Common use of Core Competencies Clause in Contracts

Core Competencies. Imaging will provide the following core services: • Routine x-Ray, Fluoroscopy, MRI, CT, US, Mammography and Bone Densitometry • Consultative services for Imaging related questions • Interventional Imaging (biopsies)Equipment and Ultrasonographer to assist Perinatalogist in providing advanced OB services • Imaging will provide basic HSG supplies Women’s Health will provide the following core services: • Appropriate and necessary exam and work-up of medical conditions prior to ordering of radiology procedures • Radiology Order Entry (XXX); compete pertinent clinical history, correct exam, ordering provider • Patient is given appropriate prep instructions / date and time • Schedule of ultrasound in the PCC and Mammograms in PCC and hospital • Contact the Ultrasonographer when same day appointments are requested • Case Manager from Women’s Health will accompany patients for HSG • Women’s Health will supply staff and additional equipment as needed Access Agreements Imaging will provide the following access: • All patients will be offered an appointment within one day for any urgent or emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. Women’s Health will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access for any outpatient consult • Continuity appointments offered within 5 days for a clinic appointment • Surgery offered within 10 days Consultation /Treatment Process • Ordering provider or support staff will call Imaging at x 2300 for scheduling outside Signature • Women’s Health schedules directly into the Signature package for appointments at the PCC US and all Mammograms • Ordering provider or support staff initiates and completes XXX • Name of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram Communication Process • Results of requested Imaging procedures will be sent back to ordering provider via e-mail with specific follow up recommendations when indicated • Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system Consultation / Treatment Guidelines (for each referral guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBG) o After CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet • Ultrasound • Fluroscopy • CT • MRI • Diagnostic Mammogram • Screening Mammogram • Bone Densitometry

Core Competencies. Imaging Pediatrics will provide the following core services: • Routine x-RayNewborn circumcisions on newborn male infants in the Special Care Nursery, Fluoroscopyand those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, MRI, CT, US, Mammography with consultation by a OB/GYN as appropriate • Collaborative management of pediatric patients admitted to the h ospital with gynecological problems • Availability to attend deliveries and Bone Densitometry Cesarean sections as requested • Consultative services for Imaging related questions Prenatal consultation • Interventional Imaging (biopsies)Equipment and Ultrasonographer to assist Perinatalogist in providing advanced OB services • Imaging will provide basic HSG supplies Women’s Health will provide the following core services: • Appropriate Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History and necessary exam Physical has been performed by Pediatrics and workthey have been cleared for surgery • Primary Obstetric management of all pregnancy teenagers during their pregnancy • Same day consults on inpatient pediatric patients with gynecological problems by on-up of medical conditions prior to ordering of radiology procedures • Radiology Order Entry (XXX); compete pertinent clinical history, correct exam, ordering call provider • Patient is given appropriate prep instructions / date Evaluation and time • Schedule management of ultrasound in the PCC any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and Mammograms in PCC and hospital • Contact the Ultrasonographer when same day appointments are requested • Case Manager from Women’s Health will accompany patients for HSG • Women’s Health will supply staff and additional equipment as needed other gynecological endocrine problems. Access Agreements Imaging Pediatrics will provide the following access: • All patients will be offered an appointment within one Same day access by on-call Doctor for any urgent or emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access by on-call Doctor for any outpatient consult urgent patients referred from Pediatrics • Continuity appointments offered Appointments within 5 days for a clinic appointment • Surgery offered within 10 days Consultation /Treatment routine referrals Communication Process • Ordering provider or support staff will call Imaging at x 2300 for scheduling outside Signature • Providers in Pediatrics and Women’s Health schedules directly into will use the Signature package ANMC Referral and Consultation Form to communicate requests for appointments at services between clinics. Providers agree to respond as requested on the PCC US referral and all Mammograms • Ordering provider or support staff initiates consultation form. Verbal and completes XXX • Name email communication between departments is encouraged to ensure continuity of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram Communication Process • Results of requested Imaging procedures will be sent back to ordering provider via e-mail with specific follow up recommendations when indicated • Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system care. Consultation / Treatment Guidelines guidelines (for each referral consultation guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBGCBG) o After CCBG CBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet Intranet Quality Assurance Agreements • Ultrasound Service agreements will be reviewed, updated and approved bi-annually with final approval by the SCF VP of the Medical Services Division. • Fluroscopy Training and education needs can be requested by either service. Each service is responsible for responding in a timely manner. • CT • MRI • Diagnostic Mammogram • Screening Mammogram • Bone DensitometryQuality review of the system will occur on a regular basis. Metrics to include: o % of time guidelines are met o % of time processes are followed o % of time adequate information is provided to consultant clinic o % of time adequate information is provided to referring clinic o % of time appointment is booked using the phone process o % of dictation consultation summary received Xxx Xxxxxxx, M D Xxxxxx Xxxxxxx, M D Signature of Women’s Health Medical Director Signature of Family Medicine Medical Director Xxxx Xxx, MD, MPH

Core Competencies. Imaging Surgery will provide the following core services: • Routine xTreatment and complex work-Rayup of a surgical diagnosis and surgical intervention for outpatients • Admission, Fluoroscopywork-up, MRIsurgical intervention and management of hospitalized Pediatric patients • Non-cardiac thorasic surgeries Lower • GI Endoscopy for pediatric patients • Upper GI Endoscopy for patients over the age of 10. For patients under the age of 10 a phone consult is required, CT, US, Mammography should go to Pediatric GI specialist. • Post-operative pain management as appropriate for the surgical procedure and Bone Densitometry patient (to be dictated into the post-op note and discharge note) • Consultative Surgical intervention and post-op management of patients with pyloric stenosis • Maintain relationships with Pediatric surgery consultant services in the community • Follow PICU agreements as developed through the Peds ICU committee for Imaging related questions • Interventional Imaging (biopsies)Equipment admission and Ultrasonographer to assist Perinatalogist in providing advanced OB services • Imaging will provide basic HSG supplies Women’s Health management guidelines Pediatrics will provide the following core services: • Appropriate Diagnosis and necessary exam and initial work-up of a surgical diagnosis based on referral guidelines • Pre-operative medical clearance for high risk patients • Pediatric hospitalists and pediatric intensivists will provide inpatient care to children when requested by general surgeons. • Pediatric consultations will be provided to pediatric surgical patients when requested by surgeons • Pediatric hospitalists and pediatric intensivists will co-manage pediatric patients when requested by surgeons • I and D of superficial abscesses below the neck • Maintain Pediatric sub-specialty consultant services in the following areas: • Pulmonology • Cardiology • GI • Nephrology • Neurology • Neonatology • Referrals will be made directly to the Pediatric Surgeon for the following conditions: • Neonatal surgical conditions prior • Hirschprung's disease • Pediatrics will develop and maintain pre-printed orders for pain management of hospitalized pediatric patient appropriate for age and weight of patient • Pediatrics will, on a daily basis, maintain familiarity with surgical patients on the Pediatrics xxxx (through discussion with the charge nurse) and will convey any concerns to ordering of the staff surgeon • Pediatrics staff will participate in all pediatric trauma codes as specified per trauma multidisciplinary guidelines and participation agreements • Sedation and monitoring for radiology procedures requiring sedation if non-intubated • Radiology Order Entry (XXX); compete pertinent clinical history, correct exam, ordering provider Evaluation and management of patients with possible pyloric stenosis • Patient is given appropriate prep instructions / date Evaluation and time admission of patients with potential neurosurgical problems such as shunt malfunction • Schedule of ultrasound in Pediatric outpatient and inpatient consultations will be provided to pediatric surgery patients when requested by the PCC and Mammograms in PCC and hospital Surgeon • Contact the Ultrasonographer when same day appointments are requested • Primary Care Provider and/or Case Manager from Women’s Health will accompany make social rounds to admitted patients for HSG • Women’s Health will supply staff and additional equipment as needed at least once during the admission Access Agreements Imaging Surgery will provide the following access: • All patients will be offered an appointment within one day for any problem • All patients requiring an operating room surgical intervention will be offered an OR time within 5 days of that determination • Immediate access for urgent or and emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. Women’s Health conditions • Inpatient consultation at any time Pediatrics will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access offered for all Pediatrics patients who can schedule by 4:00 p.m. and arrive in the clinic by 4:30 p.m. Monday - Friday • Evenings between 5:00 p.m. – 8:00 p.m. and Saturdays between 8:30 a.m. and 4:30 p.m. the clinic is staffed with one provider who covers the practice for customer convenience and urgent needs for customers who can schedule by 7:00 p.m. and arrive by 7:30 p.m. in the evenings and customers who can schedule by 4:00 p.m. and arrive by 4:30 on Saturdays • Inpatient consultation at any outpatient consult time Consultation / Treatment Process Outpatient • Continuity appointments offered within 5 days for a In order to avoid delays referring clinic appointment agrees to use the standard ANMC evaluation and consultation process • Surgery offered within 10 days Consultation /Treatment Process 8:30 a.m. – 4:30 p.m. use standard ANMC evaluation and consultation process (see flowchart) • Ordering 4:30 p.m. – 8:30 a.m. fax /scan evaluation and consultation form to Surgery/Peds Inpatient • Use standard consultation process as defined in the Medical Staff By-laws o Provider to provider or support staff will call Imaging at x 2300 for scheduling outside Signature • Women’s Health schedules directly into the Signature package for appointments at the PCC US and all Mammograms • Ordering provider or support staff initiates and completes XXX • Name of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram contact o Write order Communication Process • Results Pediatrics will identify patients who have complex issues such as, medical, logistical or social issues, when sending a consult • Dictated summary of requested Imaging procedures consults, hospitalization & surgery, outlining findings and recommendations for care on all patients to include pain management and anticipated follow-up. Send cc to PCP. • Surgery will notify the patient’s Primary Care Provider during the time of an admission to Surgery Service or within 48-72 hours of a surgical procedure. • Home Based Services (HBS): in the event a post-op patient requires HBS, Surgery personnel will be sent back responsible for referring the patient to ordering provider via ethe HBS team. This includes completing the necessary paperwork for prescriptions, equipment and nursing orders. Surgery will authorize the transfer of care to the Primary Care Provider in accordance to the MCD/MCR guidelines. • Post-mail op wound care: Surgery will communicate post-op wound care needs with specific follow the patient. If the patient requires assistance with their wound care, the Surgery clinic personnel will arrange for appropriate follow-up recommendations when indicated • Post-op pain management: Surgery will manage the post-op pain for the expected post-op recovery time. In the event the patient requires pain management beyond the anticipated recovery period, the Surgeon will communicate the patient’s status with the Primary Care Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system transfer of care. • Pediatric outpatient consultations will be provided to pediatric surgery patients when requested by the Surgeon by contacting a Case Manager at x4025 Consultation / Treatment Guidelines (for each referral guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBG) o After CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet o Surgery will participate in the Peds ICU committee • Ultrasound Clinical guidelines: Surgery Pediatrics • Fluroscopy Breast disease • CT Colonoscopy • MRI EGD • Diagnostic Mammogram GERD • Screening Mammogram Hernia • Bone DensitometrySkin and sub-cutaneous nodules • Thyroid nodules • Cholelithiasis • Pediatric admit / Post operative orders • Sedation for painful procedures • Sedation for non-painful procedures • Pain management and PCA Quality Assurance Agreements • Service agreements will be reviewed, updated and approved bi-annually with final approval by the SCF VP of the Medical Services Division and the ANMC Administrator. • Training and education needs can be requested by either service. Each service is responsible for responding in a timely manner. • Quality review of the system will occur on a regular basis. Metrics to include: o % of time guidelines are met o % of time processes are followed o % of time adequate information is provided to consultant clinic o % of time adequate information is provided to referring clinic o % of time appointment is booked using the phone process o % of dictation consultation summary received Xxxxx Xxxxx, MD Xxx Xxxxxxxxxx, MD_________ Signature of Surgery Medical Director Signature of Pediatrics Outpatient Medical Director Xxxxxxxx Xxxxx, MD__________ Signature of Pediatrics Inpatient Medical Director Xxxxxxx Xxx, MD MHP Xxx Xxxxxxxxx, RN___________

Core Competencies. Imaging Urology will provide the following core services: • Routine xTreatment and complex work-Ray, Fluoroscopy, MRI, CT, US, Mammography up of urologic surgical diagnosis and Bone Densitometry surgical intervention • Consultative Consultation for urologic conditions as per referral guidelines • Phone or email consultative services for Imaging Urologic related questions by contacting on-call Urologist • Interventional Imaging Immediate evaluation of Pediatric urologic emergencies such as testicular torsion or paraphimosis • Pediatric urology subspecialist clinic and surgical care two times a year • Post-operative pain management as appropriate for the surgical procedure and patient (biopsies)Equipment to be dictated into the post-op note and Ultrasonographer to assist Perinatalogist in providing advanced OB services discharge note) • Imaging Urology will provide basic HSG supplies Women’s Health use pre-printed orders for pain manamgnet of hospitalized pediatric patient appropriate for age and weight of patient Pediatrics will provide the following core services: • Appropriate Pediatric consultations will be provided to pediatric urological patients when requested by urologists • Pediatric hospitalists and necessary exam and workpediatric intensivists will co-up manage pediatric patients when requested by urologists • Initial conservative management of medical simple urologic conditions prior listed but not limited to: • Balanitis • Epididymitis/Orchitis • Epididymal mass • Hematuria • Hydrocele • Nephrolithiasis • Pyelonephritis • Scrotal Mass • Undescended Testicle • Urinary Incontinence • Urinary tract infections • Hydronephrosis (to ordering of radiology procedures be developed) • Radiology Order Entry Hypospadius (XXX); compete pertinent clinical history, correct exam, ordering provider to be developed) • Patient is given appropriate prep instructions / date and time Abdominal mass (to be developed) • Schedule of ultrasound in the PCC and Mammograms in PCC and hospital • Contact the Ultrasonographer Outpatient pediatric consultations will be provided to pediatric patients when same day appointments are requested • by Urology physicians by contacting Case Manager from Women’s Health at x4025 • Inpatient consultations will accompany be provided following the standard referral process • Pediatrics will, on a daily basis, maintain familiarity with surgical patients for HSG on the pediatrics xxxx (through discussions with the charge nurse) and will convey any concerns to the staff surgeon • Women’s Health will supply staff and additional equipment as needed Circumcision per guidelines Access Agreements Imaging Urology will provide the following access: • All patients will be offered an appointment within one day for any urologic problem • All patients requiring an operating room surgical intervention will be offered an OR time within 5 days of that determination (Cases referred to Pediatric Urologist will be offered the earliest available surgery date as medically indicated) • Immediate access for urgent or and emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. Women’s Health conditions Pediatrics will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access offered for all Pediatrics patients who can schedule by 4:00 p.m. and arrive in the clinic by 4:30 p.m. Monday - Friday • Evenings between 5:00 p.m. – 8:00 p.m. and Saturdays between 8:30 a.m. and 4:30 p.m. the clinic is staffed with one provider who covers the practice for customer convenience and urgent needs for customers who can schedule by 7:00 p.m. and arrive by 7:30 p.m. in the evenings and customers who can schedule by 4:00 p.m. and arrive by 4:30 on Saturdays • Inpatient consultation at any outpatient consult • Continuity appointments offered within 5 days for a clinic appointment • Surgery offered within 10 days time Consultation /Treatment / Treatment Process • Ordering provider or support staff will call Imaging at x 2300 for scheduling outside Signature In order to avoid delays referring clinic agrees to use the standard ANMC evaluation and consultation process • Women’s Health schedules directly into the Signature package for appointments at the PCC US 8:30 a.m. – 4:30 p.m. use standard ANMC evaluation and all Mammograms consultation process (see flowchart) • Ordering provider or support staff initiates 4:30 p.m. – 8:30 a.m. fax /scan evaluation and completes XXX • Name of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram consultation form to Urology Communication Process • Results Pediatrics will identify patients who have complex issues such as, medical, logistical or social issues, when sending a consult • Dictated summary of requested Imaging procedures consults, hospitalization & surgery, outlining findings and recommendations for care on all patients to include pain management and anticipated follow-up with guidelines and conditions for return to Urology. Send cc to PCP. • Urology will notify the patient’s Primary Care Provider during the time of an admission to Urology Service or within 48-72 hours of a surgical procedure. • Home Based Services (HBS): in the event a post-op patient requires HBS, Urology personnel will be sent back responsible for referring the patient to ordering provider via ethe HBS team. This includes completing the necessary paperwork for prescriptions, equipment and nursing orders. Urology will authorize the transfer of care to the Primary Care Provider in accordance to the MCD/MCR guidelines. • Post-mail op wound care: Urology will communicate post-op wound care needs with specific follow the patient. If the patient requires assistance with their wound care, the Urology clinic personnel will arrange for appropriate follow-up recommendations when indicated • Post-op pain management: Urology will manage the post-op pain for the expected post-op recovery time. In the event the patient requires pain management beyond the anticipated recovery period, the Urologist will communicate the patient’s status with the Primary Care Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system transfer of care. Consultation / and Treatment Guidelines (for each referral guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBG) o After CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet • Ultrasound Guidelines include: Urology Pediatrics • Fluroscopy Balanitis • CT Epididymitis/Orchitis • MRI Epididymal mass • Diagnostic Mammogram Hematuria • Screening Mammogram Hydrocele • Bone DensitometryNephrolithiasis • Pyelonephritis • Scrotal Mass • Undescended Testicle • Urinary Incontinence • Urinary tract infections • Hydronephrosis (to be developed) • Hypospadius (to be developed) • Abdominal mass • Circumcision • Urology and Pediatrics will include each other in development of new referral or clinical care guidelines for pediatric urological conditions.

Core Competencies. Imaging Surgery will provide the following core services: • Routine xTreatment and complex work-Rayup of a surgical diagnosis and surgical intervention for outpatients • Admission, Fluoroscopywork-up, MRIsurgical intervention and management of hospitalized Pediatric patients • Non-cardiac thorasic surgeries Lower • GI Endoscopy for pediatric patients • Upper GI Endoscopy for patients over the age of 10. For patients under the age of 10 a phone consult is required, CT, US, Mammography should go to Pediatric GI specialist. • Post-operative pain management as appropriate for the surgical procedure and Bone Densitometry patient (to be dictated into the post-op note and discharge note) • Consultative Surgical intervention and post-op management of patients with pyloric stenosis • Maintain relationships with Pediatric surgery consultant services in the community • Follow PICU agreements as developed through the Peds ICU committee for Imaging related questions • Interventional Imaging (biopsies)Equipment admission and Ultrasonographer to assist Perinatalogist in providing advanced OB services • Imaging will provide basic HSG supplies Women’s Health management guidelines Pediatrics will provide the following core services: • Appropriate Diagnosis and necessary exam and initial work-up of a surgical diagnosis based on referral guidelines • Pre-operative medical clearance for high risk patients • Pediatric hospitalists and pediatric intensivists will provide inpatient care to children when requested by general surgeons. • Pediatric consultations will be provided to pediatric surgical patients when requested by surgeons • Pediatric hospitalists and pediatric intensivists will co-manage pediatric patients when requested by surgeons • I and D of superficial abscesses below the neck • Maintain Pediatric sub-specialty consultant services in the following areas: • Pulmonology • Cardiology • GI • Nephrology • Neurology • Neonatology • Referrals will be made directly to the Pediatric Surgeon for the following conditions: • Neonatal surgical conditions prior • Hirschprung's disease • Pediatrics will develop and maintain pre-printed orders for pain management of hospitalized pediatric patient appropriate for age and weight of patient • Pediatrics will, on a daily basis, maintain familiarity with surgical patients on the Pediatrics xxxx (through discussion with the charge nurse) and will convey any concerns to ordering of the staff surgeon • Pediatrics staff will participate in all pediatric trauma codes as specified per trauma multidisciplinary guidelines and participation agreements • Sedation and monitoring for radiology procedures requiring sedation if non-intubated • Radiology Order Entry (XXX); compete pertinent clinical history, correct exam, ordering provider Evaluation and management of patients with possible pyloric stenosis • Patient is given appropriate prep instructions / date Evaluation and time admission of patients with potential neurosurgical problems such as shunt malfunction • Schedule of ultrasound in Pediatric outpatient and inpatient consultations will be provided to pediatric surgery patients when requested by the PCC and Mammograms in PCC and hospital Surgeon • Contact the Ultrasonographer when same day appointments are requested • Primary Care Provider and/or Case Manager from Women’s Health will accompany make social rounds to admitted patients for HSG • Women’s Health will supply staff and additional equipment as needed at least once during the admission Access Agreements Imaging Surgery will provide the following access: • All patients will be offered an appointment within one day for any problem • All patients requiring an operating room surgical intervention will be offered an OR time within 5 days of that determination • Immediate access for urgent or and emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. Women’s Health conditions • Inpatient consultation at any time Pediatrics will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access offered for all Pediatrics patients who can schedule by 4:00 p.m. and arrive in the clinic by 4:30 p.m. Monday - Friday • Evenings between 5:00 p.m. – 8:00 p.m. and Saturdays between 8:30 a.m. and 4:30 p.m. the clinic is staffed with one provider who covers the practice for customer convenience and urgent needs for customers who can schedule by 7:00 p.m. and arrive by 7:30 p.m. in the evenings and customers who can schedule by 4:00 p.m. and arrive by 4:30 on Saturdays • Inpatient consultation at any outpatient consult time Consultation / Treatment Process Outpatient • Continuity appointments offered within 5 days for a In order to avoid delays referring clinic appointment agrees to use the standard ANMC evaluation and consultation process • Surgery offered within 10 days Consultation /Treatment Process 8:30 a.m. – 4:30 p.m. use standard ANMC evaluation and consultation process (see flowchart) • Ordering 4:30 p.m. – 8:30 a.m. fax /scan evaluation and consultation form to Surgery/Peds Inpatient • Use standard consultation process as defined in the Medical Staff By-laws o Provider to provider or support staff will call Imaging at x 2300 for scheduling outside Signature • Women’s Health schedules directly into the Signature package for appointments at the PCC US and all Mammograms • Ordering provider or support staff initiates and completes XXX • Name of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram contact o Write order Communication Process • Results Pediatrics will identify patients who have complex issues such as, medical, logistical or social issues, when sending a consult • Dictated summary of requested Imaging procedures consults, hospitalization & surgery, outlining findings and recommendations for care on all patients to include pain management and anticipated follow-up. Send cc to PCP. • Surgery will notify the patient’s Primary Care Provider during the time of an admission to Surgery Service or within 48-72 hours of a surgical procedure. • Home Based Services (HBS): in the event a post-op patient requires HBS, Surgery personnel will be sent back responsible for referring the patient to ordering provider via ethe HBS team. This includes completing the necessary paperwork for prescriptions, equipment and nursing orders. Surgery will authorize the transfer of care to the Primary Care Provider in accordance to the MCD/MCR guidelines. • Post-mail op wound care: Surgery will communicate post-op wound care needs with specific follow the patient. If the patient requires assistance with their wound care, the Surgery clinic personnel will arrange for appropriate follow-up recommendations when indicated • Post-op pain management: Surgery will manage the post-op pain for the expected post-op recovery time. In the event the patient requires pain management beyond the anticipated recovery period, the Surgeon will communicate the patient’s status with the Primary Care Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system transfer of care. • Pediatric outpatient consultations will be provided to pediatric surgery patients when requested by the Surgeon by contacting a Case Manager at x4025 Consultation / Treatment Guidelines (for each referral guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBG) o After CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet o Surgery will participate in the Peds ICU committee • Ultrasound Clinical guidelines: Surgery Pediatrics • Fluroscopy Breast disease • CT Colonoscopy • MRI EGD • Diagnostic Mammogram GERD • Screening Mammogram Hernia • Bone DensitometrySkin and sub-cutaneous nodules • Thyroid nodules • Cholelithiasis • Pediatric admit / Post operative orders • Sedation for painful procedures • Sedation for non-painful procedures • Pain management and PCA Quality Assurance Agreements • Service agreements will be reviewed, updated and approved bi-annually with final approval by the SCF VP of the Medical Services Division and the ANMC Administrator. • Training and education needs can be requested by either service. Each service is responsible for responding in a timely manner. • Quality review of the system will occur on a regular basis. Metrics to include: o % of time guidelines are met o % of time processes are followed o % of time adequate information is provided to consultant clinic o % of time adequate information is provided to referring clinic o % of time appointment is booked using the phone process o % of dictation consultation summary received Xxxxx Xxxxx, MD Xxx Xxxxxxxxxx, MD____ Signature of Surgery Medical Director Signature of Pediatrics Outpatient Medical Director Xxxxxxxx Xxxxx, MD Signature of Pediatrics Inpatient Medical Director Xxxxxxx Xxx, MD MHP Xxx Xxxxxxxxx, RN _

Core Competencies. Imaging Pediatrics will provide the following core services: • Routine x-RayNewborn circumcisions on newborn male infants in the Special Care Nursery, Fluoroscopyand those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, MRI, CT, US, Mammography with consultation by a OB/GYN as appropriate • Collaborative management of pediatric patients admitted to the h ospital with gynecological problems • Availability to attend deliveries and Bone Densitometry Cesarean sections as requested • Consultative services for Imaging related questions Prenatal consultation • Interventional Imaging (biopsies)Equipment and Ultrasonographer to assist Perinatalogist in providing advanced OB services • Imaging will provide basic HSG supplies Women’s Health will provide the following core services: • Appropriate Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History and necessary exam Physical has been performed by Pediatrics and workthey have been cleared for surgery • Primary Obstetric management of all pregnancy teenagers during their pregnancy • Same day consults on inpatient pediatric patients with gynecological problems by on-up of medical conditions prior to ordering of radiology procedures • Radiology Order Entry (XXX); compete pertinent clinical history, correct exam, ordering call provider • Patient is given appropriate prep instructions / date Evaluation and time • Schedule management of ultrasound in the PCC any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and Mammograms in PCC and hospital • Contact the Ultrasonographer when same day appointments are requested • Case Manager from Women’s Health will accompany patients for HSG • Women’s Health will supply staff and additional equipment as needed other gynecological endocrine problems. Access Agreements Imaging Pediatrics will provide the following access: • All patients will be offered an appointment within one Same day access by on-call Doctor for any urgent or emergent problem o Currently, MRI is working on a backlog reduction project. Routine MRI examinations may take longer to schedule. empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access by on-call Doctor for any outpatient consult urgent patients referred from Pediatrics • Continuity appointments offered Appointments within 5 days for a clinic appointment • Surgery offered within 10 days Consultation /Treatment routine referrals Communication Process • Ordering provider or support staff will call Imaging at x 2300 for scheduling outside Signature • Providers in Pediatrics and Women’s Health schedules directly into will use the Signature package ANMC Referral and Consultation Form to communicate requests for appointments at services between clinics. Providers agree to respond as requested on the PCC US referral and all Mammograms • Ordering provider or support staff initiates consultation form. Verbal and completes XXX • Name email communication between departments is encouraged to ensure continuity of ordering provider must appear on XXX • Ordering provider or support staff will give the patient the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram Communication Process • Results of requested Imaging procedures will be sent back to ordering provider via e-mail with specific follow up recommendations when indicated • Provider to provider phone contact for any conditions discovered by radiologist deemed to be urgent or need quick follow up, if provider not available page on-call physician • Provide a verified report within 24 hours of exam being completed • Preliminary reports of Imaging studies is available prior to the verified report through hospital “listening only” Imaging dictation system care. Consultation / Treatment Guidelines guidelines (for each referral consultation guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Clinical Core Business Group (CCBGCBG) o After CCBG CBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC intranet Intranet Quality Assurance Agreements • Ultrasound Service agreements will be reviewed, updated and approved bi-annually with final approval by the SCF VP of the Medical Services Division. • Fluroscopy Training and education needs can be requested by either service. Each service is responsible for responding in a timely manner. • CT • MRI • Diagnostic Mammogram • Screening Mammogram • Bone DensitometryQuality review of the system will occur on a regular basis. Metrics to include: o % of time guidelines are met o % of time processes are followed o % of time adequate information is provided to consultant clinic o % of time adequate information is provided to referring clinic o % of time appointment is booked using the phone process o % of dictation consultation summary received Xxx Xxxxxxx, MD Xxxxxx Xxxxxxx, MD Signature of Women’s Health Medical Director Signature of Family Medicine Medical Director Xxxx Xxx, MD, MPH