POLICIES AND PROCEDURES

PURPOSE:

To ensure adherence to all applicable laws, rules, and regulations while ensuring patient access to HORMONE REPLACEMENT & WELLNESS SERVICES, LLC through the use of “live two-way audio-visual communication”. By implementing these procedures, HORMONE REPLACEMENT & WELLNESS SERVICES, LLC will provide “long distance” medical services to patients.

PROCEDURES

I. DEFINITIONS

Telemedicine: The use of electronic communication and information technologies to provide or support medical care at a distance. This definition includes: (1) live interactive two-way audio-video communication; and (2) any communication modalities such as phone, fax, e-mail, the internet, and still imaging that are used in conjunction with such live two-way audio-video communication. The same standards of care and protocol that exist with telemedicine is also used for assessing and treating the patient in-person/on-site. The provider-patient relationship is the same. Even though an “in person” examination is not performed, a physical inspection, utilizing the video format along with a collection of information from patient history, assessment, applicable imaging results and applicable laboratory evaluations, will constitute establishing a provider-patient relationship.

Medical Providers/Providers – A licensed MD, DO, NP, or PA.

II. APPLICATIONS/SCOPE

A. Services

1. The following services will be available through the use of telemedicine:

Women’s Health- bioidentical hormone replacement
Men’s Health- bioidentical hormone replacement, erectile dysfuction
Weight Loss Management
Thyroid Optimization
Cholesterol Management
Skin Care- acne, aging
Alcohol Use Disorder
Acute Visits- STIs, UTI

2. Treatment via telemedicine will not deviate from standards of care applicable to face-to- face assessment and treatment.

3. The telemedicine provider with HORMONE REPLACEMENT & WELLNESS SERVICES, LLC may deem a telemedicine visit an adjunct to periodic face-to-face contact or it may be the only contact by the medical provider if medical provider deems it unnecessary to have an in-person evaluation.

B. Locations

HORMONE REPLACEMENT & WELLNESS SERVICES, LLC health services will be provided as follows:

1. Patient at remote location/Provider at remote location – Medical provider will be at a location of their choosing operating under HORMONE REPLACEMENT & WELLNESS SERVICES, LLC and the patient will be at a location of their choosing such as their home.

C. Clinical Oversight

Clinical oversight of HORMONE REPLACEMENT & WELLNESS SERVICES, LLC medical care will be provided by random audits of patient charts by the Clinical Director of HORMONE REPLACEMENT & WELLNESS SERVICES, LLC. Medical providers will have access to the clinical director for clinical questions as they arise.

D. Contraindications for Use

The consulting provider should request face-to-face consultation if the patient's condition does not lend itself to a telemedicine consultation or if visual or sound quality is inadequate.

III. PROVIDERS

A. HORMONE REPLACEMENT & WELLNESS SERVICES, LLC medical care will be provided by licensed and credentialed medical providers. The clinical care will be provided within the scope of their license.

B. Providers will be licensed in each respective state they provide services to. Each provider will be board certified and have an unrestricted DEA license.

C. Providers are responsible for being aware of and abiding by the current rules/laws governing the state of practice relating to prescribing medications and telemedicine law.

D. Providers will have at least 1 year of clinic experience, preferably in hormone replacement and family medicine. Ultimate decision of hiring will be up to the clinical directors of HORMONE REPLACEMENT & WELLNESS SERVICES, LLC.

E. Providers will complete provided training material and obtain the CME credit before providing medical services unless experience dictates otherwise.

IV. PRIVACY, CONFIDENTIALITY AND SECURITY

A. The privacy and confidentiality of the telemedicine medical service will be maintained by ensuring that the locations of the patient and medical provider are secure. The services will be provided in a controlled environment (closed doors) where there is a reasonable expectation of absence from intrusion by individuals not involved in the patient's direct care.

B. “Do Not Enter” signs will be recommended to be posted on the outside doors of facilities used in order to notify individuals not to enter the room during the telemedicine visit.

C. HORMONE REPLACEMENT & WELLNESS SERVICES, LLC staff, or ancillary contracted staff, involved in the patient’s care, family members and technical staff may at times be present in interviews. Patients will be informed about others present in the room at the distant site if such persons are off camera and appropriate authorizations for disclosure of information will be obtained. Whenever possible, the presence of non-clinical staff during the telemedicine visit will be avoided.

D. The telemedicine medical service will not be audio- or video-taped without written informed consent from the patient.

V. INFORMED CONSENT

A. Informed consent for HORMONE REPLACEMENT & WELLNESS SERVICES, LLC and telemedicine services will be obtained from the patient prior to the service.

B. The patient will be made aware of the potential risks and consequences as well as the likely benefits of these telemedicine services. HORMONE REPLACEMENT & WELLNESS SERVICES, LLC will also be given the option of not participating in a telemedicine visit if this is not an appropriate format for adequate evaluation. If patient chooses to not participate in care provided by HORMONE REPLACEMENT & WELLNESS SERVICES, LLC, the telemedicine provider will refer the individual to PCP OR SPECIALIST for further management.

C. The content of the consent will be discussed fully, and a note documented in the record that the above has occurred.

D. The original signed consent will be filed in the patient’s medical record.

VI. REQUIRED DOCUMENTATION

A. All documentation of medical services will be documented in accordance with applicable standards, guidelines, by-laws, rules and regulations. Providers will be expected to document in the provided cloud based EMR.

B. A Progress Note will be completed by the medical provider to document each visit with the patient. The progress note will be completed within 24 hours of the visit.

C. Commencing services from HORMONE REPLACEMENT & WELLNESS SERVICES, LLC, an initial visit will be conducted by the medical provider and documented in the patient’s record.

D. Prescriptions will be documented within the EMR for each patient every time a prescription is issued.

E. Orders for lab work and notation of review of lab work will be documented in the progress notes.

F. When equipment failure prevents adequate diagnosis or treatment, a progress note should be written to document such failure and later transcribed into the EMR.

VII. MEDICAL RECORDS

A. Medical records will be saved in the cloud based EMR and are available/accessible for routine care and in emergency situations.

VIII. TRAINING, LICENSURE AND LIABILITY

A. All staff members involved in the operation of the EMR and provision of the services will demonstrate competency in the system’s operation (including EMR functionality and limitations and means of safeguarding confidentiality and security). Such training will be provided by HORMONE REPLACEMENT & WELLNESS SERVICES, LLC and courses that are readily available through the EMR.

B. All 1099 medical providers will have a background check performed and license verifications prior to employment and yearly thereafter.

C. Medical malpractice insurance in a (CLAIMS MADE OR OCCURRENCE POLICY) will be furnished by HORMONE REPLACEMENT & WELLNESS SERVICES, LLC. All 1099 medical providers will furnish proof of separate professional occurrence based policies for their file and will maintain active status.

IX. EQUIPMENT FOR VIDEO CONFERENCING

A. All medical providers will be expected to have a personal computer, laptop, or tablet that is capable of video conferencing and for operating the EMR.

X. SPECIFIC OPERATING PROCEDURES AND EXPECTATIONS

A. Scheduling of appointments for medical services will be predominantly performed online through the cloud based EMRs scheduling portal accessed from the website. Patients will select the medical provider in their respective state based off available open times and create an appointment. If a patient calls requesting an appointment, they may also be directed to the online portal to make the appointment themselves.

B. After hours calls for HORMONE REPLACEMENT & WELLNESS SERVICES, LLC will be directed to the clinical director for appropriate scheduling or follow up.

XI. PROVIDER RESPONSIBILITIES

A. Providers will be responsible for answering clinically relevant questions, concerns or urgent/emergent matters. The provider will be responsible to address these matters for the patients they provide care too. It is expected that the clinical matter will be addressed within 2 hours of notification by the patient.. Providers are responsible for these actions during normal business hours.

B. Providers will be responsible for ordering labs through the Access Labs portal at the end of the patient’s encounter. Provider is responsible for entering the patient’s demographic data into this lab portal and initiating the order. After the order is placed into the Access Lab’s portal, the provider must also input the lab charge into the EMR.

C. Providers are responsible for reviewing the patient’s lab work prior to the initiation of the follow up visit. It is the clinical director’s responsibility to address critical values that the lab will call into HORMONE REPLACEMENT & WELLNESS SERVICES, LLC.

D. Prescriptions will be called in or eRx by the provider.

1. It is the providers responsibility to ensure they follow lawful prescribing of controlled substances. It is the provider's responsibility to coordinate an in-person evaluation prior to the prescription of a controlled substance or as per the DEA requirement. Prescriptions for a controlled substance should not exceed the amount permitted by law.

E. Scheduling

1. During this initial consultation it is the providers responsibility to ensure the informed consent is reviewed, absolute and relative contraindications are assessed and a completely history is performed.

2. After the initial consultation, lab work will be ordered and the follow up visit will be scheduled in 2-4 weeks. This follow up visit is when lab work will be reviewed and a plan will be started.

3. (YOU NEED TO INCLUDE ANY ADDITIONAL SCHEDULING POLICIES IN THIS SECTION).

F. It is the provider’s responsibility to stay up to date in current medical practices in regards to services rendered by HORMONE REPLACEMENT & WELLNESS SERVICES, LLC.

G. It is the provider’s responsibility to educate the patient about the importance of establishing, following up and maintaining care with a primary care provider outside of services provided by HORMONE REPLACEMENT & WELLNESS SERVICES, LLC.

H. It is at the provider’s discretion to obtain a full physical examination of the patient prior to initiating treatment. An inspection examination will be performed during the initial video visit. A physical exam can be done by the patient's primary care provider or at an urgent care and sent to HORMONE REPLACEMENT & WELLNESS SERVICES, LLC.

I acknowledge that I have received a copy of the above policies and procedures, which describes important information about HORMONE REPLACEMENT & WELLNESS SERVICES, LLC, and understand that I should consult the HORMONE REPLACEMENT & WELLNESS SERVICES, LLC administrators and/or clinical director if I have questions. I have entered into employment with HORMONE REPLACEMENT & WELLNESS SERVICES, LLC voluntarily and acknowledge that it is bound to the employment contract.
Since the information, policies and procedures described here are necessarily subject to change, I acknowledge that revisions to the Manual may occur. I understand that HORMONE REPLACEMENT & WELLNESS SERVICES, LLC may change, modify, suspend, interpret or cancel, in whole or part, any of the published or unpublished personnel policies or practices, with or without notice, at its sole discretion, without giving cause or justification to any employee or contractor. Such revised information may supersede, modify or eliminate existing policies. HORMONE REPLACEMENT & WELLNESS SERVICES, LLC shall have sole authority to add, delete or adopt revisions to these policies and procedures. Any oral statement by administration or an employee of HORMONE REPLACEMENT & WELLNESS SERVICES, LLC contrary to these policies and procedures is invalid and should not be relied upon by any employee.
I understand and agree that I will read and comply with the policies contained in this Manual and any revisions, am bound by the provisions contained therein, and that my continued employment is contingent on following those policies.

Name of Contact Person: