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Now You can Purchase Individual Files for your DPC Office!

For your convenience we have provided the option for you to purchase individual files as you need them. To purchase a file, simply click on the link for the document you require and you will be redirected to the store where you can make your purchase.

  1. Compliance Policies and Procedures Chapter

    1. Compliance Policies and Procedure Chapter Introduction

      1. About CDC Policies and Procedures 

  1. Vaccine Storage and Handling Policy and Procedure
  2. Vaccine Administration Policy
  3. Vaccine Catch-Up Schedule
  4. DtapForm 
  5. Gardasil Form
  6. Hepatitis A Form
  7. Hepatitis B Form
  8. Hib Form
  9. Influenza Form
  10. IPV Form
  11. MMR Form
  12. Menactra Form 
  13. PCV-13 Form
  14. PCV-23 Form
  15. Tdap Form
  16. Varicella Form
  17. Zoster Form
  18. PPD Form
  19. Other Form

  1. About CLIA Policies and Procedures

 

  1. CLIA Policy and Procedure
  2. Tests Granted Waived Status Under CLIA

  • About Employee Policies and Procedures

 

  1. Amendment to Employment Contract
  2. Contents of Employee File
  3. Employee Exit Checklist
  4. Employee Handbook Table of Contents
  5. Employee Handbook
  6. Employee Offer Letter
  7. Employment Contract Medical Assistant
  8. Employment Contract for Physician
  9. Medical Administrative Assistant Job Description
  10. Medical Assistant Job Description
  11. Medical Office Manager Job Description
  12. Nonsolicitation, Nondisclosure, and Confidentiality Agreement

**Best Practices (CMA)—see link in iii. About Employee Policies and Procedures**

 


  1. About HIPAA Policies and Procedures
  1. Privacy Policies:
    1. Patient Access to Protected Health Information
    2. Accounting of Disclosures
    3. Amendment of Health Information
    4. Business Associates
    5. Individual Right to Request Confidential Communication
    6. De-Identification
    7. Designated Record Set
    8. Designation of Privacy Officer and Contact Person/Office
    9. Destroying/Disposal of PHI
    10. Privacy and Security Standards Training
    11. Minimum Necessary-Use/Disclosure of PHI
    12. Mitigation
    13. Use of Multi-Media
    14. Notice of Privacy Practices for Protected Health Information
    15. Personal Representatives
    16. Privacy Complaints and Inquiries
    17. Privacy Officer Job Description
    18. Record Retention and Documentation
    19. Release of Information-Authorization
    20. Restriction on Use and Disclosure of PHI
    21. Sanctions
    22. Uses & Disclosure of PHI Permitted
  2. Security Policies:
    1. Assigned Security Responsibility
    2. Breach Notification
    3. Contingency Plan
    4. Disaster Recovery Plan
    5. Encryption
    6. Facility Access
    7. Information System Activity Review
    8. Information Systems Access Policy
    9. Internet and Email Usage and Monitoring
    10. Remote Access
    11. Risk Management
    12. Security Incident Reporting Procedure
    13. Security Management Process
    14. Security Officer Description
    15. Transmission Security Mobile Device Policy
    16. User IDs & Security Codes
    17. Verification of Identity and Authority
    18. Workstation Usage and Monitoring
  3. Forms:
    1. Acceptance of Request for Access to PHI
    2. Amend Accept Letter Template
    3. Amend Denial Letter Template
    4. Amend Extension Letter Template
    5. Amend Response to Denial
    6. Request for Amendment/Correction of PHI
    7. Authorization to OBTAIN Health Information
    8. Authorization to RELEASE Health Information
    9. Business Associate Agreement
    10. Computer and Electronic Media Disposal Log
    11. Denial of Request for Access to PHI
    12. Disclosure Tracking Log
    13. Employee Access List
    14. Facility Repair/Maintenance Log
    15. Hardware Tracking Log
    16. Multi-Media Request Form
    17. Non-Employee Access List
    18. Notice of Privacy Practices
    19. Privacy and Security Policies Acknowledgement for Officers
    20. Privacy and Security Policy Training Checklist
    21. Patient Privacy Complaint Report Form
    22. Request for an Accounting of Disclosures
    23. Request for Confidential Communication of PHI
    24. Request for Remote Access Form
    25. Request to Access, Inspect, and Copy PHI
    26. Security Incident Report
    27. Vendor/Visitor Sign-In Log
  4. Training:
    1. Protecting Privacy and Security of Health Information (Power Point)
    2. Protecting Privacy and Security of Health Information-Post test
  5. Risk Assessments:
    1. Risk Analysis and Management Tool/Electronic Devices and Systems
    2. Assessment/Privacy Walk-Through Check List
    3. Security Standards Checklist
  6. BAA Facts
  7. What is a BAA?

 


  1. About OSHA Policies and Procedures

 

  1. OHSA Compliance Manual (please reference the page numbers for the policies and procedures below; they are not lettered)
    1. BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN (p.1)
    2. BLOODBORNE PATHOGENS EXPOSURE CONTROL POLICY (p.11)
    3. OSHA COMPLIANCE ANNUAL CHECKLIST (p.15)
    4. SHARPS SAFETY DEVICES TRIALED YEAR (p.17)
    5. SHARPS DEVICE EVALUATION FORM (p.18)
    6. SHARPS SAFETY SURVEY CHECKLIST (p.19)
    7. INFORMED CONSENT FOR HEPATITIS B VACCINE (p.20)
    8. INFORMED REFUSAL FOR HEPATITIS B VACCINE (p.21)
    9. OCCUPATIONAL EXPOSURE INJURY/INCIDENT REPORT (p.22)
    10. FOLLOW-UP TO EXPOSURE/INJURY/INCIDENT REPORT (p.23)
    11. JOB RISK DETERMINATION FORM (p.24)
    12. EXPLANATION OF AND CONSENT OR DECLINE FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND HEPATITIS B VIRUS TESTING OF SOURCE INDIVIDUAL FOLLOWING EMPLOYEE EXPOSURE (p.25)
    13. PHYSICIANS/INFORMANT’S CERTIFICATION (p.26)
    14. EMPLOYEE HEALTH HISTORY (p.27)
    15. EMPLOYEE INFORMED REFUSAL OF POST EXPOSURE MEDICAL EVALUATION (p.28)
    16. SUMMARY LOG OF OCCUPATIONAL PERCUTANEOUS SHARPS INJURIES (p.29)
    17. WORK RELATED SHARPS INJURY STATISTICS (p.30)
    18. BLOODBORNE PATHOGENS STANDARD PRE-TEST (p.31)
    19. BLOODBORNE PATHOGENS STANDARD POST-TEST (p.32)
    20. HAZARD COMMUNICATION PLAN (p.35)
    21. HAZARD COMMUNICATION POLICY (p.37)
    22. HAZARD COMMUNICATION STANDARD PICTOGRAM (p.46)
    23. LISTING OF HAZARDOUS CHEMICAL SUBSTANCES (p.47)
    24. EMPLOYEE INFORMED REFUSAL OF POST ACCIDENT/INJURY- (NON-PATHOGEN EXPOSURE) (p.48)
    25. EMPLOYEE INITIAL AND REFRESHER TRAINING – BLOODBORNE PATHOGENS AND HAZARD COMMUNICATION (p.49)
    26. ELECTRICAL SAFETY CONTROL PLAN (p.50)
    27. ELECTRICAL SAFETY POLICY (p.51)
    28. MONTHLY ELECTRICAL HAZARD INSPECTION CHECKLIST (p.53)
    29. ERGONOMICS CONTROL PLAN (p.54)
    30. ERGONOMICS POLICY (p.55)
    31. GENERAL ERGONOMICS RISK FACTOR CHECKLIST (p.59)
    32. EMPLOYEE ERGONOMIC INJURY RISK ASSESSMENT SURVEY (p.60)
    33. ERGONOMIC SAFETY SURVEY RESULTS (p.62)
    34. WORKPLACE VIOLENCE CONTROL PLAN (p.63)
    35. VIOLENCE IN THE WORKPLACE POLICY (p.64)
    36. WORKPLACE VIOLENCE SURVEY (p.69)
    37. VIOLENCE IN THE WORKPLACE SURVEY RESULTS (p.71)
    38. VIOLENCE IN THE WORKPLACE ASSESSMENT (p.72)
    39. WORKPLACE VIOLENCE INCIDENT REPORT (p.76)
    40. TUBERCULOSIS EXPOSURE CONTROL PLAN (p.77)
    41. TUBERCULOSIS EXPOSURE CONTROL POLICY (p.84)
    42. EMPLOYEE PPD TESTING FORM (p.94)
    43. EMPLOYEE TB EXPOSURE POTENTIAL AND RISK DETERMINATION FORM (p.95)
    44. EMPLOYEE TB EXPOSURE POTENTIAL AND RISK DETERMINATION (p.97)
    45. TB OCCUPATIONAL EXPOSURE INJURY/INCIDENT REPORT (p.98)
    46. EXPLANATION OF AND CONSENT OR DECLINE FOR TB TESTING OF SOURCE INDIVIDUAL FOLLOWING EMPLOYEE EXPOSURE (p.99)
    47. PRACTICE TB RISK DETERMINATION FORM (p.100)
    48. PRACTICE TB RISK DETERMINATION CRITERIA FORM (p.101)
    49. TB STANDARD POST TRAINING PROGRAM TEST (p.104)
    50. TB PRE/POST TRAINING TEST ANSWER KEY (p.106)
    51. EMPLOYEE INITIAL AND REFRESHER TRAINING RECORD- MYCOBACTERIUM TUBERCULOSIS TRAINING (p.107)
    52. NEW REPORTING REQUIREMENTS (p.109)
  2. Biohazard Material (Blood or OPIM) Clean Up Policy and Procedure
  3. Chemical Biohazard Spill Policy and Procedure
  4. Emergency Action Plans for Fire (R.A.C.E.), Water, Severe Weather, Chemical Spills
  5. Emergency Action Plans/R.A.C.E Training Program Test
  6. Example of Personal Protective Equipment Requirements
  7. Example of Safety Data Sheets
  8. Fire/Emergency Evacuation Policy and Procedure including R.A.C.E.
  9. Medical Emergency Policy and Procedure
  10. OSHA Audit Policy and Procedure
  11. Protocol for an Allergic Reaction
  12. Storage of Disposable Equipment Policy and Procedure
  13. Suggested Emergency Kits/Carts Contents

 


  1. Intra-Office Workflow Policies and Procedure Chapter

 1. Intra-Office Workflow Policies and Procedure Chapter Introduction

 

  1. Ancillary Billing Policy and Procedure
  2. Ancillary Billing Sheet (ABS)
  1. Asthma Action Plan
  2. Beginning and End of Day Checklist Policy and Procedure for Staff
  3. Consent to Medical/Surgical Office Procedure
  1. Helpful Tips Document for Patients (pdf/not numbered)
  2. How to Enter Medication Inventory Policy and Procedure
  3. Influenza Consent
  1. Medication Sample Dispensing Log
  1. Policy and Procedure for Scheduling Patients

 

III.  Physician Workflow Policies and Procedures Chapter

 

  1. Physician Workflow Policies and Procedures Chapter Introduction

 

  1. Against Medical Advice Acknowledgement and Waiver
  2. Communication Between PCP and Behavioral Health Specialist Policy and Procedure
  1. Daily Work-Flow Policy and Procedure
  2. Dispensary Policy and Procedure
  3. Informed Consent for Opioid Therapy
  1. Medication Policy for Direct Primary Care with PA Regulations
  2. New Patient Enrollment Policy and Procedure (General)
  3. New Patient Enrollment Policy and Procedure (GHFHC)
  1. Patient Agreement, Communication Consent and Combined Acknowledgment and Consent
  1. Patient Visit Sheet (PVS)

 

**Opioid Abuse Screening Tool/SOAPP Version 1.0-14 Q link (ACTUAL FORM NOT IN THIS MANUAL, MUST GO TO LINK BELOW TO DOWNLOAD)** https://cabhp.asu.edu/sites/default/files/reiter-screening.pdf

 

  1. Templates for Correspondence Chapter

 

  1. Templates for Correspondence Chapter Introduction

 

  1. 48 Hours for Administrative Issues
  2. Abnormal Labs
  • Against Medical Advice
  1. Cancellation of Membership by Patient (1.) and by Physician (2.)
  2. Cancellation of Membership Prior to End of 6 Month Term
  3. Chart Transfer
  • Consultant Follow Up
  • Disclaimer for Emails/Text Messages
  1. Failed Payment #1
  2. Failed Payment #2
  3. Failed Payment #3
  • Fax Cover Sheet
  • Follow Up on Recent Illness #1
  • Follow Up on Recent Illness #2
  1. Immunization Follow Up
  • Late Cancellation/Missed Appointment
  • Letter to Patients/DPC Transition #1
  • Letter to Patients/DPC Transition #2
  • Letter to Patients/DPC Transition #3
  1. Letter to Patients/DPC Transition #4
  • Mammogram/Breast Ultrasound Results
  • Medication Ready for Pick Up
  • Medication Refill(s)
  • Monthly Charity Letter
  • New Patient Enrollment/Welcome Email
  • Normal Lab/Imaging Results
  • Open Enrollment Letter
  • Overdue for Office Visit/30 Day Supply of Meds
  • Patient Discharge Letter for Non-Payment
  • Potential Patient Inquiry Form
  • Prescription Ready
  • Receipt of Old Records
  • Templates for Emails Requesting Online Reviews from Patients

 

  1. Advertising Examples for Direct Primary Care

 

  1. Advertising Examples for Direct Primary Care Introduction

 

  1. 2016 Cost Savings Data from GHDFC
  2. Case Study: Medicare Cost Savings for Medications
  • Cost Savings Case Studies
  1. Dear Small Business Owner
  2. DPC Coupled with Insurance
  3. DPC Power Point for Patient Town Hall Meeting (not lettered)
  • DPC Power Point for Chamber of Commerce/Businesses (not lettered)
  • Employer Town Hall Announcement
  1. Facebook Case Studies #1
  2. Facebook Case Studies #2
  3. GHDFC Letterhead (not lettered)
  • Letter to Health Sharing Ministries
  • Letter to Patients Requesting Permission to Share Online Office Review
  • Medically Informative Posts (MIP’s) for social media/bulk emails to patients
  1. Patient Appreciation Events
  • Presentation Supporting State DPC Legislation
  • Published Articles About DPC
  • Generic Medication Cost Comparison Table

Marketing Contents for GHDFC Patient Welcome Folder

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