Survey for Required Annual Medical Examinations & Procedures

Haypath House, MHANC CLP

Each resident must have documentation for a few, certain, annual medical exams or procedures. The exam or
procedure must be done annually and the documentation updated. It is required that we have documentation of a
recent:
 General physical
 Ophthalmology (not optometry) examination
 Audiology examination
 Dental examination
 Gynecology (for women: JS, RT, JH)
 Podiatry (for diabetics: JH, JS, NM, TT)
 PPD/QuantiFERON-TB Gold test

When you have spare time over the next few weeks or months, please:

1. Look through each of the clients’ Medical sections in their charts (big binders) and use the attached Survey
table to record who has what documentation for which examination or procedure.
2. After completing the table, call each of the resident’s providers/specialists and try to get documentation from
within the past 2 years for each of the exams/procedures (PCPs for General Physicals and
PPD/QuantiFERON-TB Gold tests), particularly from the past 1 year.
3. Update the table with notes as you go.
4. For any new documentation received, put a Post-It on it that states which exam/procedure it represents and
the date of the exam/procedure (e.g., “Ophthalmology Exam 5/1/2019” or “PPD 4/25/2019”). Then put it in a
plastic sheet protector and file it in the front of the Medical section of their charts.
5. If there is still no documentation, ask the clients if they have ever had the exam/procedure done, and ask for
the most recent provider’s contact information (perhaps they recall the town and street) and try to locate and
retrieve the documentation.
6. If you discover new providers as you go, add them to the client’s Face Sheet Contacts.
7. Some of the clients’ medical facilities have multiple specialists, and a client may have had an
exam/procedure done there that we don’t know about while they there for a different exam/procedure, so try
to get all documentation from the facility (NM & RZ’s medical facilities have multiple specialists/medical
departments).

a. RZ used to go to AdvantageCare Hicksville recently (which has multiple specialists) so call there too.
b. ADHC programs do procedures (e.g., PPD tests) or have providers come in to do exams/procedures
(e.g., podiatrists, dentists, etc.), so call there too.
i. ADHCs:
1. JS: Huntington Hills
2. AW, RZ: Cold Spring Hills
3. JH: Cold Spring Hills (discharged; try anyway)
4. RT: Forest View
c. Then call the PROS programs and ask if they have medical providers/specialists come in sometime to
do services; get any documentation of the required exams/procedures.
The main objective of this project is to get documentation of all the required exams/procedures from within the past
2 years (but we definitely need ones that are dated within 1 year by the time OMH audits us).

p. 1 of 2, Updated 5/8/19, File Location: F:(MHACOMMON)\CLP Forms\Cushman-Haypath House\Survey for Required Annual…
Survey Table for Required Annual Medical Examinations & Procedures
Haypath House, MHANC CLP

 Survey who has documentation for which required examination or procedure (excluding Declinations).
 In the table below, input the date of the examination or procedure. If there is no documentation, input an “X.”
Add notes as needed, e.g., a nearing due date (input “due” along with the due date), “appt scheduled,” the
number of attempts at acquiring the documentation, “being sent”, etc.

PPD or
General Ophthalmology Audiology Gynecology Podiatry Exam
QuantiFERON- Dental Exam
Physical Exam Exam Exam (Women) (Diabetics)
TB Gold Test

LD

TG

JH

TJ

RL

NM

JS

SS

RT

TT

AW

RZ

p. 2 of 2, Updated 5/8/19, File Location: F:(MHACOMMON)\CLP Forms\Cushman-Haypath House\Survey for Required Annual…