POF
Serious Mental illness (SMI)
Is postpartum a stand alone POF?
No (only within 12 month and meets ethnic group for BE)
How many days do you have to collect TOCs?
7 days
What is the smart phrase for a PHQ 18?
CMTPHQ15
patients goal is "I want to really work on my physical exercise" is this a SMART goal?
No, a good smart goal
I will increase my activity by using stationary bike from 8 minutes 3x/wk to 10minutes 4-5x/wk over the next 2 months
What are two substances not considered as substance use disorder (SUD)?
Tobacco, Marijuana
No
At what frequency should a PHQ9 with a score 10 be collected?
Every Month
What do you need to do and document for a patient who said yes to question 9 on PHQ 9
document using smart phrase CMTPHQSI, warm transfer to BH
When should you send out Disengagement letter?
Black, American Indian, Alaska Native, Pacific Islander
Is California Children Services by itself a POF?
No, there has to be an SDOH
What assessments require a Cosigner?
Reauthorization, CHA, Action Plan, and LTSS
When should the Action Plan be updated?
Annually or if there is any significant health/life (SDOH) changes
I have 3 goals in one ECM template, is that correct?
No, each goal needs to be in its own ECM template
Is Intellectual or Developmental Disability a POF?
No
What Counties apply to Justice Involved?
SBC and Riverside County
What is the minimum BP reading, that would require a monthly follow up?
140/90
Patient states blood pressure is 180/120 and is experiencing symptoms, What do you need to do and document for patient?
Warm transfer to RN, Document using smart phrase CMTBPCRITICAL
When should the Care Gaps be addressed?
During every call
What are the qualifications for High Utilizer?
frequency of ER and inpatient stays
Up to what age is Child Welfare a POF?
26
How soon can the Reauthorization be submitted?
60 days prior to authorization end date
How long should you wait to contact enrollment specialist when screening form is still pending?
48-72 hours
What should you do when goal is complete?
re evaluate the patient if there is any other barrrriers and create a new goal or graduate patient if no longer facing barriers