Just What the Doctor Ordered:

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Just What the Doctor Ordered Prescribing
Positive Changes to Medical Documentation Cheryl
Alto MS, RD Cheryl.l.alto_at_state.or.us
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Medical Documentation
getting the most out of this session
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Communication, Collaboration, Coordination
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Opportunity to Coordinate

• Please order Enfamil AR for my patient. Her
  sibling had to have special formula. I assume
  this child will need this formula as well and I
  would like to have it available.

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Opportunity to Collaborate

• My patient is a premature baby with special
  health care needs (congenital heart disease)
  which requires increased calories to grow. He
  will need 24 Kcal/oz formula to thrive. WIC will
  need to give 12 cans of formula for this reason.

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Communication with providers

• Articles in healthcare newsletters, magazines
• State wide letters sent June 8 2009
• Key informant surveys
• Web page for healthcare providers went live June
  1st

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Feedback from providers

• The WIC food package changes are positive
• It is nice to have a form in place of
  prescriptions

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Questions difficult issues

• What questions, concerns do you have?
• What issues have already come up for your clinic,
  for you?

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Qualifying conditions
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Special food packages for special participants
Tools in TWIST
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WIC Medical Documentation Form
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Initiation of the Med Doc form

• Healthcare provider
• WIC agency or the participant

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Nuts bolts of completing the form

• Medical diagnosis and signature to be completed
  by HCP ONLY
• WIC nutritionist can complete Section B as a
  recommendation to the HCP

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Handling changes

• If medical diagnosis remains unchanged, OK to
  receive follow up/changes by phone
• Document any changes on the medical documentation
  form with your name, date and indicate it was a
  verbal order
• Recommend documenting in med doc notes in TWIST
  as well

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Case studies

• Case study A Maribel Torres 3 mo infant
  (pg 102)
• Case study C Quinton Tarintino 14 mo old child
  (pg 106)
• Case study E Johnny Jones 3 year old child
  (pg 110)
• Case study F Sommer Tyme woman (pg 112)

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Difficult questions activity

• Sample questions from the session
• Q What if a med doc form is received and the
  medical diagnosis is missing?
• A The two sections of the medical documentation
  form that WIC staff cannot receive as verbal
  orders are
• Section A Medical Diagnosis, qualifying
  condition
• Section C Signature of healthcare provider.
  
• If either of these sections are blank, fax the
  form back to the HCP to complete and fax back to
  the local agency.

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Difficult questions activity

• Sample questions from the session
• Q Can the new medical documentation form be
  used before August 1st?
• A Yes-for medical formula. And after August
  1st, participants who qualify for foods can
  receive foods and formula, as prescribed by their
  HCP.

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Difficult questions activity

• Sample questions from the session
• Q Are current prescriptions on file still valid
  after August 1st?
• A Yes, for medical formula only. The current
  prescriptions can be honored up until their
  expiration date. If the participant qualifies
  for the other WIC foods and wants to receive
  foods and medical formula, then the new WIC
  medical documentation form needs to be completed.

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Difficult questions activity

• Sample questions from the session
• Q Can a food package be issued while waiting
  for medical documentation to be received from the
  HCP?
• A Yes. The first month of vouchers for the
  special food package can be printed while you
  wait for the medical documentation form to be
  completed. A completed form must be received by
  the WIC clinic before the 2nd month of vouchers
  can be issued.

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Difficult questions

• Additional questions will be added to the website
  in future months.
• Please email any additional questions to
  Cheryl.l.alto_at_state.or.us

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Next steps

• Further discussion at future local agency
  dietitian meetings.
• Complete the required food package module.
• Further discussion at local agencies who will
  approve the med doc forms, who will call for
  clarification from healthcare providers?
• Let State staff know what other job aids,
  resources might be helpful.

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Further communication with healthcare providers

• A listing of HCPs in your area who received
  notification letters is available from the State
  office.
• If local providers in your area were not sent a
  notification letter, notify your nutrition
  consultant with their contact information and a
  letter will be mailed to them.
• Consider following up directly with your local
  providers to assess whether they have questions.
• The change in medical documentation provides an
  opportunity for future communication,
  collaboration, and coordination of care for our
  shared clients.