Common use of Core Competencies Clause in Contracts

Core Competencies. Complementary Medicine will provide the following core services: ▪ Initial evaluation and dictated report on referred patients listed under the ‘Consultation Guidelines’. ▪ Acupuncture: For conditions outlined under ‘Consultation Guidelines for Acupuncture’. ▪ Chiropractic: All referrals must be of a musculoskeletal nature, please refer to ‘Consultation Guidelines for Chiropractic’. ▪ Clinical Massage Therapy: Is an adjunct service to Chiropractic care and is not a direct referral modality. ▪ Patients with acute pain of six (6) months or less with no associated chronic pain ▪ Patients in the Chronic Pain program, or on a pain contract, will not be seen by CMC Valley Native Primary Care Center will provide the following core services: ▪ Initial work-up and diagnosis based on referral guidelines ▪ Management of chronic pain Complementary Medicine will provide the following access: ▪ Chiropractic Evaluation within 5 days ▪ Acupuncture Evaluation within 5 days ▪ Access to Clinical Massage Therapy is prescription only by a Chiropractic Provider. ▪ Same day / next day access for Pregnancy induced nausea ▪ Pregnant non-beneficiaries may be seen by an Acupuncture Provider for pregnancy related hyperemesis only. ▪ All patients will be scheduled for an examination with a Chiropractic Provider except for referrals to Acupuncture listed under ‘Consultation Guidelines for Acupuncture’. ▪ Appointments must be scheduled and kept within 30 days of referral date. ▪ The Complementary Medicine Department agrees to accept referrals for eligible customers from SCF Primary care medical providers for customers who live in the immediate Anchorage area. Service is provided for eligible customers with residence in: Anchorage, Big Lake, Birchwood, Chugiak, Chickaloon, Elmendorf Air Force Base, Eagle River, Eklutna, Ft. Xxxxxxxxxx, Xxxxxxxx, Houston, Indian, Knik, Xxxxxx, Xxxxxx, Wasilla, and Xxxxxx. Valley Native Primary Care Center will provide the following access: ▪ Same day access offered for any Valley Native Primary Care Center empanelled patient who can arrive prior to 4:30 p.m. Monday-Friday

Core Competencies. Complementary Medicine will provide the following core services: ▪ Initial evaluation and dictated report on referred patients listed under the ‘Consultation Guidelines’. ▪ Acupuncture: For conditions outlined under ‘Consultation Guidelines for Acupuncture’. ▪ Chiropractic: All referrals must be of a musculoskeletal nature, please refer to ‘Consultation Guidelines for Chiropractic’. ▪ Clinical Massage Therapy: Is an adjunct service to Chiropractic care and is not a direct referral modality. ▪ Patients with acute pain of six (6) months or less with no associated chronic pain ▪ Patients in the Chronic Pain program, or on a pain contract, will not be seen by CMC Valley Native Primary Care Center Department will provide the following core services: ▪ Initial work-up and diagnosis based on referral guidelines ▪ Management of chronic pain Complementary Medicine will provide the following access: ▪ Chiropractic Evaluation within 5 days ▪ Acupuncture Evaluation within 5 days ▪ Access to Clinical Massage Therapy is prescription only by a Chiropractic Provider. ▪ Same day / next day access for Pregnancy induced nausea ▪ Pregnant non-beneficiaries may be seen by an Acupuncture Provider for pregnancy related hyperemesis onlyhyperemesis. ▪ All patients will be scheduled for an examination with a Chiropractic Provider except for referrals to Acupuncture listed under ‘Consultation Guidelines for Acupuncture’. ▪ Appointments must be scheduled and kept within 30 days of referral date. ▪ The Complementary Medicine Department agrees to accept referrals for eligible customers from SCF Primary care medical providers for customers who live in the immediate Anchorage area. Service is provided for eligible customers with residence in: Anchorage, Big Lake, Birchwood, Chugiak, Chickaloon, Elmendorf Air Force Base, Eagle River, Eklutna, Ft. Xxxxxxxxxx, Xxxxxxxx, Houston, Indian, Knik, Xxxxxx, Xxxxxx, Wasilla, and Xxxxxx. Valley Native Primary Care Center Departments will provide the following access: ▪ Same day access offered for any Valley Native Primary Care Center empanelled patient who can arrive prior to 4:30 p.m. Monday-Friday

Core Competencies. Complementary Medicine Urology will provide the following core services: ▪ Initial • Treatment and complex work-up of urologic surgical diagnosis and surgical intervention • Consultation for urologic conditions as per referral guidelines • Phone or email consultative services for Urologic related questions by contacting on-call Urologist • 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 (to be dictated report on referred patients listed under into the ‘Consultation Guidelines’. ▪ Acupuncture: For conditions outlined under ‘Consultation Guidelines post-op note and discharge note) • Urology will use pre-printed orders for Acupuncture’. ▪ Chiropractic: All referrals must be pain manamgnet of a musculoskeletal nature, please refer to ‘Consultation Guidelines hospitalized pediatric patient appropriate for Chiropractic’. ▪ Clinical Massage Therapy: Is an adjunct service to Chiropractic care age and is not a direct referral modality. ▪ Patients with acute pain weight of six (6) months or less with no associated chronic pain ▪ Patients in the Chronic Pain program, or on a pain contract, will not be seen by CMC Valley Native Primary Care Center patient Pediatrics will provide the following core services: ▪ • Pediatric consultations will be provided to pediatric urological patients when requested by urologists • Pediatric hospitalists and pediatric intensivists will co-manage pediatric patients when requested by urologists • Initial work-up conservative management of simple urologic conditions 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 be developed) • Hypospadius (to be developed) • Abdominal mass (to be developed) • Outpatient pediatric consultations will be provided to pediatric patients when requested by Urology physicians by contacting Case Manager at x4025 • Inpatient consultations will be provided following the standard referral process • Pediatrics will, on a daily basis, maintain familiarity with surgical patients on the pediatrics xxxx (through discussions with the charge nurse) and diagnosis based on referral will convey any concerns to the staff surgeon • Circumcision per guidelines ▪ Management of chronic pain Complementary Medicine Urology will provide the following access: ▪ Chiropractic Evaluation within 5 days ▪ Acupuncture Evaluation within 5 days ▪ Access to Clinical Massage Therapy is prescription only by a Chiropractic Provider. ▪ Same day / next day access for Pregnancy induced nausea ▪ Pregnant non-beneficiaries may be seen by an Acupuncture Provider for pregnancy related hyperemesis only. ▪ • All patients will be scheduled offered an appointment within one day for any urologic problem • All patients requiring an examination with a Chiropractic Provider except for referrals to Acupuncture listed under ‘Consultation Guidelines for Acupuncture’. ▪ Appointments must operating room surgical intervention will be scheduled and kept offered an OR time within 30 5 days of referral date. ▪ The Complementary Medicine Department agrees that determination (Cases referred to accept referrals Pediatric Urologist will be offered the earliest available surgery date as medically indicated) • Immediate access for eligible customers from SCF Primary care medical providers for customers who live in the immediate Anchorage area. Service is provided for eligible customers with residence in: Anchorage, Big Lake, Birchwood, Chugiak, Chickaloon, Elmendorf Air Force Base, Eagle River, Eklutna, Ft. Xxxxxxxxxx, Xxxxxxxx, Houston, Indian, Knik, Xxxxxx, Xxxxxx, Wasilla, urgent and Xxxxxx. Valley Native Primary Care Center emergent conditions Pediatrics will provide the following access: ▪ • 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 Valley Native time • In order to avoid delays referring clinic agrees to use the standard ANMC evaluation and consultation process • 8:30 a.m. – 4:30 p.m. use standard ANMC evaluation and consultation process (see flowchart) • 4:30 p.m. – 8:30 a.m. fax /scan evaluation and consultation form to Urology • Pediatrics will identify patients who have complex issues such as, medical, logistical or social issues, when sending a consult • Dictated summary of 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 Center empanelled 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 who can arrive requires HBS, Urology personnel will be responsible for referring the patient to the 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-op wound care: Urology will communicate post-op wound care needs with the patient. If the patient requires assistance with their wound care, the Urology clinic personnel will arrange for appropriate follow-up • 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 prior to 4:30 p.m. Monday-Fridaythe transfer of care. • 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 • Guidelines include: • Balanitis • Epididymitis/Orchitis • Epididymal mass • Hematuria • Hydrocele • Nephrolithiasis • 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. Complementary Medicine Imaging will provide the following core services: ▪ Initial evaluation • Routine x-Ray, Fluoroscopy, MRI, CT, US, Mammography and dictated report on referred patients listed under the ‘Consultation Guidelines’. ▪ Acupuncture: For conditions outlined under ‘Consultation Guidelines Bone Densitometry • Consultative services for Acupuncture’. ▪ Chiropractic: All referrals must be of a musculoskeletal nature, please refer Imaging related questions • Interventional Imaging (biopsies)Equipment and Ultrasonographer to ‘Consultation Guidelines for Chiropractic’. ▪ Clinical Massage Therapy: Is an adjunct service to Chiropractic care and is not a direct referral modality. ▪ Patients with acute pain of six (6) months or less with no associated chronic pain ▪ Patients assist Perinatalogist in the Chronic Pain program, or on a pain contract, providing advanced OB services • Imaging will not be seen by CMC Valley Native Primary Care Center provide basic HSG supplies Women’s Health will provide the following core services: ▪ Initial • 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 diagnosis based on referral guidelines ▪ Management time • Schedule of chronic pain Complementary Medicine 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 Imaging will provide the following access: ▪ Chiropractic Evaluation within 5 days ▪ Acupuncture Evaluation within 5 days ▪ Access to Clinical Massage Therapy is prescription only by a Chiropractic Provider. ▪ Same day / next day access for Pregnancy induced nausea ▪ Pregnant non-beneficiaries may be seen by an Acupuncture Provider for pregnancy related hyperemesis only. ▪ • All patients will be scheduled offered an appointment within one day for an examination with any urgent or emergent problem o Currently, MRI is working on a Chiropractic Provider except for referrals backlog reduction project. Routine MRI examinations may take longer to Acupuncture listed under ‘Consultation Guidelines for Acupuncture’schedule. ▪ Appointments must be scheduled and kept within 30 days of referral date. ▪ The Complementary Medicine Department agrees to accept referrals for eligible customers from SCF Primary care medical providers for customers who live in the immediate Anchorage area. Service is provided for eligible customers with residence in: Anchorage, Big Lake, Birchwood, Chugiak, Chickaloon, Elmendorf Air Force Base, Eagle River, Eklutna, Ft. Xxxxxxxxxx, Xxxxxxxx, Houston, Indian, Knik, Xxxxxx, Xxxxxx, Wasilla, and Xxxxxx. Valley Native Primary Care Center Women’s Health will provide the following access: ▪ • Twenty four hour per day consultation and inpatient care to Imaging patients • Same day access offered for any Valley Native Primary Care Center empanelled outpatient consult • Continuity appointments offered within 5 days for a clinic appointment • Surgery offered within 10 days • 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 who can arrive the appointment time and prep instructions for exam • Ordering provider or support staff initiates and completes XXX or requisition for diagnostic mammogram • 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 4:30 p.m. Monday-Fridaythe verified report through hospital “listening only” Imaging dictation system • 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. Complementary Medicine will provide the following core services: ▪ Initial evaluation and dictated report on referred patients listed under the ‘Consultation Guidelines’. ▪ Acupuncture: For conditions outlined under ‘Consultation Guidelines for Acupuncture’. ▪ Chiropractic: All referrals must be of a musculoskeletal nature, please refer to ‘Consultation Guidelines for Chiropractic’. ▪ Clinical Massage Therapy: Is an adjunct service to Chiropractic care and is not a direct referral modality. ▪ Patients with acute pain of six (6) months or less with no associated chronic pain ▪ Patients in the Chronic Pain program, program (with or on without a pain contract, agreement) will not be seen by CMC Valley Native Primary Care Center Women’s Health will provide the following core services: ▪ Initial work-up and diagnosis based on referral guidelines ▪ Management Primary role in the care of chronic pain pregnant women ▪ Primary role in the care of patients with complex gynecological conditions Complementary Medicine will provide the following access: ▪ Chiropractic Evaluation within 5 days ▪ Acupuncture Evaluation within 5 days ▪ Access to Clinical Massage Therapy is prescription only by a Chiropractic Provider. ▪ Same day / next day access for Pregnancy induced nausea ▪ Pregnant non-beneficiaries may be seen by an Acupuncture Provider for pregnancy related hyperemesis and smoking cessation only. ▪ All patients will be scheduled for an examination with a Chiropractic Provider except for referrals to Acupuncture listed under ‘Consultation Guidelines for Acupuncture’. ▪ Appointments must be scheduled and kept within 30 days of referral date. ▪ The Complementary Medicine Department agrees to accept referrals for eligible customers from SCF Primary care medical providers for customers who live in the immediate Anchorage area. Service is provided for eligible customers with residence in: Anchorage, Big Lake, Birchwood, Chugiak, Chickaloon, Elmendorf Air Force Base, Eagle River, Eklutna, Ft. XxxxxxxxxxRichardson, XxxxxxxxGirdwood, Houston, Indian, Knik, XxxxxxPalmer, XxxxxxSutton, Wasilla, and XxxxxxWillow. Valley Native Primary Care Center Women’s Health will provide the following access: ▪ Same Twenty four hour per day consultation and inpatient care ▪ Five day access offered for any Valley Native Primary Care Center empanelled patient who can arrive prior to outpatient consult ▪ Continuity appointments offered within 5 days for a clinic appointment ▪ All customers seen in Complementary Medicine Department will be from provider-initiated referrals ▪ 8:00 a.m. – 4:30 p.m. Monday-Fridayuse standard ANMC evaluation and consultation process (see flowchart) ▪ 4:30 p.m. – 8:00 a.m. fax /scan evaluation and consultation form to CMC ▪ All referrals are to be sent via fax (4102). ▪ Appointments made with the Consult phone (4313 or 8030), must be followed with a faxed referral (4102).