Common use of Core Competencies Clause in Contracts

Core Competencies. Pediatrics will provide the following core services: • Newborn circumcisions on newborn male infants in the Special Care Nursery, and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, 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 Cesarean sections as requested • Prenatal consultation • Women’s Health will provide the following core services: • Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History and Physical has been performed by Pediatrics and they 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-call provider • Evaluation and management of any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. Access Agreements Pediatrics will provide the following access: • Same day access by on-call Doctor for any empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Same day access by on-call Doctor for urgent patients referred from Pediatrics • Appointments within 5 days for routine referrals Communication Process Providers in Pediatrics and Women’s Health will use the ANMC Referral and Consultation Form to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity of care. Consultation / Treatment guidelines (for each consultation guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Core Business Group (CBG) o After CBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet 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. • 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 Xxx Xxxxxxx, MD Xxxxxx Xxxxxxx, MD Signature of Women’s Health Medical Director Signature of Family Medicine Medical Director Xxxx Xxx, MD, MPH

Core Competencies. Surgery will provide the following core services: • Treatment and complex work-up of a surgical diagnosis and surgical intervention for outpatients • Admission, work-up, surgical 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, should go to Pediatric GI specialist. • Post-operative pain management as appropriate for the surgical procedure and patient (to be dictated into the post-op note and discharge note) • 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 admission and management guidelines Pediatrics will provide the following core services: • Newborn circumcisions Diagnosis and initial work-up of a surgical diagnosis based on newborn male infants 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 Special Care Nursery, following areas: • Pulmonology • Cardiology • GI • Nephrology • Neurology • Neonatology • Referrals will be made directly to the Pediatric Surgeon for the following conditions: • Neonatal surgical conditions • Hirschprung's disease • Pediatrics will develop and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, with consultation by a OB/GYN as appropriate • Collaborative 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 admitted on the Pediatrics xxxx (through discussion with the charge nurse) and will convey any concerns to the h ospital with gynecological problems staff surgeon • Availability to attend deliveries Pediatrics staff will participate in all pediatric trauma codes as specified per trauma multidisciplinary guidelines and Cesarean sections as requested participation agreements • Prenatal consultation • Women’s Health will provide the following core services: • Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History Sedation and Physical has been performed by Pediatrics and they have been cleared monitoring for surgery • Primary Obstetric management of all pregnancy teenagers during their pregnancy • Same day consults on inpatient pediatric patients with gynecological problems by onradiology procedures requiring sedation if non-call provider intubated • Evaluation and management of any patients with possible pyloric stenosis • Evaluation and admission of patients with potential neurosurgical problems such as shunt malfunction • Pediatric outpatient and inpatient consultations will be provided to pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. surgery patients when requested by the Surgeon • Primary Care Provider and/or Case Manager will make social rounds to admitted patients at least once during the admission Access Agreements 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 and emergent conditions • Inpatient consultation at any time Pediatrics will provide the following access: • Same day access offered for all Pediatrics patients who can schedule by on4:00 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 time Consultation / Treatment Process Outpatient • 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 Surgery/Peds Inpatient • Use standard consultation process as defined in the Medical Staff By-call Doctor for any empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Same day access by on-call Doctor for urgent patients referred from Pediatrics • Appointments within 5 days for routine referrals laws o Provider to provider contact o Write order Communication Process Providers • 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. 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 Pediatrics the event a post-op patient requires HBS, Surgery personnel will be responsible for referring the patient to the HBS team. This includes completing the necessary paperwork for prescriptions, equipment and Womennursing orders. Surgery will authorize the transfer of care to the Primary Care Provider in accordance to the MCD/MCR guidelines. • Post-op wound care: Surgery will communicate post-op wound care needs with the patient. If the patient requires assistance with their wound care, the Surgery clinic personnel will arrange for appropriate follow-up • 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 Health will use status with the ANMC Referral and Consultation Form Primary Care Provider prior to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity 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 Guidelines (for each consultation 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 (CBGCCBG) o After CBG CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet intranet o Surgery will participate in the Peds ICU committee • Clinical guidelines: Surgery Pediatrics • Breast disease • Colonoscopy • EGD • GERD • Hernia • Skin 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 DivisionDivision 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 Xxx XxxxxxxXxxxx Xxxxx, MD Xxxxxx XxxxxxxXxx Xxxxxxxxxx, MD MD_________ Signature of Women’s Health Surgery Medical Director Signature of Family Medicine Pediatrics Outpatient Medical Director Xxxx Xxxxxxxx Xxxxx, MD__________ Signature of Pediatrics Inpatient Medical Director Xxxxxxx Xxx, MDMD MHP Xxx Xxxxxxxxx, MPHRN___________

Core Competencies. Urology will provide the following core services: • 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 into the post-op note and discharge note) • Urology will 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: • Newborn circumcisions on newborn male infants in the Special Care Nursery, Pediatric consultations will be provided to pediatric urological patients when requested by urologists • Pediatric hospitalists and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric intensivists will co-manage pediatric patients suspected of being sexually abused, with consultation when requested by a OB/GYN as appropriate urologists • Collaborative Initial 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 admitted 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 will convey any concerns to the h ospital with gynecological problems staff surgeon • Availability to attend deliveries and Cesarean sections as requested • Prenatal consultation • Women’s Health Circumcision per guidelines Access Agreements Urology will provide the following core servicesaccess: • Newborn circumcisions 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 al newborn male infants while they are inpatients in that determination (Cases referred to Pediatric Urologist will be offered the newborn nursery, after their initial History earliest available surgery date as medically indicated) • Immediate access for urgent and Physical has been performed by Pediatrics and they 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-call provider • Evaluation and management of any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. Access Agreements emergent conditions Pediatrics will provide the following access: • Same day access offered for all Pediatrics patients who can schedule by on-call Doctor 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 empanelled patient referred from Women’s Health Women’s Health will provide time Consultation / Treatment Process • In order to avoid delays referring clinic agrees to use the following access: standard ANMC evaluation and consultation process • Same day access by on-call Doctor for urgent patients referred from Pediatrics 8:30 a.m. – 4:30 p.m. use standard ANMC evaluation and consultation process (see flowchart) • Appointments within 5 days for routine referrals 4:30 p.m. – 8:30 a.m. fax /scan evaluation and consultation form to Urology Communication Process Providers • 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 Provider during the time of an admission to Urology Service or within 48-72 hours of a surgical procedure. • Home Based Services (HBS): in Pediatrics the event a post-op patient 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 Womennursing 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 Health will use status with the ANMC Referral and Consultation Form Primary Care Provider prior to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity transfer of care. Consultation / and Treatment guidelines Guidelines (for each consultation 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 (CBGCCBG) o After CBG CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet Quality Assurance Agreements intranet • Service agreements will be reviewed, updated and approved bi-annually with final approval by the SCF VP of the Medical Services Division. • 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 Guidelines include: o % Urology Pediatrics • 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 time new referral or clinical care 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, MPHfor pediatric urological conditions.

Core Competencies. Pediatrics Complementary Medicine will provide the following core services: • Newborn circumcisions ▪ Initial evaluation and dictated report on newborn male infants 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 Special Chronic Pain program, or on a pain contract, will not be seen by CMC Primary Care Nursery, and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, 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 Cesarean sections as requested • Prenatal consultation • Women’s Health Department will provide the following core services: • Newborn circumcisions ▪ Initial work-up and diagnosis based on referral guidelines ▪ Management of al newborn male infants while they are inpatients in the newborn nursery, after their initial History and Physical has been performed by Pediatrics and they 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-call provider • Evaluation and management of any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. chronic pain Access Agreements Pediatrics 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 on-call Doctor an Acupuncture Provider for any empanelled patient referred pregnancy related hyperemesis. ▪ 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 Women’s Health Women’s Health 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. Primary Care Departments will provide the following access: • ▪ Same day access by onoffered for any Primary Care empanelled patient who can arrive prior to 4:30 p.m. Monday-call Doctor for urgent patients referred from Pediatrics • Appointments within 5 days for routine referrals Communication Process Providers in Pediatrics and Women’s Health will use the ANMC Referral and Consultation Form to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity of care. Consultation / Treatment guidelines (for each consultation guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Core Business Group (CBG) o After CBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet 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. • 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 Xxx Xxxxxxx, MD Xxxxxx Xxxxxxx, MD Signature of Women’s Health Medical Director Signature of Family Medicine Medical Director Xxxx Xxx, MD, MPHFriday

Core Competencies. Surgery will provide the following core services: • Treatment and complex work-up of a surgical diagnosis and surgical intervention for outpatients • Admission, work-up, surgical 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, should go to Pediatric GI specialist. • Post-operative pain management as appropriate for the surgical procedure and patient (to be dictated into the post-op note and discharge note) • 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 admission and management guidelines Pediatrics will provide the following core services: • Newborn circumcisions Diagnosis and initial work-up of a surgical diagnosis based on newborn male infants 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 Special Care Nursery, following areas: • Pulmonology • Cardiology • GI • Nephrology • Neurology • Neonatology • Referrals will be made directly to the Pediatric Surgeon for the following conditions: • Neonatal surgical conditions • Hirschprung's disease • Pediatrics will develop and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, with consultation by a OB/GYN as appropriate • Collaborative 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 admitted on the Pediatrics xxxx (through discussion with the charge nurse) and will convey any concerns to the h ospital with gynecological problems staff surgeon • Availability to attend deliveries Pediatrics staff will participate in all pediatric trauma codes as specified per trauma multidisciplinary guidelines and Cesarean sections as requested participation agreements • Prenatal consultation • Women’s Health will provide the following core services: • Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History Sedation and Physical has been performed by Pediatrics and they have been cleared monitoring for surgery • Primary Obstetric management of all pregnancy teenagers during their pregnancy • Same day consults on inpatient pediatric patients with gynecological problems by onradiology procedures requiring sedation if non-call provider intubated • Evaluation and management of any patients with possible pyloric stenosis • Evaluation and admission of patients with potential neurosurgical problems such as shunt malfunction • Pediatric outpatient and inpatient consultations will be provided to pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. surgery patients when requested by the Surgeon • Primary Care Provider and/or Case Manager will make social rounds to admitted patients at least once during the admission Access Agreements 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 and emergent conditions • Inpatient consultation at any time Pediatrics will provide the following access: • Same day access offered for all Pediatrics patients who can schedule by on4:00 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 time Consultation / Treatment Process Outpatient • 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 Surgery/Peds Inpatient • Use standard consultation process as defined in the Medical Staff By-call Doctor for any empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Same day access by on-call Doctor for urgent patients referred from Pediatrics • Appointments within 5 days for routine referrals laws o Provider to provider contact o Write order Communication Process Providers • 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. 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 Pediatrics the event a post-op patient requires HBS, Surgery personnel will be responsible for referring the patient to the HBS team. This includes completing the necessary paperwork for prescriptions, equipment and Womennursing orders. Surgery will authorize the transfer of care to the Primary Care Provider in accordance to the MCD/MCR guidelines. • Post-op wound care: Surgery will communicate post-op wound care needs with the patient. If the patient requires assistance with their wound care, the Surgery clinic personnel will arrange for appropriate follow-up • 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 Health will use status with the ANMC Referral and Consultation Form Primary Care Provider prior to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity 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 Guidelines (for each consultation 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 (CBGCCBG) o After CBG CCBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet intranet o Surgery will participate in the Peds ICU committee • Clinical guidelines: Surgery Pediatrics • Breast disease • Colonoscopy • EGD • GERD • Hernia • Skin 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 DivisionDivision 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 Xxx XxxxxxxXxxxx Xxxxx, MD Xxxxxx XxxxxxxXxx Xxxxxxxxxx, MD____ Signature of Surgery Medical Director Signature of Pediatrics Outpatient Medical Director Xxxxxxxx Xxxxx, MD Signature of Women’s Health Pediatrics Inpatient Medical Director Signature of Family Medicine Medical Director Xxxx Xxxxxxx Xxx, MDMD MHP Xxx Xxxxxxxxx, MPHRN _

Core Competencies. Pediatrics will provide the following core services: • Newborn circumcisions on newborn male infants in the Special Care Nursery, and those who decided to have the procedure after discharge and are empanelled to Pediatrics • Evaluation of pediatric patients suspected of being sexually abused, 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 Cesarean sections as requested • Prenatal consultation • Women’s Health will provide the following core services: • Newborn circumcisions of al newborn male infants while they are inpatients in the newborn nursery, after their initial History and Physical has been performed by Pediatrics and they 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-call provider • Evaluation and management of any pediatric patient with gynecological problems, including contraception counseling, STD check, pap smears, menstrual irregularities, and other gynecological endocrine problems. Access Agreements Pediatrics will provide the following access: • Same day access by on-call Doctor for any empanelled patient referred from Women’s Health Women’s Health will provide the following access: • Same day access by on-call Doctor for urgent patients referred from Pediatrics • Appointments within 5 days for routine referrals Communication Process Providers in Pediatrics and Women’s Health will use the ANMC Referral and Consultation Form to communicate requests for services between clinics. Providers agree to respond as requested on the referral and consultation form. Verbal and email communication between departments is encouraged to ensure continuity of care. Consultation / Treatment guidelines (for each consultation guideline include graduation criteria) • The process for approving guidelines: o Guidelines developed at department (or other) level o Department presents guideline to appropriate Core Business Group (CBG) o After CBG approval guideline goes to PIC for final approval o After PIC approval guideline is posted on ANMC Intranet 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. • 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 Xxx Xxxxxxx, MD M D Xxxxxx Xxxxxxx, MD M D Signature of Women’s Health Medical Director Signature of Family Medicine Medical Director Xxxx Xxx, MD, MPH