| (B) The program physician or an appropriately trained health care professional supervised by the admitting program physician shall consider data obtained from the transferring program that verifies the amount of time the patient has spent satisfactorily adhering to the eight criteria found in subsections (i)(1)(A)-(H) of this section in determining if the patient may continue the same frequency of clinic attendance permitted at the former program immediately before transferring to the new program. (C) The program physician shall not allow the patient to attend the clinic less frequently than the most recent schedule allowed at the former program unless: (i) copies of the patient's records are obtained to sufficiently document the patient's satisfactory adherence to federal and state regulations for the required time in treatment; and (ii) the physician has completed an evaluation of the patient that includes consideration of the eight criteria in subsections (i)(1)(A)-(H) of this section and the additional criteria for attendance as found in 42 CFR, §8.12(i). (D) At a minimum, an agent of the practitioner from the admitting program shall document in the patient file and an agent of the practitioner from the transferring program must provide the following information before the initial dose of narcotic drug is administered to a transfer patient: (i) the last date and amount of narcotic drug administered or dispensed at the former program; (ii) the length of time in continuous treatment; (iii) the most recent record of clinic attendance; (iv) the name, address, and telephone number of the program contacted; (v) the date and time of the contact; and (vi) the name of the program employee furnishing the information. (E) Medical records. (i) Patients who have had a physical examination and laboratory tests within the past three months may be admitted without a new physical examination and laboratory tests, unless the program physician requests it. The admitting program shall obtain copies of these results within 15 days of admission. If records are not obtained within 15 days, the program shall consider the patient a new patient and fulfill the minimum standards for admission. (ii) The transferring program must supply patient medical records necessary to fulfill the requirements of paragraph (5)(B)-(D) of this section in response to a written request from the patient. The program shall furnish copies of medical records requested, or a summary or narrative of the records, including records received from a physician or other health care provider involved in the care or treatment of the patient, pursuant to a written consent for release of the information as provided by subparagraph (A) of this paragraph, except if the physician determines that access to the information would be harmful to the physical, mental, or emotional health of the patient, and the program may delete confidential information about another patient or family member of the patient who has not consented to the release. The information shall be furnished by the program within 15 days after the date of receipt of the request. If the program denies the request, in whole or in part, the program shall furnish the patient a written statement, signed and dated, stating the reason for the denial. A copy of the statement denying the request shall be placed in the patient's record. (F) Fees. The transferring program responding to a request for medical records shall be entitled to receive a reasonable fee for providing the requested information. A reasonable fee shall be a charge of no more than $25 for the first 20 pages and $.15 per page for every page thereafter. In addition, a reasonable fee may include actual costs for mailing, shipping, or delivery. The program providing copies of requested medical records or a summary or a narrative of such records shall be entitled to payment of a reasonable fee prior to release of the information, unless the information is requested by a licensed Texas health care provider for purposes of emergency or acute medical care. In the event the program receives a proper request for copies of medical records or a summary or narrative of the medical records for purposes other than for emergency or acute medical care, the program may retain the requested information until payment is received. In the event payment is not routed with such a request, the program shall notify the requesting party in writing of the need for payment and may withhold the information until payment of a reasonable fee is received. A copy of the letter regarding the need for payment shall be made part of the patient's medical record. Medical records requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agent, or the patient's designated recipient for such records based on a past due account for medical care or treatment previously rendered to the patient. (6) For record keeping purposes, if a patient misses appointments for two weeks or more without notifying the clinic, the episode of care is considered terminated and is to be so noted in the patient's record. An exception determination would be in circumstances where the patient can provide documentation of continuation of care. The documentation must be maintained in the patient's record. This does not mean that the patient cannot return for care. If the patient does return for care and is accepted into the program, the patient is considered a new patient and is to be so noted in the patient's record. Cumulative time spent by the patient in treatment is counted toward the number of years of treatment, provided there has not been a continuous absence of 90 days or more. (7) Dual enrollment. There is a danger of drug dependent persons attempting to enroll in more than one NTP to obtain quantities of drugs for the purpose of self-administration or illicit marketing. Therefore, drugs shall not be provided to a patient who is known to be currently receiving drugs from another treatment program without prior approval from the SMA. Patients who are known to be enrolled in more than one NTP at a time will be forced to choose one clinic for treatment. That patient must then begin treatment as a completely new patient, including attending the clinic on a daily basis or a minimum of six days per week, for a period of six months. (8) Medical Evaluation. Each patient is required to have a medical evaluation by a program physician or an authorized health-care professional under the supervision of a program physician on admission to a program. A patient is required to have a face-to-face meeting with the program physician no later than one week after admission. A patient readmitted within three months after discharge does not require a repeat physical examination unless requested by the program physician. The admission medical evaluation must be documented in the patient's record and shall include at a minimum: (A) a medical history including the required history of opiate dependence; (B) evidence of current physiologic and/or psychologic dependence unless excepted under sections (e)(3)(A)-(D); (C) investigation of the organ systems for possibilities of infectious disease, pulmonary, hepatic, and cardiac abnormalities, and dermatologic sequelae of addiction; (D) examination of the patient's general appearance, head, ears, eyes, nose, throat (thyroid), chest (including heart, lungs, and breasts), abdomen, extremities, skin, and neurological assessment; (E) determination of the patient's vital signs (temperature, pulse, blood pressure, and respiratory rate); and (F) the program physician's overall impression of the patient. (9) Intradermal tuberculosis test. (A) Programs shall follow the Mantoux technique, using 0.1 ml of purified protein derivative (PPD) tuberculin containing five tuberculin units (TU) injected into the volar surface of the forearm. (B) Reaction to the Mantoux test shall be read by a trained health care worker 48 to 72 hours after the injection. (C) Results should be recorded in millimeters (mm) in the patient's record. (D) Patients who had negative tuberculin skin tests on admission must be retested each year and results recorded in the patient's record. (E) Patients with a positive skin test must have further diagnostic evaluation as designated by the Centers for Disease Control and Prevention (CDC). (F) Documented verification of follow-up on all patients referred for tuberculosis evaluation must be placed in the patient's record. (G) Patients with previously positive PPD shall not be retested. The program shall obtain verification of diagnostic evaluation and therapeutic follow-up, including preventive treatment or treatment of tuberculosis. The patient shall be referred for further evaluation if disposition cannot be verified. Documentation of the above shall be placed in the patient's record. Cont'd... |
