274377 WHITE - CITV CIERK COUQCII � � ��� ��
PINK - FINANCE � F�
CANARV - DEPARTMENT GITY O INT PALTL
BLUE - MAVOR File NO.
i 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 North End Health Center, 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 $34,547.50,
and said agreement expiring December 31 , 1980.
Funding Code: 03215
COUNCILMEN
Yeas�� Nays Requested b Department of:
� n ty Services " .
H";,t In Favor
Le,-ine �
^_�^:'a o x /� �k�l �i.�l.
M�>;,;;,�� _�___ Against BY =—
sn��v<,�t�r f homas J. Kelley
T�azs�o
Form pproved b C' rn
Adopted by Co cil: Date 1�� ��
�r
Certifj4�$�P•ss by unci,j Secr ary BY
By
/�p� by .Vlavor. t �,F F�D L� �9�o Approved b ayor for Submission to Council
gy By i:G(/�tx �4'"
� , % n
PU�GiSi�r,? �. � - ,���
, • . ' ,
��,�,�,�.,--<<:��►°1
� , (y��
4 ,��`i� M /
AGREEl1EPdT
AN �G�EE"?E�!T, Date� thi s day of [?ecember 1979 among the
CITY 0� SAIPIT PAIIL, Fiinnesota, hereinafter called "City"; the CQL[JTY 0�
North End Health
RP.��SEY, tlinnesota, hereinafter called "County'�; and Center, Inc. ,
located at 1021 tlarion , Saint Paul , ��tinnesota, hereinafter _
called "Grantee";
l,IITf�IESSETH:
In consideration of the services of the Grantee functioning as a neigh-
borhood health center in caring for tfie medical-health needs of the cftizens
of the City and Co��nty, the parties hereto mutually agree as follouls:
1 . Thb City anci County 4��i11 each give to t�e G�antee such sum of money
as is set across from tl�e name of each as reflected on the attached Exhibit A
and in the manner set forth herein.
2. The sum of r�oney granted by th` City and County is for the Grantee's
use during 19�(!. fdo additianal or future funding or assurances thereof will be
provided or honored imless set forth in an amendment to this Agreement or a
separate agreement approved as the free act of the City and County.
3. The County shall pay to the City i�s co�tribution as reflected on
Exhibit A in equal installments an January 1 , April l, Jul� 1 , and October 1 ,
1sao.
4. The City shall pay to the Gr�ntee its and the County's contribution
in installments as follorrs: .�
(a) 25� of the totai contribution of both the City and County on
or befo�e January 1 , 193�J;
(b) 259� of the total co�tribution of both thz City and County on
or before April 1 , 1920;
(c) 25% of the total contribution of both the City and Cocmt�i on
L • , ' ,
or before July 1 , 1980; ,
- (d) 25% of the total contributio�� of both the City and County on
or before October 1 , 1930.
5. The City, acting as the transmittal agent of the contribution of both
the City and County, as set forth in Paragraph 4, shall not be liable to pay
to the Grantee the County's contribution if not received hy it from the County
pursuant to Paragraph 3.
6. The Grantee shall on �loril 24, 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 unon receipt. Further,
the Grantee shall preserve all docur�entation used by,„it in complying 4�ith the
statements and reports required by this paraqraph and shall be available to the
City and County for its review and audit as desired.
7. The Grantee si�a11 , t�rith apnroval of the City, develop and enforce a
fee schedule for patient charces.
8. The City sha11 act as the liaison to t�e Grantee for such day-ta-day
adr�inistration as nay be needed and shall be resnonsible for:
(a) Revie�ving and evaluating tfie program and fiscal activities of the
Grantee and disseminating rePorts thereof;
(b) Providing technical assistance to the �rantee in developing and
implementing tt�e fee schedule referenced in Paragraph 7;
(c) Coordinating activities common to the Division of Public Health
of the City and/or the Community Fl�alth Services Department of the County
and the:Grantee;
(d) Rendering to the Grantee such other assistance as tvithin the
City's resources;
-2-
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 provided 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 participate in research projects or other
�
activities of the Grantee, or on the basis of ability to paye
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 Nundred Thousand Dollars ($300,000). A certificate evidencing such
insurance as being in force during 198n, and co-insuring the City and County,
shall be furnished to the City Attorney for review and approval on or before
January 1 , 1980.
11 . The Grantee's organization and activities shall be guided by the
format described in the attached Exhibit B.
12. The Grantee shall submit 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 term of this Agreement 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 t{ie calendar:_year 1981 on June l , 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 compliance �rith the terms of this grant and budget developed for this grant
�
period. The Grantee shall submit a copy of the audit report to the City. 7he
City shall make said report available to the County upon receipt.
-3-
15. 7he Grantee shall make available relevant background and �ualifica-
tion su��aries of both regu7arly employe� and volunteer staff to the City and
County.
1G. The Grantee agrees that deviations of ten percent (1�%) or more,
unwards or doti,rn!��ards, fror� its 198�J actency budget, and/or additions or dele-
tions from its 1987 operational plan as approved by the City and County ��ill
be transr►itted to the City and County in a timely fashion and in a manner to
be determine� by 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 modification of pro�rams and,the subsequent pro-
jected budgetary impact for the contract year and the follo�ring year.
17. The Grantee declares Barb Lindsay to be the
�
person responsible for compliance with the terms of the Agreement, and its
Dr. Theresa Quinn as the person responsible for its
medical services.
180 7he City declares its Director of the De�artment of Community Ser-
vices or such design�e as noted in ��lriting by him as the person responsible
for compliance ���ith this Agreement.
19. The County declares its Executive Director or such designee as
noted in viriting by him as the aerson responsible for compliance with this
Agreer�ent e
20. The Grantee agrees that at all times under this Agreement, it, and
its employees, agents, and volunteers are indeoendent contractors as to the.
City, and not employees of the City.
21 . The terr� of this Agreement shall be from January 1 , 1930 through
�
December 31 , 1980.
_�_
I�J t�lITt��ESS h!!iEP,EQF, the parti es have set thei r hands as fol l ovrs:
A�proved as� to Form CQUNTY OF RA?1SEY
�y
Assistan't County Ftttorney Board Chairman
c
, Qy
Flpproved as to For� Executive Director
,
c
Funds are Available
. Assistant ity ttorney Account P�umber(s)
Amount �
GRA��TEE: Nort End Heal th Ey
Budgeting and ccounting
Center, Inc.
By � �
Insurance llpproval
Its Executive Director
By
Risk ��anager
CITY �F SAIFlT P,4UL
. �
By
_ _ hiayor --
,
Funds are Available .�
. Account flumber 03215
�
, Qy
Director, Denartment of Finance
P�1anagement Services
-5-
r � . � .
n ' • . �� ��'��
f��'��Q� �;'�
Exhibit A
North End Health Center
Revenue Sources 1930
City of Saint Paul � $34,547.50
County of Ramsey 34,547.50
Patient Fees 20,000.00
Carryover 5,000.00
Rental Income 1 ,200.00
TOTAL � �95,295.00
,
� ��. • ' ,Exh i b i t B .
� � , .
� ' � 'l��l{�fv��i S �l1�r'J��.p.�`.� • .
" • FOFi TFIE OPEFiRT I C?�I 0� tdE I GtIE30Ri-'.O��D FI�AI_TH CENTEP.S . "��'t�` �:�'��^+
, — ----- — :�+�y'�'�:� . �
STA=J�ARD I - OR�A�:)%�\i!0���,L STRUCTUctE
A. G�vernir�g body: fihe center operates unoer �he �i-ec-;ior� uF an identi_fi�btE . .
board ofi directors. � _ .
1 . This board holds regularly scheduled an� documsnted r:�etings. �
2. its mee�in5s are open to the public and are ar�nounced pubticly, � � �
at ieast five days prior to each regular(y scheduleci r��ea�tina. � �
3. This body has full legal authori-fy and resp�nsibili�y for o��erall
. conduct of the centerr � �
4. The cenfier is incorporated with ;he assistance of an attorney. � .
B. Govern i ng body r.�ake-�p: �. �
I . The board of d i re�tars i s rrade up of at I eas-t 5 t4 co�sumers. :
2. The board of direc-tors is reftectiv� racialiy, culfiurally, econc,�icaliy
. and sexually of the cen�er's neighborhood and/or service popufaiion.
C. Governing body responsibilities: the board of directors is tF�e policy-making .
body. � � �
_ �- .. ;� . . . . .
! . It adopts effective clienfi care poiicies and by-laws governing the
• . operation of the facili-ty in accor�ar,ce with lec:a! requirenents and
in conjunction wi�h medical staff. Such policies and by-la�rs are in
writing and dated, and -the board of directors e�sures they are
� � . operationai and reviews them at leas-t a�nualfy. � �
2. It has a client revisw conmittee responsibte for the developmenfi ofi
policies relative to the healfh care, safefiy and righ�s of clients. �
3. The governing body hi�es the chief adminisirative staff person. � �
4. It considers and acts or�.bud�et-s, contracis, a�reeran�s and oi-her
_ o�eration�t r�atters prese�ted to it by its stafr. .
D. Channels of resoonsibility: channels of respcnsibility as ��e11 as � �
suRervi sory re tat ionsh i ps r�i th i n the cen-ter are �oc�.:ms�ted by r.�zars
of an organizational chart or other suitable �
I . Ass i gnmen� of respons i b i I i-ty and de 1 egeti or. of author i ty a�i th i r. th� �
ce nter's organizaticn a�e specified in jeb d�scription of a3minisira- �
tive; and profESSional personnel .
- . .����,Tw�. .. ...: ....
T . . .
�'`_ . . � . . .
�• • ' . . . . � .
:� . ,
. '
, ' _. ��.::i n i strati va r�cords: admi n i s�Frat i �e re�orc� ar.d r2Fcr-ts 3re ma i nta i rec
2nc used to guide the operation a�d reflect the procress of the center.
I . Fdmi n i s l-rat i ve recerds i nc 1 ure stat i s;i ca I �'ata or, nur�bers served.
2. An annua I repart i s comp i l ed �•:h i ci� i nc I u�es a-� �eas� a sumr:iary o` .
financial opera-tion and of services rrovided. The report is made
available to the pubiic. �
��:=.'i����7 t (. - PERSOPJ��lEt POLI CI ES . -
?�rso��nel pol icies and praci ices are esfiabFished, revie:•rad periodica�l ty and � �
;�vised as necessary. � � �.
�. rersonnel policies of the ceni-er are written ard msde avaifable fio a�( 1 �
center personnel . . � � . �
�. The center has in effecfi a viable personnet grievar,ce policy. . � .
C. The written personnet policy covers: � � _ • � :• �
I . Fliring procedure, including an affi'rmafiive stafiement of tair � . .
employment in hiring. . .
2. Employee probation. , .
3. Evaluation of job perfornance. . �� � �
�. Sa I ary ad j ustr^ents �
5. Holiday, sick leave, annuat leave and other benefits. . � " _ � � � -
E. Terminations - voluntary and invo�untary. � � . � . � � . ' - '
_ . _:�� c�n�er has a �sufficient numb2r of q�alified personne! fio meet the needs of ciienfis.
C. Siaffing: staffing is adequate fio provide the services essential to i�npteneni- .
��e sfiated goals and objecFi-ves of the center.
I . AI ! rrembers of the staff are qualified to perform the duties and � �
� responsibilities assigned to therr, and neefi sucF� Fe�erat, State -
and local protessional rec�uirements as are arplicable. .
2. It the services of health care studenfis are u�ilized in providing • � •
care, such trainees k�erk under the direct on-site supervision of �
appropriately qualified professicnal personn�l . �
3. If paraprofessionals ti:ork a� i-he center, thzir job descriptions � . _ - • .
(and actual funcfiions) reflect fih2ir trairing a��� s�:i ( Is.
,
, .�a�;r Three � �
.• � . . .
,� , . ,
� ' 4. Ytr i t ten ';;.::de 1 i�es ex i st, c i t�rg r:�e m i n i��u� n�:;�ers of persr,;,ne,
' n�cessary for delivarin� services during cent�;r sessior�s. �
E. Contin:�ing Education: af 1 cenier p�rsonn�I - pai� z�!� voiur�te�; - are giv�n
the oFportunity to par�icipate in on-�oin� e�uca�ionai progr-a�s related ta .
their activities, includir.g orian;a�ion, on-the-job trainir�.^„ reoular in-�e:vice
firaining prograr�s, and participa�ior, i� v,h�rkshops, irsjitutes or cor�tinuin5
educafiio� courses. • �
STA\DAP.� i [ 1 - f 1 PJA.�JC f AL h,f1��AGEticNT . �
A. Annua! budgei-: a budgef re I ated to ths cenfier's ob jec-F i ves i s prepared annua I l y.
6. Accounti ng sysfiem and recards: an accour,ti ng systen i n ma i nta i ned fihat- -
: produces infor�ation reflecfiing the fiscal ex?erience and the c�rren� financiat
. pos i ti on of fihe cen�ker. � . .
� I . The center �mainfiains records adequaie to mset i�s operating needs . � �
� and its obligations io clients, third-party payors and oti�er � � � �
. .interested parties. . � .
2. Reports of fihe center's �current financiat position and other pertirent
financial informafiion are subr,ri-tted to the governing body at least
quarterly. � -
3. The center- provides for an iridepe.r,dent certitied audit or an . .
unaudited opinion of its finarcial operations to be carried out
annua t ly. • -�- . �
C. Insu rance: an insuranCe program. that prbvides for adequate cor�prehensiv� �
� liability insurance covering center personnet and for pro�ection of fihe centerts .
physical and financiat resources is in effecfi. � . .
D. The clinic is in compliance riith State and Federal ta�:s regarding tinancial
reporting. � . .
1 . Tax re-turn is prepared and subr�itted annually. • - . �
2. State a�d Federal employ.ee �rithliolding taxzs are deposited regufarly
within legal limits. ��
3. State and Federa I returns for er�p 1 oyee �r i thhe I d tar,es are f i f ed
quarterly. �
4. The center meets requireme�ts �or S�afie Uner.►p(oye�ent lnsurance for � .
its empioyees. ' •
5. The centsr meeys requ i rements ior ti•!orkr��n's Cer..pErsat i o� i nsurance
for its employees. �.
6. The op�ion to join the Fed�ral Social Securi�y .pro,ra� has baen offered
to the ernployees (p�rtains to 501 (c) (3), organi:atic�s) .
' � �'�n�ru� S�a�d-ards � �
.• •
` • � ••Poca FoUr .
, . . s
� • • .
STF.^�DRRD f V - O�2GAPJ I ZAT I�PJAL PLA�JP�i P�G � .
A. Goals and 05jectivas: the b����d of 'i�ectors has devalopecl a set of goals
and objecfiives �•rhich includes:
I . The overall philosophy or r�ission o� the clinic. �, � �
� 2. Its projected ou-tcomes relative to the scope o` health services avaita6le . : :
� fio its ct ien-ts.
3. The cor:�mun i iy tboth geograph i c and cu t tura I) �o be served. . -
4. Ofiher p ro jected ou-tcomes re�erred to or i r.+p I i�d by ti:e r�i ss i on sfiatenenfi �
such as cost of care, client a�vocacy, etc. . . � .
B. Progran Planning: the board annuafiy develops po[ icizs and objectives based .
on the philosophy and goals of the center. �
' I . The chief adr�inisfirative officer dsve{ops an annuat workpfan based on -. .
the priorities ot the board. �The workplan addresses: : . ' '
� a. The number of ctienfis to be served. ,
� . b. Th e scope of services -to be delivered. _ � • -
�. The effect of the services on the cost of care. . �
. a . _
� d. ��The r,�thods of f i nanc i ng the .c�re -to be de I i vered. � � : . � • :
e. The person powzr necessary to de( iver the services. �
fi.� The space necessary for delivering the services. � �
� g. The relationship wii-h oi-her providers of care. . - � . .
C. Progran Evaluation: fihe director or chief administrative officer reporfis �.to the
_ governing body annualty regarding the eftectiveness of the Frograr�. i"he report � �
includes: -
I . NumSsrs of clients served. -
2. The scope of services delivared at the center. �
3. The average cosi' of services per client visit.
4. The adequacy of the phys.ical space in which services a�are deli.vzred. .
. .
5. 7h� nur�bers and corpe�tercies of the sta`f �:ho delivered the services. .
6. Current relationships with other provi�ers of care.
, .�ag� r �ve . . . .
•;• •
. . , , .
. . , . . . . •
, . , �
, 'STAVCARD V - F�:YStCAI cP�VIROl�i�'�ivT �
The center site conforr�s to buildir.g, health and fire re:qulaflo�5 of the city,
county and/or v i I i age where i n i t i s located ane► c�t�:p 1 i ar�ce i, adec�ua�Fe I y dc,cur.,eni�ed.
STR.iyDf�RD V( - POL(�Y A�lD PRC�'tDI;RE .
Policy and .proce�u�e are d�velop�d for inple�en�irg the stated goals ar.d o�jectives
ot the center. � �
A. h;anuats: policy ar+d procedure manuals exist havinc been develaped w.ii-h the
advics of professionai persennet , adminis�-ration and ctients and are revie�•�ed
at teast annualiy and revised as necessary. The manual (s) inclLC�e guide( ines
govern i ng the Frov i s i on of emsrgar�cy a�d non-ar�ergency care si��a-F inay be gi ven
• at -the facilifiy, and cover at least The follo►�ing: .
� I . Protoco{ tcr er�ergency procedurzs �hat r.►ay be perferred in fihe cenizr.
� " 2. Procedures to be� foflowed in referring a ctienfi to ano�he� facitity �
' for care no-t ava i I ab l e at the center. . . � • -
3. Protocot regarding contact wii-h cor•�municable disease and procedures
for infec�ion contro( at i-he cen-ter. �
4. Pro�ocol for contacting clients when fotlow--up visits are necessary.
. _ . y
8. Convenier�ce/Accessibility: the center has in effecfi poticies and pracedures
which assure. that center services are a�fered at tires/occasions and in a
rranner thafi i s reasonab I y conven i ent fer the ra jor i�y of the c�i er,-�s. .
, � . . .
' 1 . The availability of transportafiion and the work/schoot requirer:,ants �
of clients are taken into account. �
� 2. A schedule showing the days and hours whEn the cEnter is open is
posteci in a conspicuous place in fihe center an� made availabte .
� " to possibte referral sources. �
3. I f 1 ang�age or cu I tura I barri ers ex i st bet►•;zen cer�ter personne t . . �
and a significant nur�ber. of clients, arrangements shouid be nade
fo r in�erpreters to b� present, multi-languace signs to be pos-ted,
� or for o�her rr�echan i sms to ensure adeguate cor::nun i catio�. �
4. Procedures are developed to accomrtiod�te ctients arith physical handicaps.
C. Appo i nfir�er�t sys-i�en: i f the center sees c I i ents by appo i n�tment, a t i rre-s�ec i f i c
appo i ntmz�i system i s estab I i shed, w i th adequate t i r�a a I I oe;ed for sfia;f -to see .
nevl clients as �vell as ttios� making return visits.
I . Average waiting timz at the center should no-t exceed one hour.
2. . To the extent possib.le.effor►s are r�a�e tc enable the client
to se2 the same provider on each returr, visit. �
�
� • ,
. .,�;ini�a.rr� S�andards : ` ,
,• � Far�.. S'i X .
� . s
3. Fo, r:�n--errer�encv c�r�e, c t i en�t sho:.!d 'nave ��c :ra i�� n� t ong�r -th�n t►•�o '
, heeks for appoi�fi�e�ts. .
� D. Cont i nu i ty of cara: the cen�er adop.ts a�d i mp 1 e�^a�1s r:echan i sms 1�� ensure
! tne co�tinuity and avaitability of care. � •
I . A rr�chzn i sn i s esta5l i shed for prov i d i r.g serv i ces -to unsch���u Icd . . _
clients urg�nt{y in nes� of care. � - _
2. The c! ient is infor�d a� th� tir�e �f ihe initiai contact ��ifih i�he � . �
. cen�er of the ser�fices avaiDable at the cen�er znd is given ihe
opportunity to plan for M�ays in a:hich these services can be � � .
integrated into his/her totai care. . � �
3. Ofif-hou� ned i ca I coverage i s prov i ded by the cenfier or an a l fiernafi i ve .
rr►zchanis� is .devetoped to ensure coverage. .
4. A recorded telephone n�ssage is utilized teaving instructions for
clients calling during times when fihe center is not open. �... . �
5. A procedure exists for. referring clients �to ofiher facilities for care '
not availabte afi the eenter and guidelines cover ai- least the foltoteing: �
a. Informing the client ot aifiernative sources of care and steFs . _
� that nust be taken to arrange for the care. � - � � •
; b. Transferring of information regarding the cl ient with i-hz - � :
client's authorization to.the receiving facility. �. •
c. Transfer.ring of informa�ivn regar �ng 1-h.e cl ient from -the � �.
receiving facility to the center �or inclusion in the clien-F's ' .
center records. � .
E. Clientst Rights/Responsibilifiies: -the center adopts and makes available to . . .
clients writi'en� policies regarding the rights/responsibili�ties ot ctients. � � . �
These policies ensure each client at least tha� he/she is: : � . • �
I . Fully informed of these rights and of alt rutes and regutations �
concerning clienfi condLCt and responsibilities. �
_ 2. lnformed of the identity(ies) of the peo�le invofved in his�her �
ca re. ( f trainees participate in the care, hels�e shal [ be so
in�ormed. �
3. (nforr�ed of the charges for services involved in the care given and '
that th� cha�ges for all services provided by the, cen�er be avaiiabfe .
at �equast. • �
4. Informed of the reasons for and nature of atl exa!:�ina�ions, testing and -
procedures that are done. � �
� �::inir.:�m S�fa:�J3�d� '
. �?a;e �SeWen ' � . ' �
. . . , .
5, Inf�rmeJ of -th� natur�: of his/her co�:di;:c:� ��d of alierr�-ii�ive •
treat�^?nts, if they exist, providir:g for his par�icipation in fihe �
pi�nning for care.
6. I nforr,ied of h i s/her r i�hi- to re f�se treatrs�nf recomrcendec! ar-�d of , �
. the possible conseque�.ces of that refusal . •
7. Inforr�sd and assisted to understand z�d exerci�e his/her rights . � .
and may, via an existing m�chanism,. voica grievances and recor,r�end . �
changes in Folicies and service to cer,ter staff and outside , :
� repres�ntatives of his/h�r choice. :
8. Assure confidentiai trea�-man-t of his/her disc(osures and record�,
and�r�y approve or refuse the release o� any intormation to any � �
individua! not involved in his/her c�re at the cenfier except as �
� required by faw or fihird-party payr.:ent contract. �
9. T�eated with consideration, respsct, and full considerafiion of �
his/her dignit'y ahd individuatity, including privacy in treatr�ent � .
and care. . � .. � . - � . . .
STAPI DARD V 1 ( - ��ED I CA L RECORDS
tndividual client �ecards and reporting systerrs necessary to carry .out program �
evaluation and to maet atl applicable professional, administrafiive, planning and
legal requirements shall be established and naintained. . � .
A. Individual clienfi records: a mzdical record is mai�lfiained for every �
client receiving medica! care provided bylthe service.
. I . A sample of inedical records is revieared periodically by designated� -
administrative and/or professiona{ s�aff to deternine the quality
of the records. �
2. Medicat records contain aII of the tollo�ring data: .
� a. Personat data including: � . � �
I , patient identification �
� 2, name(s} of person(s) io be notitied in case of er,�2rgsr,cy
3. service registratioz, or other idenfiifying nurrber
4. identification ot ofiher sources of r�dica! care � .
5. source of referral � '
6. date of visits • �
7. desig�ation of prirary physiciar� or health worker
responsible for ctier,t's carE. .
. a h':hii i,�un �Standards " - ' .
• :F'��f�..c-i�ohfi
. ' �
b. Clinicai data including:
� I . ciien� ��istory to include h:story of alf_�rgies �
and previous illnesses, hospif�lizatio��s, and • --
surgeries and medication used. � � .
2. physicai examination report . .� . _
. _. 3. cl ientts current probler�s - � •
. � 4. clinical no�es writien by approFriate center - •
personna) . � . .
5. consulfiation reporfis; if appticable
6. copy of relevanfi records of car-e rendered �
. - by other providers . .
_. c. Diagnosfiic da-ta inciudinq: � ; .
. : . 1. t aborafiory reports � . • .
2. radiology reports � . .
. 3. o�her reports; as applicable �
d. Treafiment and instructions, inctuding: --
I . client nanagemsnt pla�s, including follo���-up :� . .
� action as indicated `
2. notations af prescriptions written
• . - 3. setf-care instructions .
4. Tnstructions regarding return visits . • � � '
5. si�ned consent forms an� signed reteases - . �
6. i nstructions for care g i ven per te iephor,z �� �_
8. C�nfiidentiality: •the confiden-Fiality of al ! r�edical records is maintained subject
�o applicable la;rrs and third-party contracTS requir:ng disclosure. �
1 . The center safeguards the infor�ation in fihe record against �ioss, �
defacer�ent, '�amperi ng'.or unau►hori zed uss. . • .
2. The center's emptoyees receive instruction concerning the �_
preserva�ion of the conficentiality of the clisr,�'s r:;edical records.
3. b�lrit-te� in2ormal consent of the cliert shall be requi�ed for the �
release of Medical information. • • '. "
�� Pa��;td i ne� • ` � , . • .
�' C. � F i ;1�i n, arid ,r•�tr;=:�,-a 1 systerr.: t��ed i c�1 records are i�dex�:d and �i l e:d i n a .
� � manner- tr;�ich faci 1 ita+es tt�e acquisition af statist�ical information and . �
the retrieval of records for client car� ,and prograr.► evalu�iior, purposes. -
STAi i0r1k� Y I 1 I - LABORATG`RY SEP,V I CES
Laboratory services comrr�nsurate 4vith the center's nea�s are provi�ed by the cenier
itselt, by an outside laboratory which is pari- of an accredited or certified �
hospital , or by an ouisid� inuependent taboratory r,�hich is approved to provide services.
If the center provides la5oratory services directly, the follvrring criteria are
zPPlicable: . . �
A. Personnet : if the center provides more �han bas.ic labora�ory services,
the laboratory is under the direction of - or regular consultation is
� avilable frori - a pathologist. � -
Q. Raquests and reporfis: signed reports of laboratory findings a�re returned .
� promptly to the requesting individual and entered into the c( ient�s
medical record. � � _ •
� � �C, Safety: proper safety� precaut i ons are ma i nta i ned aga i ns� �hazards f�orr _ � '
fire, explosions, electrical equipment, volatile chemicals and flarimable �
so{utions. •
D. Quality control :
. I . The taboratory irrpleman�s en infiernal quality controf program covering
at 1 east�'he ca I i brat i on of equ i pr..ent and'va I i dat i on of fiest resu f-ts.
2._ ta boratory personnet participate in periodic revie�•�s and updates of
procedures and equiprent. :
STP,�DARD 1 X - PHARh9ACEL'TI CAL SERV!CES _
If pharmaceutical services are offered directly by the center, they are provtded . .
� in accordance v�ith acceoted protessionat principles and zppropriate Federal , '
State and local laws and with the folloti�rin� criieria: �
A. Personnel : the dispensing of prescription r�edications shculd be done �
on 1 y by a I i censed pharr^ac i sfi op�rat i ng f rom a pharrracy or by the •
physician in cemptiance wi�h 6linneso-ta Sta�uies whicti allow.s supervised
interns or n�rses to dispense drugs.
8. Prescrip#ions: rr�dicatio�s are dispensed only upcn the �•rrit;en order� of a _ .
I +censed p�actitioner/physician. All r.edications di�pensed r.wst be preperly ,
(a bz l ed w i trt at l east the na^�� of .the c l i ent, the nan�e of the prescr i b i r.g
practitioner/physician, the na:,e of the drug, the directions tor use and
the date the drug �s disper.sed.
i : . _ . . _ .. . .
; _I `.,f .. . ;
, � . .
;:f,,, . . _
. - •
. � �
' ' F•'i n i���- Sfiand3rds
Pays Te:�
C. Patie:�t �rof i le: i r the ce��e; fi I Is r~ascri,,-h�o�:s fro;t non-c�nter prac�itior,�rs/
Fhys i cans, a rned i cat i on Fro�i l e i s ma i nta i nec i n the pharrrac�/. .
D. Contro( led substancts: atl reca��-F:eepi�� and security require�:ents of the
Drug Enforcer.lent Adr:�inistration �ust be conplied r�ith if conirolled substances
are to be utilized. � � � - .
STF.;JDnP,� X - BACK-UP SERV I CES . '
Prov i s i ons are riade for care not a��a i l ab l e at the center i tse l f. �
A. :•irit�en ac�reements for the procure.�.e�t of necessary cons�ltaiions, special
ssrvices not availabte at the centar, and in-patiert care are developsd
r�i th coope rat i ng agenc i es and i nst i-�ut i ons, per i od i ca I !y rev i eti•led, and � �
a�proved by the center's governing body, and w�itte� Foiicies and
procedures exisf governing tha provision of such care. - .. �. . � . _ � _ _ . �
" : t3. Tna agreznants specify the mzchanisr� for transfer o; necessary records - - .
and inforr.►ation.
. � � �
, . �
.
, , __
: �� � � � � = i, -�
_ >
. . � ` � ` . .+�J f .. ' � . . . . . . . .. . � .
_ ,, O�i OZ: I3�3�� �
x.�_
' , .�
�
R�v. s 9/8/76 �
-�
EXP TI� aF AT.�MII�IS'�F�TZV� tS , Y �
; A�N� 8R ' , , ,
, . ��, i
� E � � � "� Ep
�mt�: January 16, 1980 JA�' � `. �9�
_ iMA►�OR'S � "
Tp; 1�YC�& C�►EO�GE LATIM�t .
� FR: 'fhon�as J. Ke1];ey, Di-rector o# Departa�ent of C�iamuni:ty Serv#ces '�
FtEs Contract among North Er�d �le�lth,�enter, the Cvunty Yof Ramsey and the CTty of " ' ,, '�
Saint Paul .�
��
�>:��;
ACTION R£4L1'ESTED: .$��
..._..,.._� .
_ executive approval and signature � � �
, -- ��
." Pi'1RpO�E �iD IiRT30NALE' PQR TSI� ,ACTIt�►N s �
r...:�u�.....�.� �.� ... r..`..,�......�._ .
°_. --
The five� cannunity cl inics (Face to Face, fa�►���� Tr�e, H�'�pri��.�tf��d, Na�rth €�d � '
and I�ast Side) have received funding from ti� ���ty and County s�fi�e"1976 to '
sup�art: �t��ir activities as:,�teighbarhood heat�h centers. This c�nt�ract co�ntf'nc�es :
� � �� . � � �� x
the f i nanc i a l su pport through 1980. . -: =
;
, A'I'TAEBMEI�t'T'S s
Councii Resoluti:on : `
, . �
cdntract decun�e�tt �- ��cop��
aPpendix A -, cop3es - � .
' aPPendix B -° copies _ ��
��I�'°`'� _