Title Page
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Conducted on
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Prepared by
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Location
Entrances and Signage
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Signs are posted in ALL entrances, waiting areas, registration areas, triage areas and treatment areas.
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Posted signs give information about the person's right to a Medical Screening Examination (MSE) regardless of the ability to pay.
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Signs are clearly visible from a distance of 20 feet or the expected vantage point of the patron.
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The signs are in the languages of the population(s) most frequently served by the facility.
Triage Process
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The waiting area is visible to triage staff so that patients can be monitored.
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Patients are directed to triage when they present for care.
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A risk report is generated when a patient leaves before of after triage but before MSE.
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Patients are informed to notify staff if they choose to leave before the MSE.
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Patients who Leave Without Being Seen (LWBS) or Leave With Out Treatment (LWOT) are asked to sign a "Leaving Against Medical Advice" form or "Informed Refusal of Care" form.
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There is a reassessment policy for patients in triage who have not yet had an MSE.
Registration Process
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Initial information collected from patients presenting for care include only basic information such as name, date of birth, chief complaint, date, time and mode of presentation. (Quick Reg)
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Initial registration information (collected prior to the MSE) is documented on the central EMTALA log.
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The MSE is not delayed for registration process.
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The registration staff have a script to address patients who insist on discussing insurance coverage prior to the Medical Screening Examination (MSE).
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Preauthorization of services with insurers does not occur until after the MSE has been conducted.
Stabilizing Treatment
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Stabilizing treatment is performed within the capability of the facility and staff.
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Physicians are presenting to the facility when called and in compliance with timeframes set forth in organization policy.
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There is a communication process between the clinical staff and the registration staff so that any required prior authorization can be sought once stabilization has been initiated.
Transfers Out
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Transfer paperwork documents that individuals with unstabilized EMCs are initiated either by a written request for transfer or a physician certification regarding the medical necessity for the transfer.
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The medical record documents that the risks and benefits of transfer were discussed with the patient.
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The physician documents certification that the benefits outweigh the risks of transfer (focus should be on the patient's complaints, symptoms, and diagnosis).
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Transfer documentation demonstrates that there is an accepting physician (name) at the receiving facility.
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Documentation reflects the name of the person at the receiving facility who accepts the patient on behalf of the facility.
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Pertinent medical records are transferred with the patient.
Transfers In
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There is a transfer IN log to document information regarding requested transfers into the facility.
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The transfer-IN request log contains the date and time of the request.
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The transfer-IN request log documents the requesting facility.
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The transfer-IN log documents service availability at the receiving hospital.
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The transfer IN log documents whether the transfer was accepted or denied.
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The transfer IN log documents the reason for denial if applicable.
Document Review - Policies and EMTALA Log
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The central EMTALA Log documents the date and time of each patient's presentation for care.
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The central EMTALA Log documents the chief complaint of patients presenting for care (preferably in patients' own words).
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The EMTALA Log documents the dates and times of final disposition.
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The EMTALA Log documents the final disposition (e.g. admitted, transferred, jail, died, AMA, LWOT, etc.)
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There is a reassessment policy for patients in triage who have not yet had an MSE.
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The EMTALA policy is up to date for regulatory changes and interpretive guidance changes.
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The EMTALA policy defines "comes to the emergency department."
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The EMTALA policy defines "dedicated emergency department."
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The EMTALA policy defines obligations for non-DED off-campus departments.
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The EMTALA policy defines cessation of EMTAL obligations upon inpatient admission.
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The EMTALA policy defines requirements for back-up arrangements for on-call coverage that are to be documented in policy.