274376 M�HITE - CITV CLERK
PINK - FINANCE GITY OF SAINT PAUL Council ������—
CANARV - DEPARTMENT
BLUE - MAVOR File NO•
O
l Resolution
,
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED, That the Council of the City of Saint Paul hereby authorizes and
directs the proper City officials to execute an agreement with the County
of Ramsey and Face to Face Health and Counseling Service, Inc. , whereby the
City and County will assist in its functioning as a neighborhood health center
in caring for the medical-health needs of the citizens of the City and County
in the adjacent geographic area; the City's contribution for the calendar
year 1980 being $51 ,612, and said agreement expiring December 31 , 1980.
Funding Code: 03215
COUNCILMEN Requested b epartment of:
Yeas �� Nays I� � .
Hunt V o n t S rvice �
in Favor
Levine � n ,,
Ma ;dox �f ��(/��L �,�.
r.�,r°,:��,on - -- Against BY ` --
s�.,,�u,ter for Thomas J. Kelley
TeJ�sco
Adopted by Cs� ci : Date '���� � � �i���� Form pproved b C' tor
_
Certi d Passe�i tiy Council Secretayy BY
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�Lli � �) Approved by Mayor for Submission to Council
/�pp by Ylavor: e — i�—
By BY ^ �
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AG�EE���ErlT
�N AG°EE�?E�l7, Date� this �ay of Decem�er 1979 among �he
CITY OF SAI I��T PAIi!, r�Ti nnesota, herei nafter cal l ed "Ci ty"; tE�e C011tJTY OF
Face to Face Health &
RA��SEY, itinnesota, hereinafter called "County"; and Counselling Ser. , Inc._,
located at 730 �1endota , Saint Paul , P•�innesota, hereinafter
called "Grantee";
l�JIT"�fESSETI�:
In consideration of the services of the Grantee functioning as a neigh-
borhood h�alth center in caring for the medical-health needs of the citizens
of ttie City and County, tne �arties i�ereto mutually agree as fvllows:
1 . Th� City and County �ti11 each givP to tt�e C_,rantee such sum of money
�
as is se� across fr�m the namt of each as reflected on the attached Exhibit �',
an3 i n ti�e manner set fortS� nerei n.
2. Th� sum of nondy granted by the City and County is for the Grantee's
use during 1���. PJo additional or future funding or assurances thereof will be
provided or honored unless set forth in an amen�ment to ti�is Agreement or a
separate aareement anproved as the free act of the City and County.
3. The County shall pay to the City its contribution as reflect?d on
Exhibit A in equal i��stallr�ents on January 1 , April 1 , July 1 , and October 1 ,
1920.
�. The City shall pa,y to the Grzntee its and the County's contribution
in installments as follo,•rs:
(a) 25`.`� of tt�e total contribution of both the City and County on
or befo�e January 1 , 1°80;
(b) 25� of the total c�ntribution of both th� City and County on
or before A.pril l , 1920;
(c) 2�% of th� total con�ribution of both t��e City and Count,i on
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or before July 1 , 1980;
� (d) 25% of the total contribution of both the City and County on
or before October 1 , 1930.
5. The City, acting as the transmittal aqent of the contribution of both
the City and County, as set forth in Paragrapi� 4, shall not be liable to pay
to the Grantee the County's contribution if not received by it from the County
pursuant to Paragraph 3.
Y•
6. The Grantee shall on Aoril 20, July 20, October 20, 1980, and January
20, 1931 submit to the City an itemized statement of all Grantee's expenditures,
revenue and report of services on a form or forms to be provided by the City.
The City shall make such reports available to the County upon receipt. Further,
the �rantee shall preserve all documentation used by it in complying a�ith the
statements and reports required by this paragraph and shall be available to the
City and County for its review and audit as desired.
7. The Grantee shall , arith apnroval of the City, develop and enforce a
fee schedule for patient charges.
8. The City shall act as the liaison to the Grantee for such day-to-day
administration as nay be needed and shall be res�onsible for:
(a) Revie�ving and evaluating the program and fiscal activities of the
Grantee and disseminating reports thereof;
(b) Providing technical assistance to the Grantee in developing and
implementing the fee �schedule referenced in Paragraph 7;
(c) Coordinating activities common to the Division of Public Health
of the City and/or the Cornmunity Health Services Department of tfie County
and the;Grantee;
(d) Rendering to the Grantee such other assistance as �,►ithin the
City's resources;
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9. The Grantee shall ensure that:
(a) Services provided to eligible individuals are furnished without
regard to race, color, creed, sex, age, marital status or family size;
(b) Services are nrovided vrith respect for individual privacy and
dignity; and
(c) Services are provided without coercion and shall not be denied
on the basis of refusal to oarticipate in research projects or other
activities of the Grantee, or on the basis of ability to pay.
10. The Grantee shall obtain and keep in force at its own expense during
the term of this Agreement, professional liability insurance in the amount of
Three Hundred Thousand Dollars ($300,000). A certificate evidencing such
insurance as being in force during 198�, and co-insuring the City and County,
shall be furnished to the City Attorney for revie�v and approval on or before
January 1 , 1980.
� 11 . The Grantee's arqanization and activities shall be guided by the
format described in the attached Exhibit B.
12. The Grantee shall su5mit to the City a total o�erating budget on
forms provided by the City and an operational plan of its services to be pro-
vided during the terr� of this Anreement on or before February 15, 1980.
13. The Grantee shall submit to the City a total operating budget on
forms provided by the City and an ooerational plan of its services to be pro-
vided during the calendar._year 1981 on June 1 , 1980.
14. The Grantee shall obtain a financial and program audit for the period
of this Agreement by a certified public accountant. This audit shall certify
to com�liance with the terms of this grant and budget developed for this grant
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period. The Grantee shall submit a copy of the audit report to the City. The
City shall make said report available to the County upon receipt.
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15. 7he Grantee shall make available relevant background and qualifica-
tion su��aries of both regularly employed and volunteer staff to the City and
Count�.
16. 7he Grantee agrees that deviations of ten oercent (107) or more,
unti•rar;ls or dot•mt�rards, fror� its 1920 actency budget, and/or additions or dele-
tions from its 198� oper�ational plan as approved by the City and County wiil
be transnit�ed to the City and County in a timely fashion and in a manner to
be deterr�ined b;/ the City's Clinic Coordinator. Such information shall be
before the fact and shall include pertinent data relative to the planned addi-
tion, deletion, or any other m�dification of programs and the subsequent pro-
jected budgetary in�act for the contract year and the follo��ing year.
17. Tye Grantee declares ��an Skelton to be the
person responsible for cor�;�liance �vith the terms of the Agreement, and its
Drs Deb Sandberg as the person responsible for its �
medical services.
18. The City declares its Director of the Department of Community Ser-
vices or such design�e as noted in ti•rriting by him as the person responsible
for compliance ��rith this Agreement.
19. The County declares its Executive Director or sucti designee as
noted in ��iriting by him as the person responsible for compliance vrith this
Agreement. .
20. 7he Grantee agrees that at all times under this Agreement, it, and
its employees, agents, and volunteers are independent contractors as to the,
City, and not er�ployees of the City.
21. The terr� of this Agreement shall bp from January 1 , 1980 through
Oecember 31 , 19�0.
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t � �
IiJ tlI?t�1ESS l��'HEP.EOF, ti�e parti es have set thei r hands as fol l ov�s:
A�proved as to Form Cf?U�JTY OF REi"1S�Y
8y
Assistani County �Ittorney � Board Chairman
z
�y
�loproved as ta Form Executive Director
Funds are Available
Assista t ty P,ttorn�y � ftccount P�umber(s)
Amo�nt
GRAi�iEE: Face to Face Health E� gy
Counselling Service, Inc. Budgeting and Accountin�
By �
Its Executive Director Insurance llpproval
By
Ri sk P�lanager
CITY OF SAItdT P,�UL
' �� �� . �
: By ``�_L.��,�� V�
hlayor .-
' Funds are Available
Account t�lumber 03215
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� �Y
Director, �enar�r�ent of Finance
t51anagement Services
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� � . F t+d 'J� {j�e.,��u,��,f.•�.�
Exhibit A
Face to Face Health and Co�.anseling Service, Inc.
Revenue Sources 19�0
x•
City of Saint Paul $51 ,617
County of Ramsey � 51 ,617
Ramsey County t�ental Health (Abuse) 65,000
Saint Paul School Qistrict 49,491
Patient Fees 16,000
blorkshops/Tapes 3,000
Counseling Fees 2,500
Interest 1 ,000
Other 32,355
TOTAL $272,580
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• � � �•f�I�1�'��i S �!1�r'J��,p.�`.� . �,,I,�..; �� �y+a.a�
" • FOk TFIC OPERF,T I C?��I OF tvE I Gt ICORi-'O��D FIEA.t_.TH CENTEP,S • � a �'`ta� ����
STA7J�AQD i - O�:Gl=,�:1%:\i(0�:.�,L STRUCTU�cE
A. G�varnir�g body: the center operates unoer �ht �ireciior� uF �n identifi�ble . .
board of directors. � _ .
{ . This board hold� regularty scheduled an� docum�r�ted nzetings. �
2. tts mee�ings are o�en to the pubiic and are announced publicly, � ' �
at least five days prior to each regularly scheduleo r-�ea-tina. -
3. This body has fut [ legal authority and resp�nsibili�y for o��erall
. conducfi of the center. . �
4. The center is incorporated with the assistance of an attorney. �
B. C,overn i ng body r.ia ke-�p: �. . �
I . The board of directars is rrade up of at least 51° co�sumers.
2. The board of direc-tors is reflective racia! !y, culturally, econo�ically
. and sexually of the center's neighborhood and/or service population.
C. Governins body responsibilities: the boarc! of directors is the policy-making .
body. _ - .
. �- .. a� . . . . .
I . It adopts effective c( ient care policies and by-iaws governing fihe
� operatien of the facili-ty in accor�ar,ce with fec:al requirenents and
in conjunction with medical staff. Such policies and by-la�•rs are irt
writing and dated, and tF�e board of direcfors e�sures they are
� � operat'ionat and reviews i-inem at least annually. � �
2, ft has a client review committee responsibte for the devetopmen-F of �
policies relative to the healfh care, safety and �ig,hts of clieRts.
3. The governing body hires the chief adminisirative staff person. �
4. It considers and acts or��.budgei-s, contrac�s, a,reeren�s and ofiher
_ o�eration�l r�atters prese�ted to it by its staff. ,
D. Channels of resoonsibility: channels of resFcnsi�ility as ��etl as �
su�ervi sory re lation�h i ps w i th i n the cen�ter are doc�.:r�s�ted by r�zars
of an organizational chart or other suitable �
1 . Assignmen� of responsibility and delegetior. of authority ��ithir. th�
center's or5anization a;e specified in job description of adminis;ra- �
tive; and professional personnet .
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. " _. F.•�.,�i n i s-trati��` recorc�s: admi n i s�trat i �e re�orc� and rzFcr-ts are ma i nta i rsc;
a�d used to guide the operation a:�d reflect the pro�ress of th� center.
I . Fdmi n i strat i ve recerds i nc I ure sfiat i s�i ca I data or, nur,�b��rs served.
2. An annua I report i s comp i l ed �:h i c's� i nc I udes at t eas� a sumrriary o� .
financial ope�ation and of services Yrovided. The report is made
available to the public. -
�i�'i��RD I I. - PERSOPIP�lEt POLI CI ES . , . �
?�rs���nel pol icies and praci-ices are esfiabl ished, revie:rad periodica'I ty and � � �
:�v:sed as necessary. . .
�. rersonne I po! i ci es of the cen-ter are wr i i ten ar,d msde ava i l ab l e to a�( I -
center personnel . . � .
�. The cenfier has In effec-h a viab{e personnel gr'ievar,ce pol icy. �_ .
C. The written personnel policy covers: � • • �- �
I�. Eliring procedure, including an affi'rmative statement of fair � . .
employmenfi in hiring. . �
2. Employee probation. . . .
3. Evaluation of job performa�ce. . � � ��
�. Sa I ary ad justr.:ents � _
� 5. Hotiday, sick leave, annua( leave and ofiher benefits. � - .. � -
. E. Terminations - voluntary and invotuntary. � � . ' . ". � ' � �
_ . T:�� c�n�er has a �sufficient num5er of qualified personne! tQ meet the needs of clients.
C. Stafting: staffing is adequate fio p rovide the services essenfiial to implenen� .
�he sfiated goa I s and ob jecf i�ve5 of the cente�.
I . A! ! rrembers of the staff are qualified to perform the duties and �
� responsibilities assigned to them, and reefi such Fe�era(, State .
and local pro#essional rec�uirer�ents as are arplicable. ,
2. If the services of health care students are u�itized in providing • � •
care, such trainees k�ork under the direct on-si�e suFervision of � �
appropriately qualified professicnal personn�l . �
3. If paraprofessionals ti:ork ai the center, fiheir job descripl-ions � . • • .
(and actual functions) reflect their trair�ing a��� skil (s.
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•�a��, Three 1 '
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� • �t. Yif'1 ft�fl �yi i QP. ( I i1B5 @Y,i S't'� C I f i�� Tri@ f!11 fl l i:lUffi fit,:��er� of perso:�ne�
' ��cessar-y for delivaring services during centEr sessior�s.
E. Con-tinuing Education: all cenier personne( - pa�� z�d votur�tce; - are giv�n
the oFportunity to par�icipate in on-aoing educa�ional progr-ar�s reteted ta .
their activitie;, includir.g ori2nta�'icn, on--tne-job �rainir�g, regular in-�e:vice
firaining prograr�s, and participatior i� V,+�rkshops, ins�itufies or cor�tir�uing
edu�afiion courses. � �
STA\DAR�] i I I - F I NA�dC I AL h',A'�AGEt��NT .
A. Annua! budget: a budget� related to the cen-rer's objectives is prepared annually.
B. Accounti ng sysfiem and records: an accour,ti ng systen i n r.a i nta i ned fihat •
: produces information reflecting the fiscal experience and -the curren� financiat
. pos i ti on of the cen�ker. � . .
� I. The cenfier �maintains records adequaie to m�e-F its aperating needs �
� and lts obligations io clients, fihird-party payors and other � � �
. _interested parties. �
2. Reports of fihe center's �current financiat position and other pertirent
financial informafiion are subr,ritted to the governing bcdy at teast
quarfierly. -
3. The center- provides for an indzpe.r,dent cerfiified audifi or an . .
unaudited opinion ot its finarcial operations to be carried out
annua� ly. . • -�- . �
C. tnsurance_ an insuranCe program thafi prbvides tor adequate cor�preh�nsivs �
� liability insurance covering center personnel and for proiection of fihe center�s .
physical and financiat resources is in effect. � � .
D. The clinic is in cor�pliance rrith State a�d Federal (aa:s �egarding financiel
reporting. � . �
I . Tax return is prepared and subr�i-tted annua! ly. � - . .
2. State and Federa I emp I oy.ee �r i thl�o I d i ng fiaxzs a re depos i ted re5u I ar I y
within legal timits. ��
3. Sfiate and Federa I returns for er�p I oyee rr i thhe I d tar.es ars f i !ed
quarterly. •
4. The center rr,eets requ i rements �or S�ate U�enployr:e�t 1 ns��rance for - .
its employees. ' •
5. The center mee;s requ i rements Tor k!orkr�en's Cer.:pensat i o� i nsurance
for ifis employees. '•
6. The op�ion to join the Fed�ral Sociaf Secu�i�y� .progra� has baen o�fered
to the employees (pertains fio 501 (c)(3), oroani_atio�s) .
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��'�i n��r^�r;� S�a�dards � �
r : � . Paca Fou�r ' .,� , .
ST�v�f�A�D f V - O�tGard I ZAT I�r�A� PLAt�r��i P�G �
A. Goais and 05jectives: the b���;d of :i �ectors has dtveloped a set of goals
and objecfiives �•+hich includes:
1 . The overali philosophy or Mission o� the clir�ic. �, � '
� 2. {ts projected ou-tcomes relative to the scope o` hea{th services available . :
fio tts clients.
3. The cormunity (bot-h geographic and culturai) �-o be served. . . -
4. OTher projected outcomes referred to or implied by tne mission statenenfi �
such as cost of care, client advocacy, etc. � . � .
B. Progran Ptanning: the hoard annualty develops policizs and objectives based .
on the philosophy and goals of the center. �
' I . The chief adr�inistrative otficer deve{ops an ann�a! workptan based on - .
the priorities ot the board. �The workpian addresses: : . ' � . '
� a. The number of ctfents to be served. � .
� . b. The scope of services to be delivered. � � �
�. The effect of the services on the cost`of care. . �
_ � . .
- d. ��The nathods of f i nanc i ng the .care 1-o be de I i vered. � � : _ ' • :
e. The person powzr necessary -to de; iver fhe services. �
f.� The space nacessary for delivering the services. � � ~
� g. The relationship with other providers of care. � _
C. Progra� Evatuation: the director or chiet administrative officer reports '.to the
governing body annually regarding the ef�ectiveness of the prograM. The r'eport �
includes: . ..
1 . Numbsrs of clienfis se�ved. -
2. The scope of services delivzred at the center. �
3. The average cost of services per ctient visit.
4. The adequacy of th� phys.ical space in which services a�ere deli.vzred. .
5. Th� nun�ers and corpe�tercies of the sta`f �:ho delivered the services. .
6. Current relationships vrith ofiher providers of care.
, .�ac���" F i va . � • .
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, 'STP,�JCARD V - F�:Y;tCAL EP�VI �O��.!�r�T �
The center site conforms to buildir.g, health and Tire rc:�ulatio�s of the city,
county and/or v i I (age �:here i n i t i s i oca�red ane� c���;�1 i ar�ce i s adec�uG-te I y dacuc��n�t�ed.
STA.t�DARC V f - P0�1 CY A"JO PRCrtOI;RE . '
Policy and .proce�u�e are develop�d for inplem�n�irg the stated goais ar.d ot�jectives �
of the center. � � - -
A. ka nuals: policy and procedure manuals e�:ist having been develaped Ytith -the
advi�� of pro�essionat personnei , adminisfrai-ion and ctients and are revie�•red
at leas-t annua( 1}� and revised as necessary. The manuat (s) incl�c�e guide( ines
govern i ng the Frov i s i on of emsrgar�cy a;�d non-2r-�ergency care ;F�at may be 5i vzn
• at the facilii-y, and cover at leasfi The folloti�ing: .
� I . Protocol fcr er�zrgency procedures ;tiai- r�ay be perfQrred i n the cen�er. �
� " 2. Procedures i-o be� fol towed in referring a cf ient -�o ano�her faci I ity �
. ' for care not ava i t ab l e at -the center. _ . � � � •
3. Protocot regarding contact with cor:�municable disease and procedures
for infec�ton controt at the cenfer. �
4. Pro�ocol for contacting cfients when follow-up visits are necessary. �
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8. Convenience/Accessibilify: the center has in effecfi poticies and procedures
. which assure. that center services are c�fered at fir.;es/occasions and in a
rr.anner thafi is reasonably convenienfi fer the rajori�y of ►he c�ier,ts, � .
� - . . . .
I . The avaifability of transportation and the work/schoot requirer:,znfis
of clienfis are taken into account. � �
� 2. A schedule shot�ing the days and ho�rs when the csnter is open is
posted in a conspicuous place in the center- and made available .
� � to possible referral sources. � . �
3. If lang�age or cultural barriers exist between cenfier personne( , . �
and a signiticant nur�ber. of clients, arrangements sh�uid be nade
for in�erpreters to bz present, rr�ulti-languace signs to be posted,
� or for other mechan i sns to ensure �dequate co�:nun i cat i o�►.
4. Proced�res are develo�ed to accomriodate clients �•tith physicat handicaps.
C. Apaointr;er�t sysi�en: if the center sees clients by appoin-�ment, a tim�-specific
appo i ntmzn� system i s estab I i shed, w i th adequate t i r�a a I I oti�red for sfia�f -to see .
nev� cl ients as 4�e) I as thoss ►naking return visits.
I . Average wa i t i ng t i r^a at the cent�r shou I d no-f e:cceed one hour.
2. To the extent possible.effor�s are r�ade tc enable th� c( ient
to se2 the same provider on each returr visit. �
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'��",in+i�a.�n.St-and3r.ds ` ,
,• , - PaS�.. Six � • ' , .
� . a
', 3. Fo, �:�n-�errer�encv c�re, c t 's en-� sho:.�!d nave t�c :�a i�� nu t ong�r 'th�n t►•�o '
, r.eehs for appcin�tr.,enfis. .
� 0. Continuity of cara: the cen�er adop,ts a�d irpte�^ar�1s r�echanisms 1�� ensure
' tne co�fiinuity and availability of care. �
� I . A rr�chznisn is estahlish�d for providir.g services to unschsduted . _ .
clients urc��ntly in nesd of ca�e. � _
2. The cl ient is informrd a� ths tir�e �f ihe initial contact with i�he .
, center of the services avaiia5le at the cen�er znd is given ihe �
. opportunity fio plan for ways in t:hich these services can be. � � � .
integrafied into his/htr tota! care. . � -
3. Off-tiou� nedica! covarage is provided by the center or an al-Fernative
rr�chan i s;� i s deve to�ed to ensure coverage. ' . �
4. A recorded telephone nassage is utilized leaving instructions for �
clienfis cafting during times when the center is not open. �. . . � �
5. A procedure exists for. referring clients •to other tacilities for care '
not available at the center and guidefines cover at feast the fo1lot�ing: �
a. Lnforming the client of alte rnative sources of care and steps . � .
� that nust be taken to arrange for fihe care. - � � •
: b. Tra�sferring of inforrr,ation regarding the cl ient wifih tha � � :
� clien-t's authorization to the receiving facility. � •
c. - Transfer-ri ng of i nfornaf i on regar i ng the ci i ent from -the � �
receiving facllity to the center �or inclusion in the clien-F's � .
center records.
E. Clients' Rights/Responsibilifiies: the center adopts and r.�akes avai [able to . , . �
ciients writfien� policies regarding the rights/responsibili�ties of clients. - �
These policies ensure each client at least tha� he/she is: = � . • �
I . Fulty inforned of these rights and of afl rules and regulations
concerning clienfi cond�ct and responsibilities. �
2. Informed ot fihe identity( ies) of the people involved in his/her � �
ca re. tf trainees participate in the care, he/she shal { be so
in`ormed. � -
3. 1 nforr�ed of -the ct�arges for serv i ces i nvol ved i n the care g i ven and �
-that ths charges for atl services provided by the. cen�er be avaitable .
at requast. �
4. tnforr�ed of the reasons for and nature of all exa�ina�ions, tesfiino and
procedures that are done. � �
'F�:�����R, s�r�;,�3;d� �
. ?a�� �Sev�rr . - � . . ' ,
. . • , .
5. I n formed of th� nature of h i s/her cor:d i;:c:� n�d of a I ierr�ai�i ve -
treatr�ents, if fhe y exis*j providir,g for his par�icipafiion in fihe �
planning for care.
6. I nforried of h i s/har r i ght 1-o re fuse treatm�nfi recorrrce�dcc! and of , �
. thz possible conseque„ces of that refusal . � '
7. [nforr*�d an� ass i sted to understanc� a�d exerc i�e h i s/her r i gFrts . � - �
and may, via an existing mechanisr�,, voica grievances and rzcor,c�end . �
changes in Folicies an� service to cer,�er sfia�t and outside . ;
repres�ni-atives of his/hsr choice. :
8. Assure confiden-tial trea�man�t ot his/her disc[osures and records,
and��y approve o� �efuse the release o� any intormation 1-o any . -
individual not involved in his/he� care at fihe cenfier except as -
required by faw or third-party payr.:ent confiract.
9. Treated with considerafiion, respect, and full consideration of �
his/her dignii'y ahd individuality, including privacy in t�eatmeni- �
and care. . .. � . •
STAtd DARD V 1 I - htED I CA L RECORDS . �
I nd i v i dua ( c t i ent recards. and report i ng systerrs necessary to ca rr-y .out program � �
. evaluation and to naet atl applicable professional , administrative, ptanning and
legal requirements shatl be established and r,taintained. _• � .
A. tndividual client records: a mzdical record is mai�l�ained for every �
client receiving msdical care provided bylthe service.
. I . A sample of inedical records is reviewed periodically by designated� •
administra-tive and/or professiona{ statf to deternine the guality .
ot the records. ��
2. Medical records contain alt of the follorring data: .
� a. Personal data incl�ding: � � � �
1 . pa-tie�t identification
2, name(s) of person(s) �o be notified in case of em2rg�r,cy
3. service registration,� or other identifying nurrber
4. identification o� ofiher sources of r�dica[ care � .
5. source of referral ' �
6. date of visits . -
� 7. designation of prir;�ary physiciar� or health worker �
responsible for client's carE. . '
. s �'i.ii i,y�dn_S�tan�Eards '
. . .
. . �'.�'z��� c i oht �
� � ,
b. Clinical data including:
1 . client F�istory to include h:story of aE ;;�rc�ies
and previous illnesses, hospiz�lizatior�s, and � �
surgeries and m�dication used. � .
� 2. physical examination report . .� .
. _. 3. cl ientts currenf probler�s � � � •
. � 4. clinical no�es written by appropriate cenfier - •
personnal . . . - .
5. consulfiation reports; if applicable �
6. copy of relevanfi records of care r�ndered �
. - by other providers .
_. c. Diagnostic da�a including: � � . .
. . - �• t aboratory reports � . : � .• .
2. radiology reporfis � _ .
. 3. oiher reports; as appticable � .
� d. Treafimenfi and instruc-tions, inctuding: • �
I . client managemant plar.s, inc(uding follo►��-up �
� action as indicated ` �
2. notafiions af prescriptions written �
• . 3. self-care instructions
� 4. insfiructions regarding return visits � • � � '
5. signed consent forms anC signed reteases . �
6. insfiructions for'care given per teiephor.z �� _
B. C�nfidentiality: •the confidenfiiality of all �edical records is mai7tained subject
to appficabJe larls and third-party contracts requiring disclosure. -
I . The center safeguards the infor►�ation in fihe reco;d against �loss, �
defacer;,enfi, ��ampering .or unau�horized use. . � � -
2. The center�s Empioyees receive instruction concerning the
preservation of the conticentiality of the clier,►'s r.;zdicat records.
3. Slritte� informal consent of the cliert shatl be required for the �
release of r:�edical information. • • � -
,� •. . .. .... .. .�.._ •
�� Pa��-,tJ i ne .. . , . • .
r' C. F i ;i i r�g arici ,r•etr i.�:�.-a 1 syster�: t%�ed i c�1 records are i�dexed a�d �i l e:d i n a .
� � manner- ►�;�i ch fac i I i tates ttie acqu i s i ti on of stdt i st�i ca I i n format i on and . �
the retrieval of records for client care ,and prograr.� evalu�tior, purposes. -
STA�•i�J�1RD V! I I - LP,BORATCRY SEP,V I CES
Laboratory services comrr�nsurate tivith the center's nez�s are provided by the center
itself, by an outside laboratory which is part of an accredited or certified •
hospital , or by an ouiside in�ependent laboratory a;hich is approved to provide services.
If the center providas labo�atory services directly, the fo{ lo�rin5 criteria are
appticable: . � . .
A. Personnel : if the center p:ovides more �han bas.ic laboratory services, �
the laboratory is under the direction of - or regutar consultation is
avi labte fror.► - a pafihologist. ' -
S. Requests and reporfis: signed reporis of laboratory findings a�rs refiurned .
promptty to the requesting individual and entered into the ctien-F1s
med i ca � record. . . - � � . -
� � �C, Safety: proper safety� precautions are mainfiained aoa�ns� �hazards fro�r , � �
fire, explosions, electrical equipment, volafiile chemicals and flamrrabte �
solutions. -
D. Quality control : . . � .
. I . The laboratory ir�pfeman�s an internal quality control program covering
at least the calibration of equipnent and�validation ot test resu(ts. .
2.. Laboratory personne� participate in periodic revie:�s and updafies of
procedures and equiprent. � � : �
STP.NDARD 1X - PHARh1ACE�TtCAC SERVlCES � � . .
! f pharmaceutica( services are otfered directly by the center, they are provided : _
� in accordance �r�ith acceofied professional principles and appropriate Federal ,
State and local laws and with the follouin� cri�eria: �
A. Personnel : the dispensing of prescription r:�edications shcufd be done �
only by a licensed pharracisfi op�rating from a pharrracy or by the -
physician in cemaliance with hlinnesota Sta�utes which �alfov:s supervised
interns or nurses to disaense drugs.
B. Prescriptions: msdicatio�s are dispensed only upcn -the �•rrit�en order of a . .
I +censed p�actifioner/physician. Atl redications di�spensed r.�ust be preperly ,
I a bz I ed vr i th at I east the na�^� of .the c I i ent, tt�e narr.e of the prescr i b i r.g
practitioner/physi�ian, the nar;e of the drug, the directions for use and
the date the drug is disper.sed.
� . �.�� , � ��(���
' w ^
. ?. f � . . . ^ � ' .. '�'"�d � ..�.17 �
• • • �
. • �
. : T'iniM��: Sfand3rds
Paye Te:� .
C. Patie-�t prc�f i le: i f the ce�ie; fi I Is r-�s�r3;,-t�o�?s fror� nor�-center rrac�ition�r�,/
Fhysicans, a medicaiion Frofile is m�intainec in the pharmacy. .
D. Controtied substancas: all recu��-E:eepi�g and security require�^ents of the
Oru� Enforcee�ent Adr�inistration mu�t be cor�plied with if conirolled subst2nces
are to be utilized. � : �
STF.��D,yP,� X - BACF:-U? SERV I CES � - � .
Prov i s i ons are r�ade for ca re not a��a i l ab l e afi fihe cente r i tse l f. �
A. :'irit�en egreements for the Frocureze�t of necessary consultations, speciat . .
ssrvices not available at the centar, and in-patiert care are devetoped
with cooperating agencies and insti�utions, peiriodically revie�•red, and . � �
a�proved b�r the center's governing body, and writte� policies an�J . ,
procedures exi si- govern i ng tha provi s ion of such care. � •. �. . � . _ : . . .
B. Tna agreenants specify the mecharism for firansfer ot necessary records � • .
and intormation. _
. ` �
. . �
t� ,. _ � h /
' cM oi: �.a,�is�s
. � ,. ' � : R�v.: g�'8/?&
E1tPLANATI4N a ADMIiIISTRATIVE 0 RS;
RESOLUT . AND RDSNANCES '
. ,�_.�._..�_._.._y.. ��y ��'�'� .
� ^i'�°�� ��:
�
, � .�
� � . �
� � � � ���, � .
. ..� y ..�� ,
IIate s January 16, l 98Q JA{� � ;' �c�� -
�' . A+IA�fQR�$ � _
Tp 1` MAYQR_ GEORGE La.TIMER •
FR: Thanas J. Kelley, Director of Department of Comr�nity Services ,
g�: Contract among Face to Face Health and Counseling Serrice, Inc. , the County of -
. Ramsey and the City of Saint Paul -
ACTION RES�TESTED: .
- ��ri�rur.rn�.+w� ���r � • �
e�cecutive approval and signature -
P;#
FVRPQ�'E AND :RA��ONALE� FOR Z'FIIS ACTZON:
The five c�nity elinics (�Face to Face, Family Tree;-Heipin� Nand, Plor�h End
and West Side) have received funding from the City and County sir�ce 1976 to
support their �ctivities as neighborhood health centers. This contraCL corttinues
. t#�e fi:�a�cial �upport through 1980. ---
�. .�"�1���S: ,
�, .�_ ��.,.,�_
�uncil Resoluticm _ . �
ccmtract do�c�n�nt �. �pies �
appendix A - opies+
aPP ndix B - � cop�es _
���t,Q,c�tit,e�-ic�2