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Mission StatementLast 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 ProgramGoal 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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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 activity2. Group (local) activity3. State wide4. 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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Scope of Practice for the Family Medicine Residency ProgramPurpose: 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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Scope of Training: Goals and Objectives of the Residency Training ProgramAt 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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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 decision-making. 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 cost-effectiveness 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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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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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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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

Paracentesis*

Joint injection/aspiration* Central line placement*

I & D*

Sprain/fracture/dislocation management*

Uncomplicated pregnancy management*

Vaginal exam*

Circumcision Induction of labor* Cryotherapy of cervix*

Episiotomy repair+ Thoracentesis+ Vasectomy+

Endometrial biopsy+ Chest tube placement+

IUD Management+

Cervical biopsy+ Frenulectomy of Newborn+

Endocervical curette+ OB Ultrasound+

1st assist at C-section+

Specific Settings for Evaluation and ManagementAdmission and/or management to regular floorEvaluation and/or management in EDAdmission and/or management in Intensive careAdmission 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 IIIThis 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 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**

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Clinical Invasive Repair simple laceration Vent Management+ Skin Biopsy

Minor skin surgery

Interpret EKG Lumbar puncture+ Endotracheal Intubation*


Paracentesis+

Joint injection/aspiration Central line placement+

I & D*

Sprain/fracture/dislocation management*

Uncomplicated pregnancy management

Vaginal exam*

Circumcision Induction of labor** Cryotherapy of cervix+

Colposcopy+

Episiotomy repair+ Thoracentesis+ Vasectomy+

Endometrial biopsy+ Chest tube placement+ IUD management+

Cervical biopsy+ Frenulectomy of Newborn+

Endocervical curette+ OB Ultrasound+

1st assist at C-section+ Primary surgeon C-section+

Tubal ligation+

Specific Settings for Evaluation and ManagementAdmission and/or management to regular floorEvaluation and/or management in EDAdmission and/or management in Intensive careAdmission and/or management on Labor and Delivery**Admission and/or management of uncomplicated newbornEvaluation 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 ProgramPerformance 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**

Clinical Invasive

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Repair simple laceration Vent Management Skin Biopsy

Minor skin surgery

Interpret EKG Lumbar puncture+ Endotracheal Intubation


Paracentesis A-line placement+

Joint injection/aspiration Central line placement I & D

Sprain/fracture/dislocation management

Uncomplicated pregnancy management

Vaginal exam

Circumcision Induction of labor EGD+

Colposcopy Colonoscopy+

Episiotomy repair Thoracentesis+ Vasectomy+

Endometrial biopsy Chest tube placement+

Nasopharyngoscopy+

Cervical biopsy Frenulectomy of Newborn

D & C+

Endocervical curette OB Ultrasound+

1st assist at C-section Primary surgeon C-section+

IUD Management+

Specific Settings for Evaluation and ManagementAdmission and/or management to regular floorEvaluation and/or management in EDAdmission and/or management in Intensive careAdmission and/or management on Labor and DeliveryAdmission and/or management of uncomplicated newbornEvaluation and/or management in FMC+Graduate should show evidence of additional training

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Resident Administrative Responsibilities by Year

PGY-I 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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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

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ADMINISTRATIVE – GENERAL INFORMATIONADVISORS (FACULTY)

NUMBER: I-0200 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

ADVISOR (FACULTY): 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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SECTION: ADMINISTRATIVE - GENERAL INFORMATIONSUBJECT: BENEFITSNUMBER: I-0300 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

BENEFITS: House staff group benefits are provided by the program and include:

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,

TIAA-Cref 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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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: CHIEF RESIDENTNUMBER: I-0400 DATE: 7/1/99REVISION: PAGE: 1 of 1

CHIEF RESIDENT: 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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SECTION: GENERAL INFORMATIONSUBJECT: DRESS CODENUMBER: I-0550 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

DRESS CODE: 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. (Tee-shirts, 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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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: HOLIDAYSNUMBER: I-0600 DATE: 7/1/99REVISION: PAGE: 1 of 1

HOLIDAYS: The UAMS AHEC Northeast office observes the following holidays:

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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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: HOSPITALIZATION INSURANCENUMBER: I-0700 DATE: 7/1/99REVISION: PAGE: 1 of 1

HOSPITALIZATION INSURANCE: 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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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: ILLNESSESNUMBER: I-0800 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

ILLNESSES: Any illness which will cause you to miss work should be reported to the Chief Resident(s)

or 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]

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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: LIBRARYNUMBER: I-0900 DATE: 7/1/99REVISION: 10/21/00 PAGE: 1 of 1

LIBRARY: The UAMS AHEC Northeast Library is located on the first floor of the Annex Building

adjacent to the Family Medicine Center. 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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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: MAILNUMBER: I-01000 DATE: 7/1/99REVISION: 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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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: MALPRACTICE INSURANCENUMBER: I-01100 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

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)

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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: MATERNITY/PATERNITY LEAVENUMBER: I-01200 DATE: 7/1/99REVISION: 10/10/01, 6/10/14 PAGE: 1 of 1

MATERNITY/ PATERNITY/ ADOPTION LEAVE: 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.

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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: MEDICAL SCREENNUMBER: I-01300 DATE: 7/1/99REVISION: PAGE: 1 of 1

MEDICAL SCREEN: 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.)

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: PAGERSNUMBER: I-01400 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

PAGERS: Teletouch display pagers are used for on-call PGY I and PGY II physicians and the PGY I

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.

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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: PARKINGNUMBER: I-01500 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

PARKING: Each resident is given a parking card for the St. Bernard’s Regional Medical Center

doctors’ lot 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.

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SECTION: ADMINISTRATION - GENERAL INFORMATIONSUBJECT: PAYROLLNUMBER: I-01600 DATE: 7/1/99REVISION: 4/3/12 PAGE: 1 of 1

PAYROLL: Payroll checks are prepared at UAMS in Little Rock and electronically deposited via

direct bank 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.

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SECTION: ADMINISTRATION – GENERAL INFORMATIONSUBJECT: PRESCRIPTIONSNUMBER: I-01700 DATE: 7/1/99REVISION: 4-12-07 PAGE: 1 of 1

PRESCRIPTIONS: 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.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: RECRUITINGNUMBER: I-01800 DATE: 7/1/99REVISION: 4-12-07, 5-4-12 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.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: REIMBURSEMENT (TRAVEL)NUMBER: I-01900 DATE: 7/1/99REVISION: 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: HotelAirlineParking @ airportRegistration [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 carPersonal entertainmentFamily expensesTipsAlcohol

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.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: REPRESENTATIVE OF FAMILY PRACTICENUMBER: I-02000 DATE: 7/1/99REVISION: 5-4-12 PAGE: 1 of 1

REPRESENTATIVE OF FAMILY PRACTICE: 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.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: RESIDENT TRAVEL (CME)NUMBER: I-02100 DATE: 7/1/99REVISION: 5-25-10, 4-5-12 PAGE: 1 of 1

RESIDENT TRAVEL (CME): 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.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: SEXUAL HARASSMENTNUMBER: I-02200 DATE: 7/1/99REVISION: 10/21/00 PAGE: 1 of 1

SEXUAL HARASSMENT: 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)

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: UAMS AFFILIATIONNUMBER: I-2300 DATE: 7/1/99REVISION: PAGE: 1 of 1

UAMS AFFILIATION: 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.]

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: VACATIONNUMBER: I-02400 DATE: 7/1/99REVISION: 5/10/10, 5/22/12 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).

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: DRUG SCREENINGNUMBER: I: 400 - 018 DATE: 6/1/99REVISION: 10/15/99 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 MethaqualoneMethadone PCP/PhencyclidineBarbiturates BenzodiazepinesPropoxyphene CannabinoidsCocaine 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. Driving or riding as a passenger in a state vehicle2. Conducting AHEC business off AHEC property3. 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.

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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.

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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



(2) 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.

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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. All questions concerning policies and procedures should be directed to the UAMS human resource department.

Responsibility for the Chain of Custody and Laboratory Quality Control rests with the Testing Laboratory.

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: DRUG SCREENINGNUMBER: I: 400-018 DATE: 6/1/99REVISION: 10/15/99 PAGE: 6 of 7

AHEC PROGRAM Procedure For Collection and Analysis – Drug Screening

UAMS AHEC Northeast will contact Occupational Health Partners

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SECTION: ADMINISTRATIVE – GENERAL INFORMATIONSUBJECT: DRUG SCREENINGNUMBER: I: 400-018 DATE: 6/1/99REVISION: 10/15/99 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 MethaqualoneMethadone PCP/PhencyclidineBarbiturates BenzodiazepinesPropoxyphene CannabinoidsCocaine OpiatesDerivatives 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.

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SECTION: FAMILY MEDICINE CENTERSUBJECT: TELEPHONE SYSTEMNUMBER: DATE:REVISION: 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: INTRODUCTION NUMBER: II-0100 DATE: 7/1/99REVISION: 4/12/07, 4-5-12 PAGE: 1 of 1

INTRODUCTION: 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: AVAILABILITYNUMBER: II-0200 DATE: 7/1/99REVISION: 4-5-12 PAGE: 1 of 1

AVAILABILITY: 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.)

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SECTION: RESIDENT PERFORMANCESUBJECT: CALL/RESIDENT RESPONSIBILITESNUMBER: II-0300 DATE: 7/1/99REVISION: 10/10/01;4/13/07; 5-4-12 PAGE: 1 of 2

PGY I: Call/ResponsibilitiesA. 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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SECTION: RESIDENT PERFORMANCESUBJECT: CALL/RESIDENT RESPOSIBILITIESNUMBER: II-0300 DATE: 7/1/99REVISION: 4-5-12 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 non-pediatric 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.

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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.

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.

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SECTION: HOSPITALSUBJECT: RESIDENT SCHEDULE/DUTIESNUMBER: IV-0301 DATE: 8/14/06REVISION: 5/29/12 PAGE: 1 of 1

INTERN CALL RULES:

- Call Scheduleo 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 1900o 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 1700o 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 0700o Works Friday from 1700 to Saturday 0900

Saturdayo Intern # 1 (Medicine Service Intern) (15 hr)

Comes in at 0500 and works until 2000o Intern # 4 (Any one of the non-medicine service

interns) (16 hr) Comes in at 1700 and works until Sunday 0900

Sundayo Intern # 2 (Medicine Service Intern) (15 hr)

Comes in at 0500 and works until 2000o 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.

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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. 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

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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 Callo 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. 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 Callo 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 Callo 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).

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The above schedules ensure that a minimum of ten (10) hours free of all responsibilities between duty periods is met.

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SECTION: RESIDENT PERFORMANCESUBJECT: RESEARCH/SCHOLARLY ACTIVITESNUMBER: II-0400 DATE: 7/1/99REVISION: 4/12/07, 5-8-12 PAGE: 1 of 2

Introduction: Residents at all levels are encouraged to discuss interesting findings with colleagues and

faculty 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 ConferenceThis 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 ConferenceThis 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 ConferenceThis 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 ConferenceThis 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

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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.

Grand Rounds ConferenceEvery 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: CONFERENCESNUMBER: II-0500 DATE: 7/1/99REVISION: 4/13/07, 5-8-12 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: CORE CONTENT REVIEWNUMBER: II-0600 DATE: 7/1/99REVISION: 4/13/07, 5-8-12 PAGE: 1 of 1

CORE CONTENT REVIEW: 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: CORRECTIVE ACTIONNUMBER: II-0700 DATE: 7/1/99REVISION: March 30, 2007 PAGE: 1 of 1

CORRECTIVE ACTION: 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.

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SECTION: RESIDENT PERFORMANCESUBJECT: DAILY REPORTNUMBER: II-0800 DATE: 7/1/99REVISION: 4/13/07, 5-8-12 PAGE: 1 of 1

DAILY REPORT: 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).

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SECTION: RESIDENT PERFORMANCESUBJECT: DUE PROCESS/GRIEVANCENUMBER: II-0900 DATE: 10/13/00REVISION: PAGE: 1 of 1

DUE PROCESS: 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.

(2) A written warning with an identified probationary period. (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.

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SECTION: RESIDENT PERFORMANCESUBJECT: CRITERIA FOR ADVANCEMENT/PROMOTION OF RESIDENTSNUMBER: II-0950 DATE: 10/13/00REVISION: 10/2007, 7/27/2012 PAGE: 1 of 7

PGY1 to PGY2PATIENT 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

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Devises appropriate management and follow-up depending on results of diagnostic tests

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

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For each patient, discusses appropriate follow-up and/or discharge planning Health maintenance information is consistently updated, including

medicine/allergy list and problem list 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

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Promotion CriteriaPGY2 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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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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Criteria for Graduation from the ProgramPGY3

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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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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SECTION: RESIDENT PERFORMANCESUBJECT: RESIDENT REMEDIATIONNUMBER: II-0950.1 DATE: 5/8/12REVISION: 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: Curriculum DirectorCourse Lecturers: 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

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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.

Required Texts: Pathophysiology of Disease, An Introduction to Clinical Medicine, McPhee, Ganong, 5th Ed, Lange

Textbook of Family Medicine. Rakel, Rakel, 8th Ed, ElsevierCourse Outline:

Week #1 Day #1 – Cell PhysiologyDay #2 – Self StudyDay #3 – Cardiovascular SystemDay #4 – Self StudyDay #5 – Pulmonary System

Week #2 Day #1 – Nervous SystemDay #2 – Self StudyDay #3 – Endocrine SystemDay #4 – Self StudyDay #5 – Renal System

Week #3 Day #1 – Immune SystemDay #2 – Self StudyDay #3 – Gastrointestinal SystemDay #4 – Self StudyDay #5 – Reproductive System

Week #4 Day #1 – Urinary SystemDay #2 – Integumentary SystemDay #3 – ReviewDay #4 – Self StudyDay #5 – Exams

Copy in Coordinator’s office.

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SECTION: RESIDENT PERFORMANCESUBJECT: SPECIALTY ROTATIONS / PRECEPTORSNUMBER: II-01200, 01400, 01600 DATE: 7/1/99REVISION: 4/13/07, 5/9/12 PAGE: 1 of 1

SPECIALTY ROTATIONS: 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.

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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: RESIDENT PERFORMANCESUBJECT: EVALUATIONSNUMBER: II-01000 DATE: 7/1/99REVISION: PAGE: 1 of 1

EVALUATIONS: 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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SECTION: RESIDENT PERFORMANCESUBJECT: MOONLIGHTINGNUMBER: II-01100 DATE: 7/1/99REVISION: 4/19/12 PAGE: 1 of 1

MOONLIGHTING: 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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SECTION: RESIDENT PERFORMANCESUBJECT: PUBLIC RELATIONSNUMBER: II-01300 DATE: 7/1/99REVISION: PAGE: 1 of 1

PUBLIC RELATIONS: 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: RESIDENT PERFORMANCESUBJECT: ROUNDSNUMBER: II-01500 DATE: 7/1/99REVISION: 5/22/12 PAGE: 1 of 1

ROUNDS: FPS I teaching rounds are conducted with the faculty attending, PGY I, PGY III, and

students at a 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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SECTION: RESIDENT PERFORMANCE SUBJECT: DUTY HOURSNUMBER: II-01700 DATE: 8/23/05REVISION: 7/1/07, 6/11/10, 4/19/12 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.new-innov.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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https://www.new-innov.com/


SECTION: RESIDENT PERFORMANCESUBJECT: INTRODUCTION NUMBER: II-0100 DATE: 7/1/99REVISION: 4/12/07 PAGE: 1 of 1

INTRODUCTION: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: Administrative StructureNUMBER: III: 0200 DATE: 07/01/99REVISION: 01/10/02; 4/13/07; 5/10/12 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: PATIENTS’ RIGHTSNUMBER: III-0250 DATE: 10/23/00REVISION: 8/7/2008 PAGE: 1 of 1

PATIENTS’ RIGHTS: 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.

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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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SECTION: FAMILY MEDICINE CENTERSUBJECT: ADMISSIONSNUMBER: III-0300 DATE: 7/1/99REVISION: 4/13/07, 5/10/12 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: AFTER HOURS CLINIC USENUMBER: III-0400 DATE: 7/1/99REVISION: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: APPOINTMENTSNUMBER: III-0500 DATE: 7/1/99REVISION: 10/10/01, 7/18/12 PAGE: 1 of 1

APPOINTMENTS: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: ATTENDINGNUMBER: III-0600 DATE: 7/1/99REVISION: 4/13/07, 5/21/12 PAGE: 1 of 1

ATTENDING: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: MEANS OF RESIDENT GUIDANCE FROM FACULTYNUMBER: III-0650 DATE: 10/23/00REVISION: 5/21/12 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: CHART REVIEWNUMBER: III-0700 DATE: 7/1/99REVISION: 4/13/07 PAGE: 1 of 1

CHART REVIEW: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: CLINIC ASSIGNMENTSNUMBER: III-0800 DATE: 7/1/99REVISION: 5/22/12 PAGE: 1 of 1

CLINIC ASSIGNMENTS: Clinics with an appropriate panel of patients are a required part of

residency training. 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: CLINIC-CHURCH HEALTH NUMBER: III-0900 DATE: 7/1/99REVISION: PAGE: 1 of 2

CHURCH HEALTH CLINIC: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: CONTINUITY OF CARENUMBER: III-01000 DATE: 7/1/99REVISION: PAGE: 1 of 1

CONTINUITY OF CARE: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: DEATH CERTIFICATESNUMBER: III-01100 DATE: 7/1/99REVISION: PAGE: 1 of 1

DEATH CERTIFICATES: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: EMPLOYEE MEDICAL CARENUMBER: III-01200 DATE: 7/1/99REVISION: PAGE: 1 of 1

EMPLOYEE MEDICAL CARE: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: FINANCIAL COUNSELINGNUMBER: III-01400 DATE: 7/1/99REVISION: PAGE: 1 of 1

FINANCIAL COUNSELING: 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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SECTION: FAMILY MEDICINE CENTERSUBJECT: FIRING PATIENTSNUMBER: III-01500 DATE: 7/1/99REVISION: PAGE: 1 of 1

FIRING PATIENTS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: HOURSNUMBER: III-01600 DATE: 7/1/99REVISION: PAGE: 1 of 1

HOURS: The clinic is open from 8:00 A.M. – 5:00 P.M., Monday through Friday.

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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SECTION: FAMILY PRACTICE CLINICSUBJECT: HOUSE CALLSNUMBER: III-01700 DATE: 7/1/99REVISION: PAGE: 1 of 1

HOUSE CALLS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: INCIDENT REPORTSNUMBER: III-01750 DATE: 7/1/99REVISION: PAGE: 1 of 1

INCIDENT REPORTS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: LABNUMBER: III-01800 DATE: 7/1/99REVISION: 4/16/07 PAGE: 1 of 1

LAB: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: MANAGED CARE PLANSNUMBER: III-01900 DATE: 7/1/99REVISION: PAGE: 1 of 1

MANAGED CARE PLANS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: MEDICAIDNUMBER: III-02000 DATE: 7/1/99REVISION: PAGE: 1 of 1

MEDICAID: The managed care plan of Medicaid requires recipients to identify one physician as

provider. You 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: MEDICARE PATIENTSNUMBER: III-02100 DATE: 7/1/99REVISION: 4/16/07 PAGE: 1 of 1

MEDICARE PATIENTS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: MEDICATIONS AND SAMPLESNUMBER: III-02200 DATE: 7/1/99REVISION: 4/16/07, 6/4/12 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: NURSING HOMESNUMBER: III-02300 DATE: 4/19/01REVISION: 6/9/2009, 5/22/12 PAGE: 1 of 1

NURSING HOME: 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 1st 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 12-12-315, 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: OB CONTINUITY OF CARENUMBER: III-02400 DATE: 7/1/99REVISION: 5/22/12 PAGE: 1 of 1

OB CONTINUITY OF CARE: 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 follow-up 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: OSHA/UNIVERSAL PRECAUTIONSNUMBER: III-02500 DATE: 7/1/99REVISION: PAGE: 1 of 1

OSHA/UNIVERSAL PRECAUTIONS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PATIENT BILLING & COLLECTIONSNUMBER: III-02600 DATE: 7/1/99REVISION: 6/5/12 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 ManagementPost Office Box 4037Jonesboro, AR 72403Phone (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.

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Having your correct insurance information will help prevent future claim problems and potential collection issues.

Patient Financial ResponsibilityInformation 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 FMC-JONESBORO 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 co-payments and deductibles from patients can be considered fraud. Failure on your part to pay 3 or more co-payments could result in termination of coverage. Please help us in upholding the law by paying your co-payment 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

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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.

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 ProcedureNon 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 services1.

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. Self-pay 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

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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.

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

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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:

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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PATIENT ACCOUNT REVIEWNUMBER: III-02700 DATE: 7/1/99REVISION: 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: FAMILY PRACTICE CLINICSUBJECT: PATIENT DISCOUNTSNUMBER: III-02800 DATE: 7/1/99REVISION: 6/5/12 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. Make sure all spaces are complete even if the answer is “none” or “does not apply.”2. Use full legal name for all patients listed. (For example, use “Robert” not “Bob”)3. Gross income or salary means the money you make before any taxes or other deductions are made.4. 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

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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 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PHARMACEUTICAL REPRESENTATIVES AND OTHER

PROFESSIONAL VISITORSNUMBER: III-02900 DATE: 7/1/99REVISION: 5/23/12 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PRE-AUTHORIZATIONSNUMBER: III-03000 DATE: 7/1/99REVISION: 4/16/07 PAGE: 1 of 1

PRE-AUTHORIZATIONS: 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PROCEDURES AND CONSULT REQUESTNUMBER: III-03100 DATE: 7/1/99REVISION: 4/16/07, 5/23/12 PAGE: 1 of 1

PROCEDURES AND CONSULT REQUEST: 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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SECTION: FPC - GeneralSUBJECT: PROFESSIONAL CONDUCTNUMBER: DATE: 7/1/99REVISION: 4/16/07 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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SECTION: FPC - GeneralSUBJECT: PROFESSIONAL CONDUCTNUMBER: DATE: 7/1/99REVISION: 4/16/07 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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SECTION: FAMILY PRACTICE CLINICSUBJECT: PROFESSIONAL COURTESYNUMBER: III-03300 DATE: 7/1/99REVISION: PAGE: 1 of 1

PROFESSIONAL COURTESY: 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: RECORDSNUMBER: III-03400 DATE: 7/1/99REVISION: 4/16/07, 5/22/12 PAGE: 1 of 1

RECORDS: Appropriate documentation of care utilizing the problem oriented medical record system is essential

and an 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: MEDICAL RECORDSNUMBER: III-03401 DATE: 1/05/04REVISION: 6/9/09, 5/22/12 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).

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SECTION: FAMILY PRACTICE CLINICSUBJECT: RESIDENT TEAMSNUMBER: III-03500 DATE: 7/1/99REVISION: 5/22/12 PAGE: 1 of 1

RESIDENT TEAMS: 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: STANDARD OF CARENUMBER: III-03700 DATE: 7/1/99REVISION: 4/16/07 PAGE: 1 of 1

STANDARD OF CARE: 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: STUDENTSNUMBER: III-03800 DATE: 7/1/99REVISION: 2/12/01 PAGE: 1 of 1

STUDENTS: The Family Practice Center serves as a learning laboratory for students interested in a

health 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: TEACHING CORRIDORNUMBER: III-03900 DATE: 7/1/99REVISION: PAGE: 1 of 1

TEACHING CORRIDOR: 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: Use of Clinic DEA NumbersNUMBER: III-02300 DATE: 9/02REVISION: PAGE: 1 of 2

Purpose:To define the policy and procedures for using the DEA number of AHEC Northeast.

DefinitionThe term “patient” refers to persons with whom a resident has established a physician-patient relationship as documented in the medical record.

Policy1. 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 patient2. the drug name, strength, dosage form, quantity prescribed, and directions for use3. resident’s last name printed as well as the signature of the resident4. 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.

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SECTION: FAMILY PRACTICE CLINICSUBJECT: Use of Clinic DEA NumbersNUMBER: III-02300 DATE: 9/02REVISION: 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.

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SECTION: HOSPITALSUBJECT: INTRODUCTIONNUMBER: IV-0100 DATE: 7/1/99REVISION: 4/16/07 PAGE: 1 of 1

INTRODUCTION: 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.

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SECTION: HOSPITALSUBJECT: ADMISSIONSNUMBER: IV-0200 DATE: 7/1/99REVISION: 4/17/07 PAGE: 1 of 1

ADMISSIONS: 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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SECTION: HOSPITALSUBJECT: CALL DUTIESNUMBER: IV-0300 DATE: 7/1/99REVISION: PAGE: 1 of 1

CALL DUTIES: 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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SECTION: HOSPITALSUBJECT: CONSULTSNUMBER: IV-0400 DATE: 7/1/99REVISION: PAGE: 1 of 1

CONSULTS: 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.

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SECTION: HOSPITALSUBJECT: HOSPITAL PRIVILEGESNUMBER: IV-0600 DATE: 7/1/99REVISION: 4/17/07 PAGE: 1 of 1

HOSPITAL PRIVILEGES: 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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SECTION: HOSPITALSUBJECT: MEALSNUMBER: IV-0700 DATE: 7/1/99REVISION: 5/23/12 PAGE: 1 of 1

MEALS: Meals are provided by SBMC for the resident on call through the cafeteria services. The

cafeteria 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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SECTION: HOSPITALSUBJECT: MEDICARE ADMISSIONSNUMBER: IV-0800 DATE: 7/1/99REVISION: PAGE: 1 of 1

MEDICARE ADMISSIONS: 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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SECTION: HOSPITALSUBJECT: NEEDLE STICKNUMBER: IV-0900 DATE: 7/1/99REVISION: PAGE: 1 of 1

NEEDLE STICK: 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.

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SECTION: HOSPITALSUBJECT: OBSTETRICS [LABOR & DELIVERY]NUMBER: IV-01000 DATE: 7/1/99REVISION: 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-callc. Family Practice Faculty Attending

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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 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.

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SECTION: HOSPITALSUBJECT: PATIENT BILLINGNUMBER: IV-01100 DATE: 7/1/99REVISION: 4/17/07 PAGE: 1 of 1

PATIENT BILLING: 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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SECTION: HOSPITALSUBJECT: PROCEDURES DOCUMENTATIONNUMBER: IV-01200 DATE: 7/1/99REVISION: Revised 6/24/09 PAGE: 1 of 1

PROCEDURES DOCUMENTATION: 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.

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https://www.new-innov.com/Login


SECTION: HOSPITALSUBJECT: MEDICAL RECORDSNUMBER: IV-01300 DATE: 7/1/99REVISION: 3/23/04, 5/22/12 PAGE: 1 of 1

RECORDS: All medical records will be kept up-to-date. Histories and physicals are to be completed

at 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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SECTION: HOSPITALSUBJECT: SERVICE RESPONSIBILITIESNUMBER: IV-01400 DATE: 7/1/99REVISION: 6/1/09 PAGE: 1 of 4

SERVICE PROTOCOLS: 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.

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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.

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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.

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SECTION: HOSPITALSUBJECT: SERVICE RESPONSIBILITIESNUMBER: IV-01400 DATE: 7/1/99REVISION: 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.

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SECTION: HOSPITALSUBJECT: TRANSFER OF CARE/HAND OFF OF PATIENTSNUMBER: IV-01450 DATE: 7/19/12REVISION: 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

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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

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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SECTION: HOSPITALSUBJECT: UNASSIGNED PATIENTS AND TRANSFERSNUMBER: IV-01500 DATE: 7/1/99REVISION: 02/10/2010, 7/15/12 PAGE: 1 of 1

UNASSIGNED PATIENTS: 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.

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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:

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.

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SECTION: HOSPITALSUBJECT: AFFILIATED HOSPITAL AUTOPSY POLICYNUMBER: IV-01550 DATE: 10/23/00REVISION: 4/17/07 PAGE: 1 of 2

AFFILIATED HOSPITAL AUTOPSY POLICY: NEA Medical Center out source their autopsies.

St. Bernards Medical Center: see below copied from their policy manual.

Rule Twenty: AutopsiesPage(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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SECTION: HOSPITALSUBJECT: AFFILIATED HOSPITAL AUTOPSY POLICYNUMBER: IV-01550 DATE: 10/23/00REVISION: 4/17/07 PAGE: 2 of 2

AFFILIATED HOSPITAL AUTOPSY POLICY: St. Bernards Medical Center: see below copied from their policy manual.

Rule Twenty: AutopsiesPage(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 delegatedresponsibility 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 hospitalo Death unexpected or unexplained following procedureo Death was obstetrics deatho Death of neonate or pediatric patient when cause of death is unknown

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