSICIAN GREAT BEHVAIORS GREAT WORDS If the physician is not there: “Great, Mr. Hampton! I’ve got all I need. Thank you!”  Use words that prepare the patient for your “Now, if you’ll come with me, I’ll show you to the departure and for what will happen next. room where Dr. Clark will see you.” Walk with patient and gesture with your arm “Please make yourself comfortable.  to show the way. Once in the room, invite them to make “Dr. Clark should be here within 10 minutes. If for themselves comfortable. some reason, she can’t get here by then, I’ll be back to give you an update.”  Overestimate the amount of time they can expect to wait and tell them what to expect if If patient is new: “Mr. Hampton, you’ll be in great the wait time is longer. hands with Dr. Clark. She’s a wonderful doctor.”  Build the patient’s confidence in the doctor. If patient already knows the doctor: “I know Dr. Clark Tell them that you are leaving, but offer to will be very glad to see you again…” help or answer questions first.  “Before I go, is there anything you need or any questions you have? Give a gracious goodbye in which you address patient and companion by name. “I hope all goes well, Mr. Hampton, and I hope to see you on your way out. TOTAL FAMILY URGENT CARE PAGE 9

, GOOD WORDS GREAT BEHVAIORS GREAT WORDS If physician is there: “Great, Mr. Hampton! I’ve got all I need. Thank you!”  Use words that prepare the patient for the transition. “Now, if you’ll come with me, I’ll show you to the exam room where Dr. Clark will see you.” Explain what will happen next. “Isn’t it a nice day? I’m so glad the rain finally let up.” Along the way, walk close to the patient and stay connected. “Oh hi, Dr. Clark, I’m glad you’re here. Mr. Hampton, this is Dr. Clark. You’ll be in good hands with her.” Make small talk. “Dr. Clark, Benjamin Hamilton is here to see you If first visit with the doctor: Introduce the again.” patient to the doctor. Say the patient’s full name first. “Dr. Clark, this is Mr. Hampton.” If patient has seen this doctor before, Dr. Clark: “Nice meeting you Mr. Hampton. I was remind the doctor of this. expecting you. Come right in.” (Turning to nurse: “Thanks Peg. I’ll take good care of him.” Introduce the doctor to the patient. “Okay, Mr. Hampton, you’re all set. I hope all goes Smile and make eye contact. Share a good well for you!” intention. TOTAL FAMILY URGENT CARE PAGE 10

GOOD BEHAVIORS 5 SCRIPTS FOR GREAT HAND-OFFS RECEPTIONIST — PASSING A PATIENT WITH A BILLING QUESTION ON TO A BILLING PERSON GREAT BEHVAIORS GREAT WORDS Make eye contact and address the person by \"Ms. Hamilton, before we schedule your follow-up name. appointment, Katy, the person who handles all our insurance and billing, would like to ask you a Explain what and who. question regarding your insurance.\"  Share the good intentions behind the \"Katy's here to make sure everything goes smoothly request. so you can continue to get the care you need.\" Build customer's confidence in your co- “Can you speak with Katy for a few moments?” worker. “Oh hi, Dr. Clark, I’m glad you’re here. Mr. Hampton, Solicit the person's agreement. this is Dr. Clark. You’ll be in good hands with her.” Gesture enthusiastically and walk with the “Dr. Clark, Benjamin Hamilton is here to see you patient to your coworker's desk. again.” Introduce your coworker by full name and “Dr. Clark, this is Mr. Hampton.” position. Dr. Clark: “Nice meeting you Mr. Hampton. I was Then introduce the patient to your expecting you. Come right in.” (Turning to nurse: coworker. “Thanks Peg. I’ll take good care of him.” Say something to remind coworker of why “Okay, Mr. Hampton, you’re all set. I hope all goes the patient is here. well for you!” Before you go, clarify when and if they will \"Ms. Hamilton, this is Katy Hammond our Financial you see the person again. Accounts Representative. Katy helps all of our patients with their insurance and payment.\"  \"Katy, this is Ms. Hamilton, here to discuss your insurance question.\" “Ms. Hamilton, when you and Katy have finished talking, you can come back out to the front desk and I’ll help you schedule your next appointment.” TOTAL FAMILY URGENT CARE PAGE 11

, GOOD WORDS TRANSFERRING A PHONE CALL GREAT BEHVAIORS GREAT WORDS Keep in mind that the caller may have been \"“Can I have your name please? transferred to several other offices before reaching yours.  “I’m sorry, Mr. Mancini. This is Martin Internal Medicine, and it sounds like you want the pharmacy. If the caller reached you by mistake when I’ll be glad to transfer your call.”  trying to reach someone else, tell the caller which office he or she has reached and offer “In case we get disconnected or you get a busy to transfer the call to the proper office.  signal, would you want to write down the number? Is a pencil handy?” Take the time to understand what the caller needs and to figure out who he or she “Their number is XXX-XXXX. Can I repeat that for should actually be calling. you?” If you do not have the correct extension at “Please hold while I transfer your call.”  your fingertips, take the time to look it up. “And thank you for calling.” Be sure to give the caller the correct number for future use and for use if transfer is disconnected. When you transfer the call, stay on the line to make sure you’ve connected the person to the place they want to reach. TOTAL FAMILY URGENT CARE PAGE 12

GOOD BEHAVIORS 5 SCRIPTS FOR GREAT HAND-OFFS RECEPTIONIST – PASSING A PATIENT WITH A COMPLAINT TO THE OFFICE MANAGER GREAT BEHVAIORS GREAT WORDS Call the person by name and thank the Receptionist: \"I’m glad you spoke up about this, Mrs. person for speaking up. Jones. It sounds very frustrating. I want to connect you to the right person. I think Marla Roberts, our Express empathy without judging, agreeing, office manager, is the person who can best help you. or disagreeing. I know she’ll be very concerned. Would you like me to see if Marla’s available now or would you prefer Tell patient that you want to help.  that I have her call you later today?” Handle the issue or draw in the right person To Marla: “Marla, I’m glad you’re here. You know who can. Mrs. Jones? She has a concern that I know you’ll want to know about. Do you have a few minutes to Build up your colleague in the patient’s talk with Mrs. Jones? I know you can help.” mind. Express confidence that this colleague cares and will help. To Mrs. Jones: “You’ll be in good hands with Marla. Thanks for waiting.” Give the person options.  Follow through on the option they choose. Make sure you close the loop. Make sure the person connects with the office manager before you let go. TOTAL FAMILY URGENT CARE PAGE 13

, GOOD WORDS PROVIDER GOOD-BYE TIPS FOR THE END OF THE PATIENT VISIT REMEMBER! Leave your patient feeling connected and valued. Leave your patient feeling clear about what you’ll do and what they’ll do. Leave your patient feeling finished. Leave your patient feeling confident. Leave your patient feeling touched by your warmth. GREAT BEHVAIORS GREAT WORDS Smile, make eye contact “Okay, Mrs. Hamilton. I think we have a good plan. ” Move to the patient’s level “Helen or I will call you with your test results in about three or four days—as soon as we receive your Use the patient’s preferred name results. I’d like to see you again in two weeks to check on your progress.”  Say closing words that help prepare patient for ending “If you’ll stop at the front desk on your way out, Suzy will find a convenient appointment time for Say what to expect/do next and why. you.” Invite last questions or at least “one last “Before you go, Helen, do you have any more question.” questions? I want you to feel confident that you know what to do and why.” Give thorough explanations to each question.  “Please let me know if I’ve answered your questions. This is complicated and I want to be clear.” Check back frequently for understanding in a way that helps patients feel comfortable to “Please don’t hesitate to call if you have questions or tell you if they do not understand. concerns after you leave.” Tell person what to do if they have questions or concerns after they leave. TOTAL FAMILY URGENT CARE PAGE 14

GOOD BEHAVIORS, GREAT WORDS PROVIDER GOOD-BYE TIPS FOR THE END OF THE PATIENT VISIT REMEMBER! Leave your patient feeling connected and valued. Leave your patient feeling clear about what you’ll do and what they’ll do. Leave your patient feeling finished. Leave your patient feeling confident. Leave your patient feeling touched by your warmth. GREAT BEHVAIORS GREAT WORDS Address patient and companion by “Thanks for coming in. I hope you can get back on preferred name.  the tennis court very soon.” Make eye contact. \"We strive to deliver the best service to our patients and love to hear their feedback so we can learn and Put your heart in it. improve how we can make your experience better. How was your experience today?\" Share a good intention/good wishes. \"Do you feel satisfied with the service you received Ask the patient if they were satisfied with today?\" their visit \"Would you be willing to leave a review about your Request patient to leave a review about their wonderful experience with us today before you wonderful experience before they leave for leave today? We are offering a $5 off coupon for a $5 off coupon your kind words and valuable time.\" \"If you don't have time right now, we can send you can email to complete the review along with your $5 off coupon to use towards your services on your next appointment. How does that sound to you\" TOTAL FAMILY URGENT CARE PAGE 15

DO'S AND DON'T 5 SCRIPTS FOR GREAT HAND-OFFS TAKING AND DELIVERING A PHONE MESSAGE DO'S DON'TS “I’m sorry, he’s not available right now”  “She’s impossible to find or reach, but as soon as I can, I’ll give her your message.”  “She’s out of the office at the moment. I expect her back at 4:00. May I take a “She’s working at home.”  message?”  “She’s always off somewhere. It’s a real challenge to “He’s in a conference right now but I’ll be get her.”  happy to take a message.” “He’s taken the afternoon off for personal business.” ACTION Write down the caller’s name and phone number. Include other identifying information (e.g., name of patient the caller is associated with).  Don’t be shy about asking the caller to spell out a difficult name when necessary. Note the date and time of the call, and the subject if you can tactfully find that out. This will help your coworker prioritize. If you can, locate any information your coworker will need when returning the call and provide it to him or her with the message. Be sure to put your initials at an appropriate place on the message so that your coworker will know who took the call in the event of questions. Sometimes you may have to take a message for someone who is in and nearby but who is on the phone or involved in some other work requiring immediate attention. You have a caller on the line and you need to get your coworker’s attention in order to complete the call. To attempt this, place a written note in front of your coworker explaining the situation. Wait for a response. Your co- workers will appreciate your courtesy and thoughtfulness as much as patients do. TOTAL FAMILY URGENT CARE PAGE 16

TEAM VALUES We are what we practice Respect: Treat everyone in our diverse community, including patients, their families and colleagues, with dignity. Integrity: Adhere to the highest standards of professionalism, ethics and personal responsibility, worthy of the trust our patients place in us. Compassion: Provide the best care, treating patients and family members with sensitivity and empathy. Healing: Inspire hope and nurture the well-being of the whole person, respecting physical, emotional and spiritual needs. Teamwork: Value the contributions of all, blending the skills of individual staff members in unsurpassed collaboration.InnovationInfuse and energize the organization, enhancing the lives of those we serve, through the creative ideas and unique talents of each employee. Excellence: Deliver the best outcomes and highest quality service through the dedicated effort of every team member. Stewardship: Sustain and reinvest in our mission and extended communities by wisely managing our human, natural and material resources. TOTAL FAMILY URGENT CARE PAGE 17

A SHARED VISION TEAM APPROACH Shared vision is generally fostered by a combination of leadership foresight and visualization with team creativity, definition, and implementation. In other words, the team members further refine the vision and translate it into day-to- day care. A frequent theme was the use of team- building exercises focused on input into the vision, goals, and mission of the treatment team. Many teams even developed the mission statement together, which increased team commitment and cohesion. TOTAL FAMILY URGENT CARE PAGE 18

TRAINING Go to respective website MODULES complete designated modules for learning improvements. PROJECT TEAM-BASED Create an account to take the quiz CARE - STAFF Screenshot results at the end Email: [email protected] TEAM-BASED CARE QUIZ IMPROVE PATIENT CARE AND Date Completion TEAM ENGAGEMENT THROUGH Screenshot results COLLABORATION AND STREAMLINED PROCESSES https://edhub.ama-assn.org/stepsforward/module/2702513 Learning Objectives 1. Define elements that constitute the model of team-based care 2. Describe how to implement team-based care in your practice 3. Identify benefits of implementing team-based care in your practice MEDICAL ASSISTANT QUIZ PROFESSIONAL DEVELOPMENT Date Completion ENHANCE THE SKILLS AND ROLES Screenshot results OF SUPPORT STAFF https://edhub.ama-assn.org/stepsforward/module/2702558 Learning Objectives: At the end of this activity, you will be able to: 1. Identify steps to begin a medical assistant (MA) professional development program in your practice; 2. Describe best practices on developing a professional development training curriculum and materials; 3. Explain how to execute and evaluate an MA professional development program. TOTAL FAMILY URGENT CARE    |   19

TRAINING Go to respective website MODULES complete designated modules for learning improvements. PROJECT TEAM-BASED Create an account to take the quiz CARE - INTERNS Screenshot results at the end Email: [email protected] HEALTH COACHING QUIZ HELP PATIENTS TAKE CHARGE OF Date Completion THEIR HEALTH Screenshot results https://edhub.ama-assn.org/stepsforward/module/2702562 Learning Objectives 1. Identify steps to develop and implement the health coaching model for your practice 2. Discuss methods to recruit, train and mentor health coaches 3. Describe how to evaluate and track their progress over time TOTAL FAMILY URGENT CARE    |   20

TEAM COMMUNICATION THE TEAM FOCUS IS ON MEETING THE NEEDS OF THE PATIENT WHILE MAXIMIZING THE EXPERTISE OF HEALTHCARE PROVIDERS ON THE TEAM Effective communication amongst team Individually team members should assume the members is essentially a core concept of high best motives of others. they should be able to functioning teams and safe and reliable patient recognize that their initial assumptions May care. Team communication serves a dual reflect their own views and should first seek to purpose of providing an opportunity to relay understand others views and then to be important information about the task related understood. Active listening is an important responsibilities for the team and providing key aspect of successful interprofessional evidence about the nature of the team's collaboration and respect when interpersonal performance. It allows for a communicating with patients and colleagues. comfortable atmosphere and create a culture Providers should be able to trust each other to that enables a continuous learning environment function within their practices' organization's within the practice and translates to a better and protocols and be able to relay information to more efficient care.  the next person. In order to establish effective communication On an organizational level each practice should you must instill these qualities into your roles: encourage open and effective communication honesty, respect, trust, transparency, privacy, amongst the providers. Members should be accuracy, and timeliness. tools to encourage encouraged to share their concerns and ideas these attributes and promote effective without fear and they should be able to rely on communication can be implemented on the each other to help recognized practice patterns individual staff members and on an that compromise the quality of care. This way organizational level. you can find ways to further correct them before any mishaps occur. TOTAL FAMILY URGENT CARE PAGE 21

TEAM COMMUNICATION It's important to mention the effectiveness of adopting a framework for structuring the communication of patient status reports to facilitate consistency and completeness of information shared. Patients should receive complete and timely information about their health records and changes in their care. It may be a good idea to establish daily routine short meetings with the team members that will be providing care that day in order to establish an agenda for the day. This agenda will go over the expectations for the day regarding: patient flow and appointments, designated rules and responsibilities for each team member for the day, designated work desk for each employee, scheduled breaks, any changes or updates, delegate tasks, and assign new tasks if any. The meeting should not last more than 10 minutes and should be conclusive where everyone understands their roles and responsibilities. this interaction provides an opportunity for all of these staff members to be involved and to gain insight on the team's needs and expectations. this will further be an opportunity for members of the team to solicit concerns and any questions they may have. As a team you may be able to reach a consensus on goals for care for your patients. Having regular meetings can facilitate effective communication by making sure everyone attends on time everyone is being consistent and due to the openness you have a reliable group communication. Meeting should address patient care, patient condition, collaborative problem-solving, and team functioning feedback. Team members should always remember to communicate openly honestly and respectfully. Each day amongst the team there should be one active working physician, one active medical assistant working with the physician, one receptionist, and one billing/checkout employee. Each member of the team should be assigned a designated role and responsibilities for the day. At the end of the day a closing meeting shall be conducted to review the results of the day, the results of the meeting from earlier, what to expect tomorrow, any remaining tasks, any concerns or questions that may be answered. if there are any changes throughout the day in change of roles and responsibilities or changes in leadership the team should all be informed immediately along with the patient in a timely manner. this is an effective method in care coordination. This includes clarifying and communicating team member roles, workflow, and evaluation. TOTAL FAMILY URGENT CARE PAGE 22

SAMPLE SCENARIO MEET & GREET Lobby Room/ Front Desk/ Check-in (5-7mins) Registration: The registration desk is the first contact point in the patient pathway continuum with the RECEPTIONIST. Patients are sorted through a numbered color scheme registration system: green for those with appointments, yellow for older individuals as a fast track option, and blue for general Walk-in patients, orange will indicate if the patient is a TFUC member. As the patient enters the clinic the receptionist is to acknowledge and to welcome the patient to TFUC. Receptionist will direct the patient to sign in and help them enter their information through the iPad portal system. If there is a volunteer student available, he/she will be trained to greet the patient and direct them to sign in on the iPad portal system. Patient may have already filled out their forms prior to their appointment which will allow for automatic data entry into the system once the patient signs in. Have the patient take a seat and enjoy a magazine or coffee while they wait. Key Points Meet and greet guest immediately Positive emotions and good eye contact Check-in patient Have patient enter information through ipad system Make patient feel comfortable Explain the next steps TOTAL FAMILY URGENT CARE    |   23

SAMPLE SCENARIO Pre-Exam History Vitals Room (5-7mins) Vitals: Patient is politely directed and walked over to the vitals room with the assigned MEDICAL ASSISTANT. The assigned MA will take care of the patient from the beginning to the end without any handoffs in between to limit any loss of information due to inappropriate communication. Engage patient with small talk. Have patient seated in the vitals room and begin procedure. Height and weight: Body weight and height measurements are collected at every visit for every patient, along with blood pressure measurements. Blood pressure: Blood pressure measurements are carefully collected and repeated if the first measurement is high. A second high indicator is followed up with a manual BP measurement. Patients are referred to the emergency room (ER) if the manual measurement is also high.Blood exam: Patients coming in for blood work are referred to the lab. Medical history and medical education: Medical assistants will conduct a pre-medical short interview with a series of relevant questions that include: patient name, age, DOB, chief complaint, new complaint, old complaint, any changes in life, allergies, and past medical history. Patients receive a consultation on their current medical history before meeting with the doctor. This medical history is entered into the client chart and clinic database. For high-risk patients requiring additional health and nutritional education, such as patients with Stage 3 chronic kidney disease (CKD) - they are identified and referred to a community peer counselling group where professionals provide relevant information regarding eating habits, food and drug consumption, and current trends in the community. At the end of these sessions, a feedback system ensures that participants provide their opinions, ideas, and perspectives. Key Points Assign designated MA to each patient to avoid loss of information and focus on patient trust with the same MA from check in to check out Positive emotions and good eye contact Engage patient in small talk Obtain patient vitals and brief medical history Obtain patient chief complaint and summary for the doctor Obtain patient feedback Explain the next steps Prepare patient for the physician TOTAL FAMILY URGENT CARE    |   24

SAMPLE SCENARIO Medical Exam Doctor Visit (10-15 mins) Doctor visit: Patient charts and registration numbers are assembled and prepared for the doctor with a summary of the relevant information before entering the patient room. Patients chart on screen will includes their name, registration number, and photograph. Patient charts include a star system that ranks their sugar or blood pressure levels for the visit. The doctor conducts the exam with a series of questions, provides physical exam, and consults the patient based on the information and findings the physician encounters. The physician will be responsible to record their notes on their ipads on a live document that is linked to their medical assistants account. The physician then adjusts and prescribes essential medicines as needed and also records the medical codes for the encounter in the ipad digital chart. Key Points Summary of patient history already entered in patient file and patient information all posted on the doctors screen Physician conducts complete exam including questionnaire and physical exam Engage patient in small talk Record notes on live notes software linked with personal medical assistants account enables her to see your notes in live time Record notes, prescribes essential meds, and enters the medical codes for the visit Obtain patient feedback Explain the next steps Prepare patient for the medical assistant to complete the visit MA During Doctor Visit (10-15 mins) MA during the Doctor Visit: The personal Medical Assistant on the case shall be at their work desk in the vitals room, entering the doctors notes into the electronic medical records system in real time while the physician is writing the notes in the patient room. By the time the physician has completed his exam and entered his notes, the medical assistant is able to read and enter the instructions and notes into the EMR and prepare the patient for their next steps. Key Points Enter doctor notes into EMR in real time while the doctor is in the examination room Prepare items for patient TOTAL FAMILY URGENT CARE    |   25

SAMPLE SCENARIO Post Medical Exam Post Exam Material (5-7 mins) Post Exam Material: The personal Medical Assistant will then meet the patient in their respective room and inform the patient of the next steps. The MA must confirm the patient understood the next steps and is on the same page before you proceed. The MA will complete any actions directed by the physician such as vaccinations, blood draw, urine test, prescriptions, etc, before preparing the patient towards check out. It is the medical assistant’s responsibility (if there is no student available) to walk the patient to the check- out desk, ask the patient how was their experience, and request the patient to leave a review about their experience on one of our ipad stations to receive a $5 off coupon towards their services. Ask the patient how they learned about TFUC. The medical assistant (or student) will then leave the patient with the check-out nurse / billing coordinator to address the remaining visit. Key Points Explain the next steps to the patient once the exam is complete Confirm patient understood the directions and if is need for any clarifications Prepare patient to complete the visit by explain the next steps Engage patient in small talk Complete any actions directed by physician such a vaccinations, blood draw, etc Walk patient to the check-out desk Obtain patient feedback Prepare patient for the check-out nurse to complete the visit and to set up future appointment TOTAL FAMILY URGENT CARE    |   26

SAMPLE SCENARIO Post Medical Exam Check-out Nurse (5-7 mins) Check-out nurse: Patients meet with an exit nurse to review their visit and prescribed medicine before visiting the pharmacy for their medicine. Any additional purchases can also be made here. All the benefits of enrolling in our membership plan is relayed to the patient along with any current specials before they are told their balance. Any further critical information is collected by the nurse and added to the patient record. The patient is given their login information for Kareo and further they are explained how they can view their results and notes for their visit online. If the patient needs any brochures or infogenics, the checkout nurse would also provide these. The nurse is also responsible for setting up any future appointments for the patient along with enrolling them in text message and email reminders and confirmation system. Having the patient subscribe to our online profile and accounts is very important too. If not already signed up to receive news, make sure the patient enters their information. Once the patient is checked out, the patient is greeted and thanked for stopping and welcomed to come visit again. Key Points Prepare patient to complete the visit by explaining the next steps Review the patients visit and prescribed medications Confirm patient understood the directions and if is need for any clarifications Ask the patient if they would like any more informational brochures/ flyers Answer any questions the patient may have Propose the TFUC membership plan benefits Engage patient in small talk Confirm patient satisfaction Confirm patient is subscribed and enrolled in text message reminders Greet patient and thank them for visiting Invite patient back to visit again TOTAL FAMILY URGENT CARE    |   27

SAMPLE SCENARIO TOTAL FAMILY URGENT CARE    |   28

PROGRESS Knowing what one's responsibilities is equally Roles & important to understanding Responsibilities what their role is as a part of the team. Teamwork is The power of defining roles and responsibilities to eliminate essential to provide the best communicational error and focus on patient care and care for our patients. With satisfaction. everyone on the same page, the patient can entrust us with their health and wellbeing. A fact is something that has really occurred or is actually the case. The usual test for a statement of fact is verifiability, that is, whether it can be demonstrated to correspond to experience or be able to provide concente evidence. DEFINITION & STRUCTURE Having a unique faction and structure to your business model is very important in establishing an efficient work ethic and better working environment. There is a sense of understanding without the constant blaming of loss of information due to lack of communication. Because everyone has a defined and structured role and responsibility for their job description, there is no reason for conflict to incur. Once the roles have been defined, the team is expected to learn and implement their responsibilities in the workplace. If every member of the team is doing what they are supposed to be doing, there is a higher chance of success and growth. TOTAL FAMILY URGENT CARE    |   29

MAINTAIN CONSISTENCY Working in the healthcare can be a rewarding job, however it can also get very hectic if there aren't several rules and regulations in place. Having clear and defined roles and responsibilities is essential to maintain consistency and structure in your work environment. That is why TFUC has taken the initiative to delegate roles and responsibilities amongst the staff and providers to limit and avoid any confusion and error in communication. Each physician will have 1 receptionist, 1 personal medical assistant, 1 check-out nurse at all times during operational hours. If there is a second medical assistant on duty for a particular day, then during the daily meeting sessions, the MA's will define clear roles and timings for their duties to avoid conflict during the shifts. One MA at a time will be responsible for processing one patient at a time from beginning to end. The second MA can take the next patient and process the patient beginning to the end. The coordinating MA will have the responsibility to relate all the necessary information to the working physician directly. TOTAL FAMILY URGENT CARE    |   30

PROGRESS Knowing everyone's role is equally important as knowing Roles & your own role. There are several Responsibilities times we are needed to step up and take on someone else's PHYSICIAN responsibility in certain emergencies. For those situations, each employee is expected to be aware of each others responsibilities. SUMMARY: This position is primarily responsible for assisting in examination and treatment of patients. TEAM PLAYER: Discuss any possible side effects to medication or immunization with patients. Arrive each day prepared to work at your appointed Utilize online resources to perform travel time. consultations. Be prepared to leave at the end of the day only after Be willing to obtain DOT medical examiner patient care is completed. certification via online training and pass Attend staff meetings and offer suggestions. official examination. Listen to others with an open mind. Be willing to learn and utilize EMR and Be willing to sign off on PA and Nurse Practitioner tablet/laptop technology at the bedside. notes as well as review lab results and imaging Prescribe and administer vaccinations to studies during down time (non-patient care periods immunize patients from communicable during the clinical shift). diseases. Review patient file/record, including allergies, Promote health by advising patients about problems, medications, and immunization status. diet, hygiene, and methods for prevention of Elicit and record information about patients’ medical disease. histories. Perform mini-surgical procedures Interview patients concerning their symptoms and commensurate with urgent care competency. conduct a thorough physical examination. Refer patients to medical specialists for Order or execute various tests, analyses, and consultation services when necessary for the diagnostic images to provide information on patients’ well-being of the patients. conditions. Document the patients’ visits including Analyze reports and findings of tests and medical history, physical exam, diagnoses, examinations, and diagnose conditions of patients. and plan of action. Administer or prescribe treatments. Determine and prescribe medication, dosage, and schedule given the patients’ conditions and allergies. TOTAL FAMILY URGENT CARE    |   31

Follow-up daily on laboratory tests and X-Rays. Conduct physical examinations to provide information needed for admission to school, consideration for jobs, or eligibility for insurance coverage. Maintain a professional appearance. Maintain a current CPR certification. Understand the concepts of universal precautions, HIPAA and OSHA. Be a team player who is equally comfortable working independently. Maintain a warm, friendly attitude with excellent patient interaction skills. Maintain excellent verbal and communication skills. Be adaptable in different situations. Possess excellent client interaction skills. Be able to multi-task. Exhibit Excellent Customer Service; be patient-centric and customer service oriented. COMPUTER SKILLS: To perform this job successfully, an individual should have knowledge of our EMR (Kareo & Engage) and the internet. On-site training will be provided for the EMR System. If you feel inproficient in any of these areas, please let your clinical director know and we will provide you the tools and resources for training and learning purposes. TOTAL FAMILY URGENT CARE    |   32

Knowing everyone's role is equally important as knowing your own role. There are several times we are needed to step up and take on someone else's responsibility in certain emergencies. For those situations, each employee is expected to be aware of PROGRESS each others responsibilities. Roles & Responsibilities MEDICAL ASSISTANT • Prepare treatment rooms for patient examinations, keeping the rooms neat and SUMMARY: Direct, supervise, schedule and clean. evaluate work activities of medical assistants • Interview patients to obtain medical under the direction of the clinical information and measure their vital signs, director.  Administrative duties may include weight, and height. documenting/maintaining medical records and • Show patients to examination rooms and calling in prescriptions. Clinical duties may prepare them for the physician. include taking and recording vital signs and • Prepare and administer medications as medical histories, preparing patients for directed by a physician. examination, IV/Blood draw, ECG, office diagnostic testing, x-rays, splinting/wound care • Obtain ECG’s, take x-rays, start IV’s, splint and administering medications as directed by injuries, clean wounds, etc. physician. • Collect blood, tissue, or other laboratory specimens, log the specimens, and prepare TEAM PLAYER: them for testing. • Authorize prescription information to • Select, train, coach, discipline and direct all MA pharmacies. staff team members. Coordinates the MA staffing • Clean and sterilize instruments and dispose schedule. Responsible for the performance, of contaminated supplies. productivity and reviews of MA staff. Performs • Perform routine laboratory tests and duties of the MA as required. Monitors sample analyses. timekeeping prior to pay period processing. • Obtain patient satisfaction review • Record patients' medical history, vital statistics, or information such as test results in electronic medical records. TOTAL FAMILY URGENT CARE    |   33

QUALIFICATIONS Qualifications and Education • High School Graduate or GED • Minimum one to two years experience in the medical field as a Medical Assistant, in the field of urgent care medicine preferred • Medical Assistant Certificate preferred • Strong knowledge of medical terminology • Demonstrated computer skills for documenting patient care in an electronic medical record • Ability to communicate effectively in person, on the telephone, and in writing • Ability to work independently and as a team • Ability to read and comprehend patient medical charts, medical terminology, prescription medications, and physician messages • Proficient in IM medication administration, ECG’s, blood draws • Must have the ability to perform overall the standard technical functions of a Medical Assistant with advanced skill. Experience and knowledge of best practices in Urgent Care and Family Medicine, medical ethics and standards.  • Familiar with medical diagnoses and treatments. COMPUTER SKILLS: To perform this job successfully, an individual should have knowledge of our EMR (Kareo & Engage) and the internet. On-site training will be provided for the EMR System. If you feel inproficient in any of these areas, please let your clinical director know and we will provide you the tools and resources for training and learning purposes. TOTAL FAMILY URGENT CARE    |   34

Knowing everyone's role is equally important as knowing your own role. There are several times we are needed to step up and take on someone else's responsibility in certain emergencies. For those situations, each employee is expected to be aware of PROGRESS each others responsibilities. Roles & Perform administrative support tasks, such Responsibilities as proofreading, transcribing handwritten information, or operating calculators or RECEPTIONIST computers to work with patient information, or other documents. SUMMARY: Answer inquiries and provide File and maintain patient records and information to the general public, customers, adhere to patient confidentiality policy. visitors, and other interested parties regarding Provide information about establishment, services provided at the office and location of such as location of departments or offices, departments, offices, and employees within the employees within the organization, or organization.  Perform administrative duties using services provided. specific knowledge of medical terminology and Collect, sort, distribute, or prepare mail, practice, clinic, or laboratory procedures. Schedule messages, or courier deliveries.Process and and register patients for visits, verify insurance, prepare memos, correspondence, travel check out patients and collect co-pays. vouchers, or other documents. TEAM PLAYER: Receive payment and record receipts for services. Operate telephone switchboard to answer, Schedule and confirm patient diagnostic screen, or forward calls, providing information appointments, surgeries, or medical or taking messages. consultations. Greet persons entering establishment, Receive and route messages or documents, determine nature and purpose of visit, and such as laboratory results or prescription direct or escort them to specific destinations. refills to appropriate staff. Transmit information or documents to Perform various clerical or administrative customers, using computer, mail, or facsimile functions, such as ordering and maintaining machine. an inventory of supplies. Hear and resolve complaints from customers or Interview patients to complete documents, the public. case histories, or forms, such as intake or insurance forms. TOTAL FAMILY URGENT CARE    |   35

QUALIFICATIONS Qualifications and Education High School Graduate or GED1 year front desk experience in a medical environment preferred Basic knowledge of medical terminology Demonstrated computer skills for documenting patient care in an electronic medical record ICD-9 CM Knowledge a plus Ability to communicate effectively in person, on the telephone, and in writing Ability to work independently and as a team Ability to read and comprehend patient medical charts, medical terminology, prescription medications, and physician messages COMPUTER SKILLS: To perform this job successfully, an individual should have knowledge of our EMR (Kareo & Engage) and the internet. On-site training will be provided for the EMR System. If you feel inproficient in any of these areas, please let your clinical director know and we will provide you the tools and resources for training and learning purposes. TOTAL FAMILY URGENT CARE    |   36

Knowing everyone's role is equally important as knowing your own role. There are several times we are needed to step up and take on someone else's responsibility in certain emergencies. For those situations, each employee is expected to be aware of PROGRESS each others responsibilities. Roles & Perform administrative support tasks, such Responsibilities as proofreading, transcribing handwritten information, or operating calculators or CHECKOUT NURSE /BILLING computers to work with patient information, or other documents. SUMMARY: A Billing Coordinator is a client-facing File and maintain patient records and job that deals with accounts payable to a company adhere to patient confidentiality policy. by overseeing all invoicing. They need to ensure Provide information about establishment, that they charge customers appropriately and track such as location of departments or offices, and collect payments consistently and correctly. employees within the organization, or Ability to read and comprehend patient medical services provided. charts, medical terminology, prescription Collect, sort, distribute, or prepare mail, medications, and physician messages. Provide any messages, or courier deliveries.Process and relevant information the patient may request or prepare memos, correspondence, travel require. vouchers, or other documents. TEAM PLAYER: Receive payment and record receipts for services. Be a point of contact for clients, insurance Schedule and confirm patient diagnostic companies, and school districts appointments, surgeries, or medical Client intake and registration consultations. Insurance verification and authorizations Receive and route messages or documents, Coordinate future appointment schedule  such as laboratory results or prescription Conduct client satisfaction survey refills to appropriate staff. Maintain client files in compliance with state Perform various clerical or administrative requirementsInput client information into client functions, such as ordering and maintaining management software and complete file an inventory of supplies. Other duties as assigned Interview patients to complete documents, case histories, or forms, such as intake or insurance forms. TOTAL FAMILY URGENT CARE    |   37

QUALIFICATIONS Qualifications and Education 1+ year of experience in healthcare management is strongly preferred, but not required 1+ year of medical billing experience is preferred, but not required Bachelor's degree or higher is highly preferred Work effectively and seek out opportunities to partner with other employees Maintain an open line of communication with clients and other employees. Communicates with promptness, consistency, and patience.Resolves compliant, disputes, and conflicts effectively and professionally. Coordinates and organizes multiple tasks and accomplishes them accurately and on time. Pays attention to details and corrects mistakes promptly and accurately. Earns trust from clients and other employees with consistent practice and follow through. Reflects on and think of ways to improve yourself when problems arise. Become an effective member of the social entrepreneurial agency and contributes to its mission. COMPUTER SKILLS: To perform this job successfully, an individual should have knowledge of our EMR (Kareo & Engage) and the internet. On-site training will be provided for the EMR System. If you feel inproficient in any of these areas, please let your clinical director know and we will provide you the tools and resources for training and learning purposes. TOTAL FAMILY URGENT CARE    |   38

TRAINING Screenshot results SCHEDULE Email: [email protected] Submit this sheet after completion to DEADLINES management HEALTH COACHING DEADLINE: ________ ______, 2020 HELP PATIENTS TAKE CHARGE OF THEIR HEALTH Date Completion & Signature https://edhub.ama-assn.org/stepsforward/module/2702562 Screenshot results TEAM-BASED CARE DEADLINE: FEBURARY 18, 2020 IMPROVE PATIENT CARE AND TEAM ENGAGEMENT THROUGH Date Completion & Signature COLLABORATION AND Screenshot results STREAMLINED PROCESSES https://edhub.ama-assn.org/stepsforward/module/2702513 MEDICAL ASSISTANT DEADLINE: PROFESSIONAL DEVELOPMENT FEBURARY 25, 2020 ENHANCE THE SKILLS AND ROLES Date Completion & Signature OF SUPPORT STAFF Screenshot results https://edhub.ama-assn.org/stepsforward/module/2702558 TOTAL FAMILY URGENT CARE    |   39

CHECKLIST Meet & Welcome Patient immediately by Receptionist or by a student Have patient enter their information into digital form to enter directly to EMR. Otherwise manual enter. Once checked in by Receptionist - assign patient to an MA for process and evaluation Once checked in by Receptionist - assign patient to an MA for process and evaluation MA is responsible for this patient coordination and will take patient to the vitals room for vitals and pre- history Once Pre-Check is complete - MA directs patients to examination room where Physician will conduct exam Physician will review history and perform exam and evaluation. Then he will record notes in real time to his MA who will be in other room entering notes into EMR. Once Physician is complete, MA will inform the patient of the next steps and review what the doctor requested MA will complete the directions provided by the doctor and take the patient to checkout and will request patient to leave review about their experience. Patient will then be checked out by the checkout nurse and informed of any billing charges and will assist in schedule any future appointments. Also provide information about membership program and specials. TOTAL FAMILY URGENT CARE    |   40