- Read each policy below. Click on the "I ACCEPT" buttons to certify that you have received, read, understand and agree to comply with all the policies, procedures, expectations and requirements specified in each policy. This is a MANDATORY requirement for your orientation.
General Information
Most facilities will ask you for a copy of your RN license and any credentials you have such as BCLS, ACLS, Fetal Heart Monitoring, etc. during your orientation to the facility. Be sure to bring these with you. You should always have available while you are working in any facility.
During your hospital orientation you may be required to do much of the same safety, HIPAA, age specific, etc. training and testing that you will be doing by completing this packet. Please understand that the facilities all require this to be done prior to your start date but still require their own specific training and testing. We strive to provide the most comprehensive, JCAHO compliant orientation and testing, however some facilities have very specific, individualized requirements.
- Parking
- Dress Code
- Smoking Policy
- Breaks/Lunches
- Chain of Command
- Emergency Codes
- Quality Improvement - How are you expected to participate in the facility's Quality Improvement processes
As always, you will be expected to follow individual facility policy related to each of the above.
Mission Statement:
Emerald is dedicated to providing for the growing supplemental nurse staffing needs to healthcare facilities throughout California, Texas, Arizona, Florida and Nevada by providing the most efficient and effective recruitment of qualified registered nurses while meeting all regulatory compliance requirements. We provide superior customer service to both our nurses and our healthcare clients. It is our belief that by playing a vital role in placing nurses who excel in their work, Emerald significantly affects the quality of direct patient care.
Abuse Reporting Policy
All Epic Travel Staffing nurses will report all actual and suspected incidences of child and/or dependent/elder abuse according to State & Federal mandates. Travel nurses are expected to inquire at each facility they are assigned to as to the appropriate personnel/agencies to contact in the event of abuse suspected or witnessed at the assigned facility. An inability to locate the correct agency for reporting purposes is not an acceptable reason for not reporting abuse!
Child Abuse & Neglect (Penal Code 11166)
Section 11166 of the California Penal Code REQUIRES any health practitioner, in his/her professional capacity or within the scope of his/her employment who has knowledge of or observes a child whom he/she knows or reasonably suspects has been the victim of child abuse must report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by telephone and prepare and send a written report thereof within 36 hours of receiving the information about the incident. "Reasonable suspicion" means that it is objectively reasonable for a person to entertain such a suspicion, based upon facts that could cause a reasonable person in a like position, drawing when appropriate on his/her training and experience, to suspect child abuse.
Dependent/Elder Abuse (Welfare & Institutions Code Section 15630)
California law requires health practitioners, who (in their professional capacity or within the scope of their employment) observe evidence of or have been told by an elder or dependent adult that he/she is a victim of physical abuse are REQUIRED to report this to county adult protective services or a local law enforcement agency immediately, or as soon as possible, by telephone with a written report submitted within two working days. State law PERMITS reporting of other types of abuse such as neglect, intimidation, fiduciary abuse, abandonment, isolation, or other treatment that results in physical harm, pain, or mental suffering when the reporter has knowledge of or reasonably suspects one or more of these types of abuse have occurred. Elders are defined as persons 65 years or older, and dependent adults are defined as persons between the ages of 18-64 whose physical or mental limitations restrict their ability to care for themselves.
Suspected Inflicted Injury as a Result of Assaultive or Abusive Conduct (AB 1652 & Penal Code 11160)
Any health practitioner employed in a health facility, or clinic who has knowledge of, or observes, in his/her professional capacity or within the scope of his/her employment, a patient whom he/she knows or reasonably suspects is a person suffering from any wound or other injury inflicted by his/her own act or inflicted by another where the injury is by means of a knife, firearm, or other deadly weapon, or suffering from any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abuse conduct shall make a report to a local law enforcement agency, by telephone, immediately or as soon as practically possible. A written report shall be prepared and sent to the local law enforcement agency within two working days of receiving the information regarding the person.
Failure to comply with these laws is a misdemeanor, in California, punishable by up to six months in jail, by a fine of $1000, or both.
Substance Abuse Policy
It is the policy of Epic Travel Staffing (EHS) that all employees must report to work completely free from the presence of illegal drugs and/or the effect of alcohol. Employees, while working, are prohibited from purchasing, transferring, using or possessing illegal drugs or from abusing alcohol or prescription drugs in any way that is illegal.
Drug testing is a requirement for all assignments and general employment as a travel nurse (employee) with EHS. All employees must consent to drug testing prior to beginning an assignment, annually thereafter and to additional testing if illicit drug use is suspected (i.e. missing narcotics, impaired performance, erratic behavior, etc.). Employees who decline to undergo drug testing will not be considered for employment. Employees who have a positive drug test result will be terminated from theit current contract, be reported to the board of nursing for the license they are working under, and will be put on employment hold until the time they can provide EHS with proof from the board of nursing that their issue has been resolved.
The use of prescription drugs, as part of a prescribed medical treatment by a licensed physician is not prohibited. Each drug test is reviewed by the MRO (medical review office) for these occurances to vet out any necessary medical prescriptions. Nurses are required to inform his/her supervisor at the assigned facility and the Director of Nursing at Epic Travel Staffing if the legal use of a prescription drug will in any way affect the ability of the nurse to perform his/her assigned job. It is the employee's responsibility to determine whether a prescribed drug may impair job performance. Working while impaired in any way will be subject to disciplinary action up to and including termination.
It is the employee's responsibility to seek assistance from drug or alcohol rehabilitation programs before this problem affects judgment, performance or behavior.
All employees should report evidence of alcohol or drug abuse to a supervisor at the assigned facility immediately. In cases where the use of alcohol or drugs pose an imminent threat to the safety of persons or property, an employee must report the violation. Failure to do so could result in disciplinary action for the non-reporting employee.
Refusing to comply with this policy may be cause for disciplinary actions, up to and including termination.
Nothing in this policy shall be construed to alter or amend the at-will employment relationship between Epic Travel Staffing and its employees.
Disciplinary Action Policy
This policy provides guidelines only related to attendance, performance, behavior and progressive disciplinary action for Epic Travel Staffing travel nurses; not all possible situations are covered specifically in this policy.
Tardiness
Emerald nurses are expected to be on their assigned unit ready to begin working prior to the beginning of the shift. Tardiness is defined by the facility the nurse is assigned. Excessive tardiness will be subject to disciplinary action.
Sick Calls/Cancellations
When nurses accept a contractual assignment, they have committed themselves to the assigned facility and to Emerald. If a sick call or cancellation becomes necessary, the nurse is expected to give both the assigned facility AND Emerald a four (4) hour notice. More than two (2) sick calls/cancellations in a thirty (30) day period, or more than one (1) sick call with less than four (4) hours notice will be grounds for disciplinary action.
Unexcused Absence - No Call/Show
When a nurse does not notify the assigned facility and/or Emerald and does not report to duty as scheduled, the no call/no show is grounds for immediate termination.
Performance and Behavior
Emerald nurses are expected to conduct themselves professionally at all times. This includes both verbal and non-verbal communication with patients, family, staff and management. Nurses are expected to maintain professional, courteous attitudes at all times. Any complaints made by the assigned facility related to performance and/or behavioral issues about the nurse will be investigated by the Director of Nursing, or designee, at Emerald. Unsatisfactory work performance or behavior is unacceptable and may result in disciplinary action up to and including immediate termination.
Disciplinary Action Procedures
Generally, Emerald utilizes progressive discipline in which performance or behavior problems are dealt with progressively stricter actions if improvement is not made. However, in some cases, depending on the severity of the unacceptable behavior or performance, immediate termination may be necessary. The following actions will be utilized for non-compliance with Emerald policies: * Counseling/Verbal Warning - verbal consultation with nurse to identify problem(s), appropriate actions and expected outcomes.
* Written Warning - A written warning will be given if a problem/issue identified during counseling/verbal warning continues.
* Termination - Termination will occur when all efforts to satisfactorily resolve the issue of concern have been exhausted and/or if the severity of the issue warrants termination.
HIPAA Policy
The confidentiality of protected health information (PHI*) is protected by law and Epic Travel Staffing policy. The intent of these laws and policy is to assure that confidentiality of information is appropriately maintained when any such information is used for business or clinical operations. Nurses may see or hear confidential information in any form (oral, written, electronic) regarding patients and/or their family members (i.e. patient records, test results, conversations, financial information).
All nurses employed with Epic Travel Staffing are expected to adhere to the following: *Maintain and protect the privacy of all business and medical information relating to patients.
*Acknowledge that any confidential information learned on the job does not belong to the nurse and he/she has no right or ownership to it. Access to confidential information may be removed by the facility a nurse is assigned to at any time for any reason. *Will not misuse confidential information and will only access information that is necessary for the nurse to do his/her job. The nurse will not use or disclose any confidential information in any manner (verbal, written, electronic) unless required to do so in order to provide appropriate and necessary care to a patient. *Will not share, alter or destroy any confidential information unless it is a necessary part of the job. If it is necessary, the nurse will follow the correct procedure as directed at the assigned facility. Nurse will not share any patient names with Emerald staff. *Will only print or download information from any computer system when it is necessary for a legitimate work related purpose. The nurse is accountable for this information until it is properly disposed of or filed. *Will keep any computer password secret and will not share it. The nurse is responsible to protect his/her password or other access to confidential information. The nurse understands that use of an electronic system at the assigned facility may be periodically monitored and audited to ensure compliance with the law. *Must immediately report to the assigned hospital supervisor/manager if he/she suspects anyone is misusing confidential information or is using his/her password. Epic Travel Staffing will not tolerate any retaliation against the nurse for making such a report. *Upon termination of my assignment with any health care facility, the nurse will promptly return any facility documents or data containing that facility's confidential information or date that is in my possession or control. *Will follow the HIPPA policy and procedures as defined by each individual health care facility the nurse may be assigned to during employment with Epic Travel Staffing.
Any failure to comply with each term in this agreement may result in disciplinary action up to and including termination of assignment and/or employment with Epic Travel Staffing.
*PHI is defined as any information, including demographic information, collected from an individual that (a) is created or received by a health care provider, health plan, employer or health care clearing hours; and (b) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision for health care to an individual and identifies the individual or with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE This notice describes our organization's practices and that of: *Any employee authorized to enter information into your employee file. *All departments and units of the company. *All employees, staff, and other hospital personnel *All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other company/hospital operations purposes described in this notice. OUR PLEDGE REGARDING MEDICAL INFORMATION We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create an employee record on you to ensure you meet the requirements of healthcare facilities that you may be assigned a travel nurse position. We need this record to comply with certain legal requirements. This notice applies to all of the medical information/records of you that we receive as part of your employment with us and as required by contracted healthcare facilities. Your contracted healthcare facility may have different policies or notices regarding the healthcare facility's use and disclosure of your medical information created in our office. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to: *Make sure that medical information that identifies you is kept private; *Give you this notice of our legal duties and privacy practices with respect to medical information about you; and *Follow the terms of the notice that is currently in effect. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
*For Company Operations. We may use and disclose medical information about you for company operations. These uses and disclosures are necessary to run the company and to make sure that all of our contracted healthcare facilities meet their travel nurse policy and procedures and meet the requirements from regulatory agencies regarding the health status of healthcare providers. We may use medical information to determine whether or not you meet healthcare provider requirements to work at a contracted healthcare facility as a travel nurse. Different departments of the company also may share medical information about you in order to secure a travel assignment for you at a healthcare facility. *Appointment Scheduling and Reminders. We may use and disclose medical information to contact you to set up appointments or as a reminder that you have an appointment for testing and/or care at a medical clinic.
*As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. *To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. SPECIAL SITUATIONS*Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. *Lawsuits and Disputes. If you are involved in a lawsuit, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested. *Law Enforcement. We may release medical information if asked to do so by a law enforcement official: *In response to a court order, subpoena, warrant, summons or similar process; *To identify or locate a suspect, fugitive, material witness, or missing person; *About the victim of a crime if, under certain limited circumstance, we are unable to obtain the person's agreement; *About a death we believe may be the result of criminal conduct; *About criminal conduct at the company or at the assigned hospital; and *In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. *National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU You have the following rights regarding medical information we maintain about you: *Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your assignments at healthcare facilities. *To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Human Resources/Clinical. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. *Right to Amend. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the company. To request an amendment, your request must be made in writing and submitted to Human Resources/Clinical. In addition, you must provide a reason that supports your request. *We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: *Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
*Is not part of the medical information kept by or for the company; *Is not part of the information which you would be permitted to inspect and copy; or *Is accurate and complete. *Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. *To obtain a paper copy of this notice, please call the Human Resources/Clinical Department.CHANGES TO THIS NOTICE We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The notice will contain an effective date.
COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the company or with the Secretary of the Department of Health and Human Services. To file a complaint with the company, contact the Human Resources/Clinical Department. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical information that we have already received on you.
Documentation Policy
- All Epic Travel Staffing nurses are expected to adhere to the following when documenting, whether electronically or in writing. *Use correct grammar & spelling
*Date & Time ALL entries
*No "block" documentation
*No white out, tape, stickers
*Document education and pain assessments
*Check for correct name on each page you write on or on the computer "page"
*Never skip lines or leave blanks - fill in blanks with "N/A"
*Document every notification to MD or family
*Note every MD order - means that you have checked that everything regarding order is in place, done, etc. - always follow facility policy and procedure
*Never destroy or discard any part of a medical record.
*Include the following when documenting:
*Initial and ongoing assessments
*Any action taken, including reports to physicians
*Each observation (failure to document will produce gaps in the patient's record that will suggest that you neglected the patient)
*Variations from the assessment and plan
*Accountability information, including forms signed by the patient, location of patient valuables, and patient education
*Notation of care by other disciplines, i.e. physicians
*Health teaching, including content and response
*Procedures and diagnostic tests
*Patient response to any interventions, including drugs, diagnostic tests and therapy
*Statements made by patient and family
*Patient comfort and safety measures
*Document objectively, not subjectively - do not use judgments - only state the FACTS - not opinions
*All documentation must be: *Timely
*Clear, accurate, problem focused
*Succinct, brief
*Interdisciplinary
*Don't interrupt others while they are documenting
*Do not "hoard" charts - allow others access to charts
*Chart as much as you can as soon as you leave the patient's room Each professional has a legal duty to maintain the medical record in sufficient detail. Inadequate documentation may result in liability or non-reimbursement
The Eight Deadly Sins of Documentation: *Abbreviations - use only facility approved
*Labels - use description of behavior vs. naming the behavior (i.e. yelling vs. angry)
*Dirty Laundry - do not document inappropriate behavior of other healthcare providers
*Never charting before care is given - this includes meds - Result is that you lose credibility and is illegal.
*Incident/Accident - don't use these words in your documentation.
Document what happened in objective terms. Fill out incident report but don't write in chart, "filled out incident report" *Staffing problems - don't document that staffing is short, etc.
*Alteration/destruction of records - Do not throw away soiled or torn documents, start a new one and keep with the old one.
*ILLEGIBLE HANDWRITING - including spelling errors. Sloppy charting will be interpreted by a jury as sloppy care. If you cannot write legible, then you MUST print.
REMEMBER: If it's not documented, it wasn't done! Communication Policy
Patients expect a lot from nurses - to have clinical expertise, to be advocates, to provide education, etc. Nurses are the face and personality of any facility. They are everything to the patients - response time, pain management, source of information, compassion & concern. The overall perception by patients of the care received is influenced dramatically by the way you communicate.
Communication Expectations & Guidelines: *Greet patients by introducing yourself *Address patient by name
*Tell them who your are, giving your name and position
*Always wear a name tag
*Helps to provide security
*Make eye contact, talk to patients not over them, and use their name
*Provide privacy *Knock when entering a patient room
*Close door or draw curtains
*Maintain confidentiality at all times - If you have to ask patient personal questions, let them know why you are asking.
*Make every effort to keep patients informed and involved in their care and put things in writing whenever possible. *Ask for questions - Ask "What additional information can I give you", instead of "Do you have any questions" *Tell patients when they can expect you back & make sure you go back *Attitude *Attitude is something that is within your control - you can control your reaction to events that are not within your control
*Chronic complaining, criticizing and looking for fault in others are trademarks of the classic bad attitude
*SMILE - is a gesture of care and comfort. May take conscious effort to remind yourself to smile especially when you are deep in thought
*Stop "Victim thinking" - Ask yourself, "Am I part of the problem or part of the solution?" Chronic complaining about circumstances won't change them. By choosing to be part of the solution, you are breaking out of the victim role. If the problem is beyond your ability to control or actually solve, do not let it continue to affect you - there are many things in life you simply can not solve so don't waste time complaining about them.
*Be aware of how you communicate with co-workers *Remember actions speak louder than words - watch your body language and behaviors
*Listening is frequently more important than talking
*Treat others with respect at all times
*If someone misperceives what you said, make sure you communicate exactly what you want him or her to perceive.
*Never make assumptions
*Phone Etiquette *When you pick up the phone you become the face and voice of the organization
*Treat phone contacts with the same regard as you would face-to-face contacts
*Speak on the phone or page with a smile
*Always state your name
*Ask, "How can I help you?"General standards of conduct exist to ensure orderly operation and provide the best possible work environment. All employees are required to adhere to all policies, procedures and professional standards of conduct. Failure to abide by these rules may result in disciplinary action, up to and including termination.
Epic Travel Staffing STANDARDS *Always strive for professional excellence
*Be flexible, innovative, and responsive to change
*Manage human and financial resources wisely
*Be a team player, help others succeed
*Encourage open communication
*Treat all individuals with dignity and respect
*Provide superior service to all customers
*Take pride in Epic Travel Staffing and your role in our collective success INFRACTIONS – While it is not intended to be an exhaustive list, the types of misconduct listed below are examples of conduct that may lead to disciplinary action, including immediate termination.
*Violation of the policies of hospitals employee is working at or of Epic Travel Staffing policies, or directing others to violate policies
*Dishonesty, theft, or embezzlement
*Falsification of documents (e.g., employment applications, time sheets, patient records, etc.)
*Referring business to a direct competitor of Epic Travel Staffing
*Accessing, disclosing or discussing confidential information with those not involved with the care or with a need to know
*Refusal to perform work as required and/or as permitted within your scope of practice
*Insubordination, refusing to follow a supervisor’s direction or other disrespectful conduct
*Use of profanity
*Possession, use, or distribution of illegal substances or alcohol on hospital or company premises – or appearing for duty under the influence of alcohol or drugs
*Retaliation, directly or indirectly, against another employee for reporting a suspected violation of policies or applicable laws or regulations
*Conduct that may cause injury to persons or damage to property
*Sleeping on the job
*Actual or threatened physical violence or abuse towards patients or other employees
*Harassment (including sexual harassment)
*Illegal discrimination
*The use of the working relationship to build a personal relationship for monetary gain. Offers of money and gifts to nurses, should be declined politely and firmly.
*Violating safety, health rules or practices or engaging in conduct that creates a safety/health hazard.
*Unsatisfactory job performance or failure to follow professional standards of conduct.
*Unexcused absence, excessive absenteeism and excessive tardiness.Floating Policy
Floating Policy: Emerald travel nurses are expected float, as needed, to alternate patient care units as long as the traveler has the competency and skills to provide care to the patient population in the alternate unit. Floating of nursing personnel is often necessary in order for a hospital to provide sufficient nursing staff throughout the hospital.
What to do if you are asked to float: *Ask for orientation to the unit *Explain your limitations, if any *Be flexible *Do not operate unfamiliar equipment - ask for assistance *Do not act like you know more than you do *If you feel you do not have the clinical competencies to work in the unit, request to be assigned a limited assignment of nursing care duties, which utilize your current clinical competencies. *If you are not sure if you should accept the float assignment, ask yourself if accepting will be more detrimental to the patients than refusing to float. *If you feel you must refuse to float, inform your hospital supervisor/manager, explaining that you do not possess the skills and competency for the float assignment. *Feeling "uncomfortable" floating is NOT an acceptable reason for refusing or not floating. Keep in mind:
*Your California nursing license requires you to maintain basic nursing competency. This competency can be used in the majority of floating situations. *If your unit needed additional staff, wouldn't you want someone to float into your unit? *Regardless of what unit you are assigned to work for your travel assignment, floating may be required, again, if you have the competency and skills for the alternate unit. If you have any questions or concerns about floating, please call Emerald's Director of Nursing.Sentinel Events Policy
Policy: All Emerald travel nurses are to inform Epic Travel Staffing of any unexpected incidents, including errors, unanticipated deaths and other events, injuries, and safety hazards related to the care and services provided. This information will be used for record keeping and tracking purposes. The reporting of errors contributes to improved patient safety and to the development of valuable educational services for the prevention of future errors.
Procedure: If any of the following occur to a patient during the shift the patient is assigned to you, call the Director of Nursing at (800) 917-5055 within 72 hours to report the event/occurrence. Report the date, time, type of occurrence, outcome, hospital and your name (punitive action will not be taken for reporting).
Patient falls - witnessed or unwitnessed, with or without patient injury
Medication errors - includes, but not limited to, misinterpretations, miscalculations, misadministrations, difficulty in interpreting handwritten orders, and misunderstanding of verbal orders, near misses.
Sentinel events - A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
The event has resulted in an unanticipated death or major permanent loss of function, not related to the natural course of the patient's illness or underlying condition, ("Major permanent loss of function" means sensory, motor, physiologic, or intellectual impairment not present on admission requiring continued treatment or life-style change) or
The event is one of the following (even if the outcome was not death or major permanent loss of function unrelated to the natural course of the patient's illness or underlying condition):
Suicide of any individual receiving care, treatment or services in a staffed around-the-clock care setting or within 72 hours of discharge
Unanticipated death of a full-term infant
Abduction of any individual receiving care, treatment or services
Discharge of an infant to the wrong family
Rape - defined as unconsented sexual contact involving a patient and another patient, staff member, or unknown perpetrator while being treated or on the premises of the health care organization, including oral, vaginal or anal penetration or fondling of the patient's sex organ(s) by another individual's hand, sex organ or object.
Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities
Surgery on the wrong individual or wrong body part
Security Incidents - this would such things as theft and property damage
Facts About Workers' Compensation
- The Way It Was
In the early 20th century, a worker injured on the job had to sue his employer to recover medical expenses and lost wages. Lawsuits took months and sometimes years. Juries had to decide who was at fault and how much, if anything, would be paid. In most instances, the worker got nothing. It was costly, time consuming, and often unfair.
The Way It Is Today, the California workers' compensation law provides a faster, fairer way to take care of injured workers…where fault doesn't have to be proved to recover medical expenses and lost wages. This job-injury insurance is paid for by your employer and supervised by the state. If you can't work due to a job-related injury or illness, workers' compensation pays your medical bills and provides money to help replace lost wages until you can return to work.
Who's Covered? Almost every employee in California is protected by workers' compensation, but there are a few exceptions. People in business for themselves and unpaid volunteers may not be covered. Maritime workers and federal employees are covered by similar laws. If you have a question about coverage, ask your employer.
What's Covered? Any injury or illness is covered if it's due to your job. It can be caused by one event, like ea fall, or repeated exposures, such as repetitive motion over time. Everything from first-aid type injuries to serious accidents are covered. Workers' compensation even covers injuries - including physical or psychiatric injuries - resulting from a workplace crime. (Some injuries from voluntary, off-duty recreational, social or athletic activity - for example, the company bowling team - may not be covered. Check with your supervisor or the claim administrator listed at the end of this document if you have questions.).
Coverage is automatic and immediate. There is no qualifying period, no need to earn a certain amount in wages before you are covered…protection begins the first minute you are on the job.
What You Have To Do Immediately notify your supervisor or the employer representative listed on the back of this pamphlet so you can get medical help right away. If it's more than a simple first-aid injury, your employer will give you a claim form so you can describe the injury and how, when and where it happened. To file a claim, complete the "Employee" section of the claim form, keep one copy and return the rest to your employer. You employer will then complete the "Employer" section of the claim form and send one to the claims administrator, who is responsible for handling your claim and notifying you about your eligibility for benefits.
Benefits can't start until the claims administrator knows the injury, so report the injury and file the claim form as soon as possible. State law requires employers to authorize medical treatment within one working day of receiving a claim form, and employers may be liable for as much as $10,000 in treatment until a claim is accepted or rejected. Delays in reporting may delay workers' compensation benefits, and you many not be able to get benefits if you don't file a claim within one year of the date of injury, the date you knew the injury was work related, or the date benefits were last provided. To insure your right to benefits, report every injury, no matter how slight, and request a claim form if it's more than a simple first aid injury.
Benefits The California workers' compensation law guarantees you three kinds of benefits:
*All reasonable and necessary medical care for your injury or illness…with no deductibles. Medical benefits may include treatment by a doctor, hospital, services, lab tests, x-rays, physical therapy, and medicines, but for injuries on or after January 1, 2004, state law limits some medical expenses.
*Tax-free payments to help replace lost wages while you are temporarily disabled. Additional payments are made if the injury causes permanent disability or death.
*For injuries on or after January 1, 2004, if your injury or illness causes permanent disability, your employer doesn't offer appropriate modified or alternative work, and you don't return to work fort the employer within 60 days of when temporary disability ends, you may be eligible for a supplemental job displacement benefit. This is a nontransferable voucher for education-related retaining and/or skill enhancement at state-approved schools. The amount ranges from $4,000 to $10,000 in vouchers depending on the level of permanent disability. Benefit Payments *Medical Care: All medical expenses for reasonable and necessary treatment will be paid directly by the claims administrator, so you should never see a bill. The name and address of the claims administrator are at the end of this document and are pre posted at your workplace.
*Temporary Disability: If you are unable to work for more than three days, including weekends, you are entitled to temporary disability (TD) payments to help replace your lost wages. About two weeks after reporting the injury, you'll get a check. You will continue to receive temporary disability checks every two weeks after that until the doctor says you can return to work. (Payments won't be made for the first three days, however unless you are hospitalized, unless you're hospitalized as an inpatient or unable to work more than 14 days). The amount of these checks will be tow-thirds of your average wage, subject to minimums and maximums set by the state legislature. It probably won't be the full amount of your regular paycheck, but there are no deductions and the payments are tax-free. Under state law, for single injury occurring on or after April 19, 2004, TD payments may not extend for more than 104 compensable weeks within two years from the date of the first payment; or for more than 240 weeks within five years from the date of injury for a few long-term injuries such as severe burns or chronic lung disease.
*Permanent Disability: If your doctor says your injury or illness will always leave you somewhat limited in your ability to work, you many receive permanent disability payments. The amount depends on the doctor's report, how much of the permanent disability was directly caused by your work, and factors such as your age, occupation, type of injury, and the date of injury. The minimum and maximum amounts are set by state law, and vary by injury date, but if you have a permanently disability, your claims administrator will send you a letter explaining how the benefit was calculated. In general, the total amount is a set weekly rate spread over a fixed number of weeks. The first payment is due within 14 days after the final temporary disability payment, or if you were not receiving temporary disability, 14 days after your doctor says your condition is permanent and stationary. After that, the benefit will be paid every 14 days until you reach the maximum or you settle your case and receive a lump sum.
*Death Benefits: If the injury or illness causes death, payments may be made to your relatives or household members who were financially dependent on you. These benefits are set by state law and the amount depends on the number of dependents. These payments are made at the same rate as temporary disability payments. In addition, workers' compensation provides a burial allowance.
*Supplemental Job Displacement Benefits: For injuries on or after January 1, 2004, if you receive temporary disability payments, within 30 days after that benefit ends, your claims administrator will send a letter advising whether your employer has a modified job or alternative work available for you, and explaining your potential rights to a supplemental job displacement benefit. If your employer does not offer modified or alternative work, you don't return to work for the employer within 60 days after your temporary disability ends, and it is determined that you have a permanent disability, you may chose to receive nontransferable vouchers to use at a state accredited school for educational-related retraining or skill enhancement. If you qualify for the supplemental job displacement benefit, your claims administrator will provide vouchers up to a maximum set by state law:
A) Up to $4,000 for permanent disability awards of more than 0 but less than 15 percent.
B) Up to $6,000 for permanent disability awards between 15 percent and 25 percent.
C) Up to $8,000 for permanent disability awards between 26 percent and 49 percent.
D) Up to $10,000 for permanent disability awards between 50 percent and 99 percent.
Other Benefits Workers' Compensation is sometimes confused with State Disability Insurance (SDI). They seem similar, but there are important differences. Workers' compensation insurance covers on-the-job injuries and illnesses and is paid for entirely by your employer. On the other hand, SDI covers off-the-job injuries or sickness, and is paid for by deductions from your paycheck. If you are not receiving workers' compensation benefits, you may me able to get State Disability benefits. For information, call the local office of the state Employment Development Department listed in the government pages of your phone book.
If You Have Any Questions Ask your supervisor or employer representative. Or contact the workers' compensation claims administrator (the name, address, and phone number are listed at the end of this document and are posted at your workplace). You can also contact and information and assistance officer at the State Division of Workers' Compensation (DWC). Information and assistance officers are available at no charge to answer questions, review problems and provide additional written information about workers' compensation. The local office is listed at the end of this document and is posted at your workplace, or you can call 800-736-7401, check the local listing in the white pages of the phone book under State Government Officers/Industrial Relations/Workers' Compensation, or go to the DWC web site athttp://www.dir.ca.gov/dwc.
Physician Predesignation You can be treated immediately by your personal medical doctor (M.D) or a doctor fo osteopathy (D.O) if:
*Your employer officers offer group health coverage;
*The doctor has treated you in the past and has your medical records;
*Prior to the injury the doctor agreed to treat you for work injuries or illnesses and you have your employer the doctor's name and address in writing. This is called "predesignating a personal physician". If you give your employer the name and address of a personal chiropractor (D.C) or acupuncturist (L.A.C) in writing prior to the injury or illness, your claims administrator will arrange treatment with another doctor, then you may switch to the chiropractor or acupuncturist upon request during the first 30 days after your employer knows of your injury or illness. You can notify your employer of a physician predesignation by completing the following form and returning it to your employer. More About Medical Care Good medical care is important - to you, your family and your employer. Quality medical treatment is the quickest way to recover.
*If emergency medical care is needed, call for help immediately and get the best treatment available until emergency personnel arrive. Emergency phone numbers are listed on the back of this document.
*If first-aid is available at your workplace, seek immediate treatment. Report to your employer where and when and how the accident happened. If it's more than a simple first-aid injury, ask your employer for a claim form.
*To make sure your medical bills get paid and you get all your benefits, complete the "Employee" section of the claim form and return it to your employer as soon as possible. Employers are required to notify the claims administrator and authorize medical treatment within one working day of receiving a claim form, so get a signed and dated copy of the claim form back from your employer and keep it with all the other paperwork related to your claim.
*If additional treatment is necessary, your claims administrator will arrange medical care that meets applicable treatment guidelines for the injury. The doctor may be a specialist for your particular type of injury, and he or she will be familiar with worker's compensation requirements and will report promptly so your benefits can be paid.
*The doctor with overall responsibility for treating your injury or illness is your "primary" treating physician (PTP). The PTP decides what kind of medical care you need and when you can return to work. If necessary, he or she will review your job description with you and your employer to define any limitations or restrictions that you may have when you go back to work. The doctor is also responsible for coordinating care between other medical providers, and if it is a serious injury, will write reports about permanent disability or the need for future care. Generally your employer selects the PTP you will see for the first 30 days, but if you want to change doctors for any reason, ask your employer or claims administrator. They're as interested as you are in your prompt recovery and return to work and will select a different doctor for you.
*You can be treated by your personal doctor immediately if your employer offers group health coverage, the doctor agreed in advance to treat you for any work injuries or illnesses, and you gave your employer the doctor's name and address in writing before the injury. If you give the name of your personal chiropractor or acupuncturist, different rules may apply and you many need to see an employer-selected doctor first. If you decide to give your employer the name of a doctor to be your primary treating physician in case of a work injury or illness, he or she must be someone who has treated you before and who has your medical records. You can use the form inside of this pamphlet to give your employer the information about your doctor.
*Generally, if you haven't given your employer the name of your personal physician before the injury, you can switch to your own doctor 30 days after the injury is reported. (Different rules apply if you are a member of a Health Care Organization or a workers compensation medical provider network, so check with your claims administrator if that's the case.) If you switch, choose your doctor carefully - most people don't have a family surgeon, for example. If you want advice about specialists, talk to your claims administrator.
*In an event, report your choice as soon as you make it so the bills will be paid for you. Above all, don't treat yourself. Even minor injuries need expert care. Prompt, quality medical care is the best investment you and your employer can make. In An Emergency
*Seek first aid. If emergency medical care is needed, call for help immediately (see emergency telephone numbers below) and get the best available treatment until emergency personnel arrive.
*Report injuries immediately to your supervisor or employer representative. Your employer is required to provide you with a claim form within one working day of learning of your injury, so insure your rights to benefits by reporting every injury, no matter how slight, and request a claim form if it's more than a simple first-aid injury. Your employer must notify the claims administrator and authorize medical treatment within one working day of receiving your claim form, and will direct you to a doctor, clinic or hospital if necessary. If your claim or benefits are denied, you have a right to challenge the decision, the there are deadlines for filing the necessary papers at the Workers' Compensation Appeals Board, so don't delay.
*Call your employer representative or claims administrator if you have questions or problems. It is illegal for an employer to fire or discriminate against you just because you file, intend to file, or settle a workers' compensation claim, or because you testify for a co-worker who was injured. If you prove this kind of discrimination, you will be entitled to job reinstatement, lost wages and increased benefits, plus costs and expenses up to a maximum set but the state legislature.
Free help and information are available by contacting a Division of Workers' Compensation information and assistance officer at the local office listed below. You can hear recorded information and get a list of local offices by calling 800-736-7401, or you can get additional written information about workers' compensation by going to the Division of Workers' Compensation web site athttp://www.dir.ca.gov/dwc. Worker's Comp Medical Provider Network
- Español
Initial Written Employee Notification Re: Medical Provider Network
(Title 8, California Code of Regulations, section 9767.12)
California Law requires your employer to provide and pay for medical treatment if you are injured at work. Your employer Epic Travel Staffing has chosen to provide this medical care by using a Workers' Compensation physician network called a Medical Provider Network (MPN) accessing the GENEX/First Health Select Comp America providers effective April 16, 2007. This MPN is administered by BROADSPIRE. Your employer's workers' compensation carrier is Zurich American Insurance Company through Cedar Hill Insurance. This notification tells you what you need to know about Zurich American Insurance Company's MPN program and describes your rights in choosing medical care for work related injuries and illnesses.
What is a MPN?
A Medical Provider Network (MPN) is group of health care providers (physicians and other types of providers) set up by an insurer or selfinsured employer and approved by the Division of Workers' Compensation's Administrative Director to treat workers injured on the job. Each MPN must include a mix of doctors specializing in workrelated injuries and doctors with expertise in general areas of medicine. MPNs must meet access to care standards for common occupational injuries and work-related illnesses. Further, the regulations require MPN providers to use medical treatment guidelines adopted by the DWC.
MPNs must allow employees a choice of provider(s) in the network after the employee's first visit.
How do I find out which doctors are in my MPN?
Your employer or insurer has identified the following department/person to be the MPN Contact for all employees:
BROADSPIRE
500 N. State College Blvd., Suite 300
Orange, CA 92868
Toll Free 877-498-4648
This department/person will be answer your questions about the MPN and tell you how to receive or access the names of the doctors in the MPN. Access to a list of MPN providers is available by calling your MPN contact at the number provided above or by going to the website at:
www.genexservices.com
Customer Resources
GENEX Provider Pathway
Enter Log Name & Password
Name: CHI002
Password: chi2
What happens if I get injured at work?
In case of an emergency, you should call 911 or go to the closest emergency room.
If you are injured at work, notify your employer as soon as possible. Your employer will provide you with a claim form. When you notify your employer or insurer that you have had a work-related injury, your employer or insurer will arrange an initial appointment with a doctor in the MPN.
You may be able to treat with your personal physician if you submit in writing a valid predesignation prior to the occurrence of an injury. Refer to the attached PREDESIGNATION OF A PERSONAL PHYSICIAN optional form for the requirements and to predesignate your physician.
How do I choose a provider?
After the first visit, you may continue to be treated by this doctor, or you may choose another doctor from the MPN. You may continue to choose doctors within the MPN for all of your medical care for this injury. If appropriate, you may choose a specialist or ask your treating doctor for a referral to a specialist. If you need help in choosing a doctor, you may contact the MPN Contact listed above.
For non-emergency care, appointments for initial treatment will be available within three (3) business days. In addition, non-emergency appointments with specialists will be available within twenty (20) business days. If you have trouble getting an appointment with a doctor within the MPN, contact the MPN Contact who will assist you.
What if there are no providers in my area?
If you require non-emergency medical treatment outside of the MPN service area or cannot locate a MPN provider within your service area, and fall under any of the following circumstances, you should notify your supervisor of your need for medical treatment outside the MPN Service Area:
*If you are temporarily working or traveling for work *If you are a former employee who permanently resides outside of the MPN service area *If you are an injured employee who decides to temporarily reside outside of the MPN service area. *If your specialty of provider is not available within the MPN service area *If your primary treating physician refers you to a type of specialist not included in your MPN
Your supervisor should provide you with at least three providers outside of the MPN geographic service area who have either been referred by your primary treating provider or selected by you. The referred providers shall be located within the access standards described for the MPN. Employees may change treating physicians or obtain second or third opinions from among the referred physicians.
Are there any guidelines for treatment?
Yes, the MPN will review your treatment and authorize it based on approved treatment guidelines. If your injuries are not covered by the approved treatment guidelines, the MPN will authorize your treatment in accordance with other evidence based medical treatment guidelines generally recognized by the national medical community and that are scientifically based. The MPN will advise you if your treatment is not authorized because it is not supported by the approved practice or treatment guidelines.
What happens if the MPN does not authorize my medical treatment?
If your treatment is reviewed and not authorized, you may request an appeal by following the appeal instructions that were attached to the notice which include information on the phone numbers to contact and the process. This is the MPN's internal utilization review appeals process.
In the event you disagree with the appeal decision and wish to dispute it, you must send written notice of your objection to the claims administrator within twenty (20) days of receipt of the utilization review decision in accordance with Labor Code section 4062. You must meet this deadline even if you are participating in the claims administrator's internal utilization review appeals process.
You may file an Application for Adjudication of Claim and Request for Expedited Hearing, DWC Form 4, showing a bona fide dispute as to entitlement to medical treatment in accordance with sections 10136(b)(1), 10400, and 10408. If you want further information, you may contact the local state Information and Assistance office by calling 1-800-736-7401.
You may also consult an attorney of your choice. Should you decide to be represented by an attorney, you may or may not receive a larger award, but, unless you are determined to be ineligible for an award, the attorney's fee will be deducted from any award you might receive for disability benefits. The decision to be represented by an attorney is yours to make, but it is voluntary and may not be necessary for you to receive your benefits.
What if I disagree with my doctor about medical treatment?
If you disagree with your doctor or do not like your doctor for any reason, you may always choose another doctor within the MPN. If you disagree with either the diagnosis or treatment prescribed by your doctor, you may ask for a second opinion from a doctor within the MPN.
If you want a second opinion, you must contact the MPN Contact and tell them you want a second opinion. The contact person will make sure you have access to a regional area listing of MPN doctors to choose from. Then you may choose a doctor from the MPN and make an appointment within 60 days. You must tell the MPN Contact person of your appointment date.
If you do not make an appointment within 60 days, you will not be allowed to have a second opinion with regard to this disputed diagnosis or treatment of this treating physician.
If the second opinion doctor feels that your injury is outside of the type of injury he or she normally treats, the doctor's office will notify your employer or insurer and you will get access to a new regional area listing of MPN doctors or specialists so you can make another selection.
After you receive a second opinion, if you still disagree with your doctor, you may ask for a third opinion. If you want a third opinion, you must contact the MPN Contact and tell them you want a third opinion. MPN will provide you with access to a regional area listing of MPN providers. Then you may choose a doctor from the MPN and make an appointment within 60 days. You must tell the MPN Contact of your appointment date.
If you do not make an appointment within 60 days, then you will not be allowed to have a third opinion with regard to this disputed diagnosis or treatment of this treating physician.
If the third opinion doctor feels that your injury is outside of the type of injury he or she normally treats, the doctor's office will notify your employer or insurer and you will get access to a new regional area listing of MPN doctors or specialists so you can make another selection.
A copy of the written opinion report from the second and or third opinion physician will be provided to you, your current treating physician and the MPN contact, in accordance with Title 8 CCR §9767.7.
If after the third opinion, you still disagree with your doctor, you may ask for an Independent Medical Review (IMR). Your employer or MPN contact person will give you information on requesting an Independent Medical Review and a form at the time you request a third opinion.
An IMR will be done by a physician outside of the MPN who will be selected to conduct an independent assessment of your dispute.
As long as your second opinion, third opinion or Independent Medical Reviewer agrees with the treating doctor, you can obtain the recommended treatment within the MPN. You can obtain this treatment by changing physicians to the second opinion provider, third opinion provider or other MPN provider.
If the second opinion, third opinion or Independent Medical Reviewer does not agree with your treating doctor, you will be allowed to receive that medical treatment from a provider either inside or outside MPN. If you decide to receive treatment outside the MPN, it can only be for the treatment or diagnostic service recommended by the second opinion, third opinion or Independent Medical Reviewer.
Once this treatment is completed, you will receive all other treatment with a doctor of your choice back in the MPN Network.
What if I am already being treated for a work-related injury before the MPN begins? What is "transfer of care"?
Your employer or insurer has a Transfer of Care Plan (TOCP) that describes what will happen if you are currently treating for a workrelated injury with a physician who is not a member of the MPN. You can obtain a copy of this policy upon request. Prior to making any transfer of care plans, your MPN will provide you with specific instructions that may include the following:
If your current treating doctor is a member of MPN, then you may continue to treat with this doctor and your treatment will be under MPN. Your current doctor may be allowed to become a member of MPN.
If your current treating doctor is not or is not allowed to become a member of MPN, then you may be sent to a MPN doctor for treatment. If this occurs, you will be sent a letter and your doctor will be notified. You will not be transferred to a doctor in MPN if your injury or illness meets any of the following conditions:
*Acute: The treatment for your injury or illness that has a duration of less than 90 days; *Serious or chronic: Your injury or illness is one that is serious and continues for at least 90 days without full cure or worsens and requires ongoing treatment. The MPN will allow you to treat with your current doctor for up to one year, until a safe transfer of care can be made. The one-year period for completion of treatment starts from the date of your receipt of notification, of the determination that you have a serious chronic condition. *Terminal: You have an incurable illness or irreversible condition that is likely to cause death within one year or less. *Pending Surgery: You already have a surgery or other procedure that has been authorized by your employer or insurer that will occur within 180 days of the MPN effective date.
If MPN is going to transfer your care and you disagree, you may ask your treating doctor for a report that addresses whether you are in one of the categories listed above.
If either MPN or you do not agree with your treating doctor's report, this dispute will be resolved according to Labor Code Section 4062. You must notify the MPN Contact listed previously if you disagree with this report.
If your treating doctor agrees that your condition does not meet one of those listed above, the transfer of care will go forward while you continue to disagree with the decision.
If your treating doctor believes that your condition does meet one of those listed above, you may continue to treat with him or her until the dispute is resolved. An overview of the MPN's Transfer of Care Plan is attached. You may obtain a copy of this policy at any time upon request.
What if a MPN doctor is treating me and the doctor leaves the MPN?
Your employer or insurer has a written Continuity of Care Plan (TOCP) that may allow you to continue treatment with your doctor if your doctor is no longer actively participating in MPN. This policy may be obtained upon request.
If you are being treated for a work-related injury in the MPN and your doctor no longer has a contract with the MPN, your doctor may be allowed to continue to treat you if your injury or illness meets one of the following conditions:
*An (acute) medical condition that involves a sudden onset of symptoms due to an illness, injury, or other medical problem that requires prompt medical attention and has a duration less than 90 days. BROADSPIRE will authorize completion of the treatment for the duration of less than 90 days. *A (serious chronic) condition that is due to a disease, illness, catastrophic injury or other medical problem, or medical disorder that is serious in nature and persists without full cure or worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration. BROADSPIRE will authorize completion of treatment for up for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined by the insurer or employer in consultation with the injured employee and the terminated provider and consistent with good professional practice. Completion of treatment under this paragraph shall not exceed 12 months from the contract termination date. *(Terminal) You have an incurable illness or irreversible condition that is likely to cause death within one year or less. Completion of treatment shall be provided for the duration of the terminal illness. BROADSPIRE will authorize completion of treatment for the duration of a terminal illness; *(Performance of a surgery) or other procedure that is authorized by the insurer or employer as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the contract's termination date. BROADSPIRE will affirm continued treatment for a specified time frame after the regulation time periods have been met.
If the contract with your doctor was terminated or not renewed by MPN for reasons relating to medical disciplinary cause or reason, fraud or criminal activity, you will not be allowed to complete treatment with that doctor. An overview of the MPN's Continuity of Care Plan is attached.
What if I have questions or need help?
You may always contact the MPN Contact if you need more help or for an explanation about your medical treatment if you have a work-related injury or illness.
BROADSPIRE 500 N. State College Blvd., Suite 300 Orange, CA 92868 Toll Free 877-498-4648
The MPN website is:
http://www.dir.ca.gov/dwc/MPN/DWC_MPN_Main.html
DWC Information and Assistance Officer
If you have concerns, complaints or questions regarding the MPN, the notification process, or your medical treatment after a work-related injury or illness, you can call Information and Assistance Officer at the Division of Workers' Compensation at 1-800-736-7401.
Independent Medical Review
If you have questions about the Independent Medical Review process or the Independent Medical Reviewer, you may contact the Division of Workers' Compensation's Medical Unit at: PO Box 8888, San Francisco CA 94128-8888, (650) 737-2700 or (800) 794-6900
Zurich American Insurance Company Medical Provider Network
Continuity of Care Plan
Employee Overview
Zurich American Insurance Company, administered by BROADSPIRE has established a Medical Provider Network (MPN) for any work related injuries covered employees may sustain. Under Labor Code 4616.2, if an employee has an injury and the treating provider terminates from the MPN, the injured worker may qualify to continue treating with the terminated provider under specific circumstances. This overview will provide information about the employer’s MPN Continuity of Care Plan (COCP) and the responsibilities under this plan.
Zurich American Insurance Company must submit a copy of its COCP to the State for approval. Under this COCP Zurich is responsible with providing information about its COCP at least 30 days prior to implementation, when the employee joins the organization, when an employee transfers into the MPN or when the employee has a workrelated injury or illness. If, at any time the employee wishes to receive more information about the COCP, the employee may contact its employer for a copy of this policy.
If an employee has a work-related injury and is receiving treatment from a provider who terminates the employer’s MPN, the employer will send a notice to alert the injured worker whether they qualify to continue treating with the terminated provider. Below are the exceptions:
*If the MPN terminated a provider because of disciplinary reasons, fraud or criminal activity, BROADSPIRE will advise the injured worker to seek care with another MPN provider. *If the injured worker has the following circumstances, the injured worker may continue treating with the treating provider even though the provider has terminated the MPN. The conditions include the following:
*An acute condition. An acute condition is a medical condition that involves a sudden onset of symptoms due to an illness, injury, or other medical problem that requires prompt medical attention and that has duration less than 90 days. Completion of treatment shall be provided for the acute condition for the duration of less than 90 days. *A serious chronic condition. A serious chronic condition is a medical condition due to a disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over an extended period of time of at least 90 days or requires ongoing treatment to maintain remission or prevent deterioration. Completion of treatment shall be provided for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined by the insurer or employer in consultation with the injured employee and the terminated provider and consistent with good professional practice. Completion of treatment under this paragraph shall not exceed 12 months from the contract termination date. *A terminal illness. A terminal illness is an incurable or irreversible condition that has a high probability of causing death within one year or less. Completion of treatment shall be provided for the duration of a terminal illness. *Performance of a surgery or other procedure that is authorized by the insurer or employer as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the contract's termination date.
*Upon notice of a terminated provider, BROADSPIRE will review the claim and conditions and determine whether the injured worker may continue to seek treatment with the non-network provider. Tithe employer or insurer shall notify the covered employee of the determination regarding the completion of treatment and whether or not the employee will be required to select a new provider from within the MPN. *The notification shall be sent to injured worker’s residence and primary treating physician. The notification shall be written in English and Spanish and use layperson’s terms to the maximum extent possible *BROADSPIRE will contact the provider to confirm whether the provider is unwilling or incapable of continuing treatment for the injured worker. *Based on the provider’s response, BROADSPIRE will advise the injured worker whether continued treatment with the non-network provider is authorized. The notification will be sent to the injured worker’s residence and a copy of the letter shall be sent to the injured worker’s primary treating provider. *If the terminated provider agrees to continue treating the injured worker and if the injured covered employee disputes the medical determination, the injured worker shall request a report from the primary treating physician that addresses whether the covered employee falls within any of the conditions of an acute condition, a serious chronic condition, a terminal illness or a performance of a surgery or other procedure that is authorized by the insurer or employer as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the contract’s termination date. *The treating physician shall provide the report to the covered employee within twenty calendar days of the request. If the treating physician fails to issue the report, then the determination made by the employer or insurer shall apply. *If the employer, insurer or injured worker objects to the medical determination by the treating physician, this dispute resolution process will follow the rules under Labor Code §4062. More details regarding §4062 procedure will be provided at the onset of any dispute. *If the treating physician agrees with the employer’s or insurer’s determination that the injured covered employee’s medical condition does not meet the conditions set forth in Labor Code section 4616.2(d)(3), the employee shall choose a new provider from within the MPN during the dispute resolution process. *If the treating physician does not agree with the employer’s or insurer’s determination that the injured covered employee’s medical condition does not meet the conditions set forth in Labor Code section 4616.2(d)(3), the injured covered employee shall continue to treat with the terminated provider until the dispute is resolved. *BROADSPIRE will agree to process authorized bills accordingly at an agreed upon rate or at the State’s fee schedule. BROADSPIRE will not agree to process bills for unauthorized care *BROADSPIRE will make copies of their TOCP policies and procedures available upon request.
Zurich American Insurance Company Medical Provider Network
Transfer of Care Plan
Employee Overview
Zurich American Insurance Company, administered by BROADSPIRE, has established a Medical Provider Network (MPN) for any work related injuries its employees may sustain. Under Title 8 CCR 9767.9, if an employee has a workers’ compensation injury prior to implementing the MPN, the injured worker may qualify to continue treating with the non-network provider under specific circumstances. This overview will provide information about the employer’s MPN Transfer of Care Plan (TOCP) and the responsibilities under this plan.
Zurich American Insurance Company must submit a copy of its TOCP to the State for approval. Under this TOCP, Zurich is responsible with providing information about its TOCP at the time of implementation or when the employee joins the organization. If at any time the employee wishes to receive more information about the TOCP, the employee may contact its employer for a copy of this policy.
If an employee has a work-related injury and is receiving treatment prior to the implementation of the employer’s MPN, the employer will send a notice to alert the injured worker that they may qualify to continue treating with the non-network provider. Below are the exceptions:
* If the injured worker has one of the following circumstances, the injured worker may qualify to continue treating with the treating provider even though the provider is not part of the MPN. The conditions include:
*An acute medical condition involves a sudden onset of symptoms due to an illness, injury or other medical problem that requires prompt medical attention and that has duration of not more than 90 days. BROADSPIRE will authorize completion of the treatment for the duration of 90 days. *A serious, chronic medical condition that is due to a disease, illness, catastrophic injury, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over 90 days and requires ongoing treatment to maintain remission or prevent deterioration. BROADSPIRE will authorize completion of treatment for a period of time up to one year and will make arrangements for transfer to another provider within the MPN, as soon as feasible. The one-year period for completion of treatment starts from the injured covered employee’s receipt of the notification of the determination that the employee has a serious chronic condition. *A terminal illness is an incurable or irreversible condition that has a high probability of causing death within one year or less. BROADSPIRE will authorize completion of treatment for the duration of a terminal illness. *Performance of a surgery or other procedure that is authorized by the insurer or employer as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days from the MPN coverage effective date. BROADSPIRE will affirm continued treatment for a specified time frame after the regulation time frames have been met.
*Upon notice of a non-network provider, BROADSPIRE will advise the injured worker on the conditions and timeframe for continuing services with the non-network provider, where appropriate. *In the event there are conditions, which would allow the injured worker to continue treatment with the non-network provider, BROADSPIRE will contact the provider to affirm the provider’s willingness to continue treatment. *Within the communication to the injured worker, BROADSPIRE will advise the injured worker on the timeframe they will be authorized to continue treatment with the non-network provider. Nothing will prohibit BROADSPIRE from extending the timeframe for continued treatment. *Upon authorization for continued treatment with the provider, BROADSPIRE will agree to process non-network authorized bills accordingly. BROADSPIRE will not agree to process bills for unauthorized care at an agreed upon rate or at the State’s fee schedule. *If the provider is unwilling to continue treatment for the injured worker, BROADSPIRE will advise the injured worker to seek treatment within the MPN. *If the injured worker does not have a condition that would allow them to continue treating with the non-network provider, BROADSPIRE will advise the injured worker to seek further care within the MPN. *If BROADSPIRE decides to transfer the injured worker into the MPN, BROADSPIRE will notify the injured worker regarding the duration for completion of treatment. All notifications will be sent to the injured worker’s residence and primary treating physician. All notifications will be written in English and Spanish and use layperson’s terms to the maximum extent possible. *If the injured worker disputes the medical determination, he/she must request a report from the treating physician that addresses the conditions. The treating physician will provide the report to the injured worker within twenty calendar days of the request. If the treating physician fails to issue the report, then the determination made by BROADSPIRE shall apply. *If BROADSPIRE or injured worker objects to the medical determination by the treating physician, the dispute regarding the medical determination made by the treating physician concerning the transfer of care shall be resolved pursuant to Labor Code section 4062. *If the treating physician agrees with BROADSPIRE’s determination that the injured covered employee’s medical condition does not meet the conditions set forth in subdivisions the transfer of care shall go forward during the dispute resolution process. *If the treating physician does not agree with BROADSPIRE’s determination that the injured worker’s medical condition does not meet the conditions, the transfer of care shall not go forward until the dispute is resolved. *BROADSPIRE will make copies of their TOCP policies and procedures available upon request.
Notificación Escrita Inicial al Empleado
Red De Proveedores Medicos
(Título 8, Código de Regulaciones de California, sección 9767.12)
La Ley de California requiere que su empleador brinde y pague tratamiento médico si usted se lesiona en el trabajo. Efectivo April 16, 2007 su empleador Epic Travel Staffing ha elegido brindar este cuidado médico, usando una red de médicos de Compensación Laboral que se llama una Medical Provider Network – Red de Proveedores Médicos (MPN), accediendo a proveedores medicos de GENEX/First Health Select Comp America . Esta MPN es administrada por BROADSPIRE. La aseguradora de compensación laboral de su empleador es Zurich American Insurance Company a travez de Cedar Hill Insurance. Esta notificación le avisa sobre lo que usted debe saber sobre el programa MPN Zurich American Insurance Company y detalla sus derechos con la elección de cuidado médico para lesiones y enfermedades ocasionadas en el trabajo.
¿Qué es una MPN?
Una Medical Provider Network – Red de Proveedores Médicos (MPN) es un grupo de proveedores de salud (médicos y otros tipos de proveedores) establecido por una aseguradora y empleador con seguros propios y aprobados por la División del Director Administrativo de Compensación Laboral para tratar trabajadores lesionados en el trabajo. Cada MPN debe incluir una mezcla de médicos especializados en lesiones ocasionadas en el trabajo y médicos con experiencia en áreas generales de medicina. Las MPN deben cumplir acceso a normas de cuidado para lesiones ocupacionales comunes y enfermedades relacionadas al trabajo. Además, las regulaciones requieren que los proveedores MPN usen normas de tratamiento médico adoptadas por la DWC.
Las MPN deben permitir que empleados tengan una selección de proveedores en la red después de la primera visita del empleado.
¿Cómo averiguo cuales médicos son de mi MPN?
Su empleador o aseguradora ha identificado la siguiente departamento/persona para que sea el Contacto MPN para todos los empleados:
BROADSPIRE
500 N. State College Blvd., Suite 300
Orange, CA 92868
Numero Gratuito: 877-498-4648
Esta departamento/persona podrá contestar sus preguntas sobre la MPN y avisarle cómo recibir o lograr acceso a los nombres de los médicos de la MPN. Acceso a una lista de proveedores MPN está disponible llamando a su contacto MPN al numero proveido anteriormente o consultando la página electrónica a:
www.genexservices.com
Customer Resources
GENEX Provider Pathway
Enter Log Name & Password
Name (Usuario): CHI002
Password (Contrasena): chi2
¿Qué pasa si me lesiono en el trabajo?
En caso de una emergencia, usted debe llamar al 911 o ir al sala de emergencias más cercano.
Si usted se lesiona en el trabajo, notifique a su empleador lo antes posible. Su empleador le brindará una forma de reclamo. Cuando usted notifique a su empleador o aseguradora que ha sufrido una lesión en el trabajo, su empleador o aseguradora fijará una cita inicial con un médico de la MPN.
Usted podria recibir cuidado medico para su lesion o enfermedad de trabajo atravez de su medico personal si usted sometio por escrito una predesignacion valida antes del occurrimiento de una lesion. Refierase ala forma opcional PREDESIGNACION DE UN MEDICO PERSONAL para los requisitos y para que predesigne a su medico.
¿Cómo elijo a un proveedor?
Después de la primera visita, usted puede seguir recibiendo tratamiento de este médico, o puede elegir otro médico de la MPN. Usted puede seguir eligiendo médicos dentro de la MPN para todo su cuidado médico para esta lesión. Si es apropiado, usted puede elegir un especialista o pedir una referencia a un especialista de su médico de cabecera. Si usted necesita ayuda para elegir un médico, puede comunicarse con el Contacto MPN listado arriba.
Para cuidado que no sea de emergencia, citas para tratamiento inicial estarán disponibles dentro de tres (3) días hábiles. Además, citas que no son de emergencia con especialistas estarán disponibles dentro de veinte (20) días hábiles. Si usted tiene problemas en conseguir una cita con un médico dentro de la MPN, comuníquese con el Contacto MPN para asistencia.
¿Qué pasa si no hay proveedores en mi área?
Si usted requiere tratamiento médico que no sea de emergencia fuera del área de servicio MPN o no puede ubicar un proveedor MPN dentro de su área de servicio, y cae bajo cualquiera de las circunstancias siguientes, debe notificar a su supervisor de su necesidad para tratamiento médico fuera del Área de Servicio MPN:
*Si usted está trabajando temporalmente o viajando por trabajo *Si usted fue empleado que reside permanentemente fuera del área de servicio MPN *Si usted es empleado lesionado que decide residir temporalmente fuera del área de servicio MPN. *Si la especialización de su proveedor no está disponible dentro del área de servicio MPN. *Si su médico de cabecera lo refiere a un tipo de especialista no incluido en su MPN.
Su supervisor debe brindarle por lo menos tres proveedores fuera del área de servicio geográfica MPN que han sido referidos por su médico de cabecera o elegidos por usted. Los proveedores referidos se encontrarán dentro de las normas de acceso detalladas para la MPN. Empleados pueden cambiar médicos de cabecera u obtener segundas o terceras opiniones de entre los médicos referidos.
¿Hay normas para tratamientos?
Sí. La MPN revisará su tratamiento y lo autorizará basado en normas de tratamiento aprobadas. Si sus lesiones no están cubiertas por las normas de tratamiento aprobadas, la MPN autorizará su tratamiento de acuerdo con otra evidencia basado en normas de tratamiento médicas generalmente reconocidas por la comunidad médica nacional y que tienen base científica. La MPN lo avisará si su tratamiento no es autorizado porque no es apoyado por la práctica aprobada o normas de tratamiento.
¿Qué pasa si la MPN no autoriza mi tratamiento médico?
Si su tratamiento es revisado pero no autorizado, usted puede solicitar una apelación, siguiendo las instrucciones de apelar que adjuntaron a la notificación que incluye información sobre el teléfono del contacto y el proceso. Este es el proceso de apelaciones de la revisión de utilización interna de la MPN.
En el evento que usted no esté de acuerdo con la decisión de apelaciones y desea disputarla, debe enviar notificación escrita de su objeción al administrador de reclamos dentro de veinte (20) días del recibo de la decisión de la revisión de utilización conforme al Código Laboral, sección 4062. Usted debe cumplir esta fecha corte si está participando en el proceso de apelaciones de la revisión de utilización interna del administrador de reclamos.
Usted puede presentar una Application for Adjudication of Claim and Request for Expedited Hearing - Aplicación para Adjudicación de Reclamo y Solicitud para Audiencia Apresurada -, DWC Forma 4, que indica una disputa real con relación a un derecho a tratamiento médico conforme a las secciones 10136(b)(1), 10400, y 10408. Si usted desea información adicional, puede comunicarse con la oficina local del estado de Información y Asistencia al 1-800-736-7401.
Usted también puede consultar con el abogado de su elección. Si usted decide ser representado por abogado, puede o puede no recibir una decisión monetaria más grande; sin embargo, a menos que lo determinen no elegible para una adjudicación, los honorarios del abogado serán deducidos de cualquier adjudicación que pudiera recibir para beneficios de incapacidad. La decisión de ser representado por abogado es suya; es voluntaria y puede no ser necesaria para que usted reciba beneficios.
¿Qué pasa si no estoy de acuerdo con mi médico sobre mi tratamiento médico?
Si usted no está de acuerdo con su médico o no le gusta su médico por cualquier motivo, siempre puede elegir otro médico dentro de la MPN. Si usted no está de acuerdo con el diagnóstico o tratamiento recetado por su médico, puede pedir una segunda opinión de un médico dentro de la MPN.
Si usted quiere una segunda opinión, debe comunicarse con el Contacto MPN y decirle que quiere una segunda opinión. La persona contacto se cerciorará que usted tiene acceso a una lista del área regional de médicos MPN para hacer una elección. Luego, usted puede elegir un médico de la MPN y hacer una cita dentro de 60 días. Usted debe avisarle al Contacto MPN de la fecha de su cita.
Si usted no hace una cita dentro de 60 días, no le permitirán una segunda opinión con relación a este diagnóstico o tratamiento disputado de este médico de cabecera.
Si el médico de la segunda opinión cree que su lesión queda por fuera del tipo de lesión que él o ella trata normalmente, la oficina del médico notificará a su empleador o aseguradora y usted logrará acceso a una
nueva lista regional de médicos o especialistas MPN para que pueda hacer otra elección.
Después de recibir su segunda opinión, y todavía no está de acuerdo con su médico, usted puede solicitar una tercera opinión. Si usted desea una tercera opinión, debe comunicarse con el Contacto MPN y decirle que desea una tercera opinión. La MPN le brindará acceso a una lista del área regional de proveedores MPN. Luego, usted puede elegir un médico de la MPN y fijar una cita dentro de 60 días. Usted debe avisar al Contacto MPN sobre la fecha de su cita.
Si usted no fija una cita dentro de 60 días, no le permitirán conseguir una tercera opinión con relación al diagnóstico o tratamiento disputado de este médico de cabecera.
Si el médico de la tercera opinión cree que su lesión queda por fuera del tipo de lesión que él o ella trata normalmente, la oficina del médico notificará a su empleador o aseguradora y usted logrará acceso a una nueva lista del área regional de médicos o especialistas MPN para que pueda hacer otra elección.
Una copia del informe de la opinión escrita del médico de la segunda y tercera opinión será brindada a usted, su médico de cabecera actual y el Contacto MPN, conforme al Título 8 CCR §9767.7.
Si después de la tercera opinión, usted todavía no está de acuerdo con su médico, puede solicitar una Revisión Médica Independiente (IMR). Su empleador o Contacto MPN le dará información al solicitar una Revisión Médica Independiente y una forma en el momento que usted solicite una tercera opinión. Una IMR será realizada por un médico fuera de la MPN elegido para realizar una evaluación independiente de su disputa.
Siempre que su segunda opinión, tercera opinión o Evaluador Médico Independiente esté de acuerdo con su médico de cabecera, usted puede obtener el tratamiento recomendado dentro de la MPN. Usted puede obtener este tratamiento cambiando médicos al proveedor de la segunda opinión, proveedor de la tercera opinión, o Evaluador Médico Independiente.
Si la segunda opinión, tercera opinión o Evaluador Médico Independiente no está de acuerdo con su médico de cabecera, usted tendrá permiso de recibir ese tratamiento médico de un proveedor dentro o fuera de la MPN. Si usted decide recibir tratamiento fuera de la MPN, solo puede ser para el tratamiento o servicio diagnóstico recomendado por la segunda opinión, tercera opinión o el Evaluador Médico Independiente.
Una vez se concluya este tratamiento, usted recibirá todo tratamiento adicional de un médico de su elección de la Red MPN.
¿Qué pasa si ya estoy recibiendo tratamiento para una lesión ocasionada en el trabajo antes de iniciar la MPN? ¿Qué es "transferencia de cuidado"?
Su empleador o aseguradora tiene una Política de Transferencia de Cuidado (TOCP siglas en Ingles) que detalla lo que pasará si usted actualmente está recibiendo tratamiento para una lesión ocasionada en el trabajo con un médico que no es miembro de la MPN. Usted puede obtener una copia de esta política al solicitarla. Antes de hacer cualquier plan de transferencia de cuidado, su MPN le brindará instrucciones específicas que pueden incluir lo siguiente:
Si su médico de cabecera actual es miembro de la MPN, usted puede seguir recibiendo tratamiento de este médico y su tratamiento caerá bajo la MPN. A su médico actual le puede ser permitido hacerse miembro de la MPN.
Si su médico actual no es o no tiene permiso de hacerse miembro de la MPN, usted puede ser enviado a un médico MPN para tratamiento. Si esto ocurre, le enviarán una carta a usted y su médico será notificado. Usted no será transferido a un médico de la MPN si su lesión o enfermedad cumple cualquiera de las condiciones siguientes:
*(Aguda) El tratamiento para su lesión o enfermedad que tiene un duración de menos de 90 días; *(Seria o crónica) Su lesión o enfermedad es seria y continúa por lo menos 90 días sin cura completa o se empeora y requiere tratamiento continuo. La MPN permitirá que usted reciba tratamiento de su médico actual por hasta un año, hasta que se pueda hacer una transferencia de cuidado segura. El período de un año para conclusión de tratamiento comienza a partir de la fecha de su recibo de notificación, de la determinación que usted sufre de una seria condición crónica. *(Terminal) Usted sufre de una enfermedad sin cura o condición irreversible que probablemente provocará la muerte en un año o menos. *(Pendiente de Cirugía) Usted ya ha tenido cirugía u otro procedimiento que ha sido autorizado por su empleador o aseguradora que ocurrirá dentro de 180 días de la fecha efectiva MPN.
Si la MPN va a transferir su cuidado y usted no está de acuerdo, puede pedir un informe de su médico de cabecera que indica si usted cae dentro de una de las categorías listadas arriba.
Si la MPN o usted no están de acuerdo con el informe de su médico de cabecera, esta disputa será resuelta conforme al Código Laboral, Sección 4062. Usted debe notificar al Contacto MPN listado anteriormente si usted no está de acuerdo con este informe.
Si su médico de cabecera está de acuerdo con que su condición no cumple una de las categorías listadas arriba, la transferencia de cuidado seguirá adelante mientras usted continúe en desacuerdo con la decisión.
Si su médico de cabecera cree que su condición no cumple una de las categorías listadas arriba, usted puede seguir recibiendo tratamiento de él o ella hasta que se resuelva la disputa. Una reseña del Plan de Transferencia de Cuidado MPN se encuentra adjunta. Usted puede obtener una copia de esta política en cualquier momento al solicitarla.
¿Qué pasa si un médico MPN que me está tratando sale de la MPN?
Su empleador o aseguradora tiene una Política de Continuidad de Cuidado (COCP siglas en Ingles) escrita que puede permitir que usted siga recibiendo tratamiento de su médico si su médico está participando activamente en la MPN. Se puede obtener esta política al solicitarla.
Si usted está recibiendo tratamiento por una lesión ocasionada en el trabajo en la MPN y su médico ya no tiene contrato con la MPN, su médico puede recibir permiso para seguir tratándolo si su lesión o enfermedad cumple una de las siguientes condiciones:
*Una aguda condición médica que involucra el inicio repentino de síntomas debido a una enfermedad, lesión, u otro problema médico que requiere rápida atención médica y tiene una duración de menos de 90 días. BROADSPIRE autorizará conclusión de tratamiento para la duración de menos de 90 días. *Una seria condición crónica que se debe a una enfermedad, lesión catastrófica u otro problema médico, o desorden médico que es serio en naturaleza y sigue sin cura completa o se empeora sobre un período de tiempo extendido o requiere tratamiento continuo para mantener remisión o evitar deterioro. BROADSPIRE autorizará conclusión de tratamiento para hasta un período de tiempo necesario para concluir un curso de tratamiento o arreglar para una transferencia segura a otro proveedor, como determinado por la aseguradora o empleador en consulta con el empleado lesionado y el proveedor terminado, consistente con buenas prácticas profesionales. Conclusión de tratamiento bajo este párrafo no excederá 12 meses a partir de la fecha de terminación del contrato. *Terminal. Usted sufre de una enfermedad sin cura o condición irreversible que probablemente provocará la muerte dentro de un año o menos. Conclusión de tratamiento será brindada para la duración de la enfermedad terminal. BROADSPIRE autorizará conclusión de tratamiento para la duración de una enfermedad terminal; *Realización de una cirugía u otro procedimiento que es autorizado por la aseguradora o empleador como parte de un curso de tratamiento documentado y ha sido recomendado y documentado por el proveedor que ocurrirá dentro de 180 días de la fecha de terminación del contrato. BROADSPIRE aprobará tratamiento continuo para un período de tiempo específico después de terminar los períodos de tiempo regulados.
Si el contrato con su médico fue terminado o no renovado por la MPN por motivos relacionados a causa o motivo de disciplina médica, fraude o actividad criminal, usted no recibirá permiso de concluir tratamiento con ese médico. Una reseña del Plan de Continuidad de Cuidado MPN se encuentra adjunta.
¿Qué pasa si tengo preguntas o necesito ayuda?
Usted siempre puede comunicarse con el Contacto MPN si necesita más ayuda o una explicación sobre su tratamiento médico si sufre una lesión o enfermedad ocasionada en el trabajo.
BROADSPIRE
500 N. State College Blvd., Suite 300
Orange, CA 92868
Numero Gratuito: 877-498-4648
La página electrónica MPN es:
http://www.dir.ca.gov/dwc/MPN/DWC_MPN_Main.html
Oficial de Información y Asistencia DWC
Si usted tiene inquietudes, quejas o preguntas relacionadas a la MPN, el proceso de notificación, o su tratamiento médico después de una lesión o enfermedad ocasionada en el trabajo, puede llamar al Oficial de Información y Asistencia en la División de Compensación Laboral al 1- 800-736-7401.
Revisión Médica Independiente
Si usted tiene preguntas sobre el proceso de Revisión Médica Independiente o el Evaluador Médico Independiente, puede comunicarse con la División de la Unidad Médica de Compensación Laboral a: PO Box 8888, San Francisco, CA 94128-8888, (650) 737-2700 o (800) 794-6900
Zurich American Insurance Company Medical Provider Network - Red de Proveedores Médicos
Plan de Continuidad de Cuidado
Reseña del Empleado
Zurich American Insurance Company, administrado por BROADSPIRE, ha establecido una Medical Provider Network – Red de Proveedores Médicos (MPN) para cualquier lesión ocasionada en el trabajo sostenida por sus empleados. Bajo el Código Laboral 4616.2, si un empleado sostiene una lesión y el proveedor tratante sale de la MPN, el trabajador lesionado puede calificar para seguir recibiendo tratamiento del proveedor terminado bajo circunstancias específicas. Esta reseña brindará información sobre el Plan de Continuidad de Cuidado de la MPN (siglas en Ingles COCP) y las responsabilidades bajo este plan.
Zurich American Insurance Company debe presentar una copia de su COCP al Estado para aprobación. Bajo este COCP Zurich es responsable de brindar información sobre su COCP por lo menos 30 días antes de su implementación, cuando el empleado es contratado por la organización, cuando un empleado transfiere a la MPN, o cuando el empleado sostiene una lesión o enfermedad ocasionada en el trabajo. Si en cualquier momento el empleado desea recibir más información sobre el COCP, el empleado puede comunicarse con su empleador para una copia de esta reseña.
Si un empleado sostiene una lesión ocasionada en el trabajo y está recibiendo tratamiento de un proveedor que sale de la MPN del empleador, el empleador enviará una notificación para avisar al trabajador lesionado si califica para seguir recibiendo tratamiento con el proveedor terminado. A continuación se encuentran las excepciones:
*Si la MPN terminó un proveedor debido a motivos disciplinarios, fraude o actividad criminal, BROADSPIRE avisará al trabajador lesionado para que busque cuidado con otro proveedor MPN. *Si el trabajador lesionado se encuentra en las circunstancias siguientes, el trabajador lesionado puede seguir recibiendo tratamiento aunque el proveedor ha salido de la MPN. Las condiciones incluyen lo siguiente:
*Una aguda condición médica. Una aguda condición médica que involucra el inicio repentino de síntomas debido a una enfermedad, lesión, u otro problema médico que requiere rápida atención médica y tiene una duración de menos de 90 días. Conclusión de tratamiento será brindada para la aguda condición por una duración de menos de 90 días. *Una seria condición crónica. Una seria condición crónica es una condición médica debido a una enfermedad, u otro problema médico, o desorden médico que es serio en su naturaleza y sigue sin cura completa o se empeora sobre un período de tiempo extendido de por lo menos 90 días o requiere tratamiento continuo para mantener remisión o evitar deterioro. Conclusión de tratamiento debe seguir por un período de tiempo necesario para concluir un curso de tratamiento o arreglar para una transferencia segura a otro proveedor, como lo determinen la aseguradora o empleador en consulta con el empleado lesionado y el proveedor terminado, consistente con buenas prácticas profesionales. Conclusión de tratamiento bajo este párrafo no excederá 12 meses a partir de la fecha de terminación del contrato. *Enfermedad Terminal. Una enfermedad terminal es una condición sin cura o irreversible que probablemente provocará la muerte dentro de un año o menos. Conclusión de tratamiento será brindada por la duración de la enfermedad terminal. *Realización de una cirugía u otro procedimiento que es autorizado por la aseguradora o empleador como parte de un curso de tratamiento documentado y ha sido recomendado y documentado por el proveedor que ocurrirá dentro de 180 días de la fecha de terminación del contrato.
*Con la notificación de un proveedor terminado, BROADSPIRE revisará el reclamo y condiciones para determinar si el trabajador lesionado puede buscar tratamiento del proveedor fuera de la red. El empleador o aseguradora notificará al empleado cubierto de la determinación relacionada a la conclusión de tratamiento y si el empleado deberá o no elegir un nuevo proveedor de dentro de la MPN. *La notificación será enviada a la residencia del trabajador lesionado y al médico de cabecera. La notificación será en inglés y español y usará términos no profesionales hasta el máximo punto posible. *BROADSPIRE se comunicará con el proveedor para confirmar si el proveedor no tiene voluntad o no es capaz de seguir tratando al trabajador lesionado. *Basado en la respuesta del proveedor, BROADSPIRE avisará al trabajador lesionado si tratamiento continuo es autorizado con el proveedor fuera de la red. La notificación será enviada a la residencia del trabajador lesionado y una copia de la carta será enviada al médico de cabecera del trabajador lesionado. *Si el proveedor terminado está de acuerdo con seguir tratando al trabajador lesionado y si el empleado cubierto lesionado disputa la determinación médica, el trabajador lesionado solicitará un informe del medico de cabecera que se dirija a si el empleado cubierto cae dentro de cualquiera de las condiciones de una aguda condición, una seria condición crónica, una enfermedad terminal, o una realización de una cirugía u otro procedimiento que es autorizado por la aseguradora o empleador como parte de un curso documentado de tratamiento y ha sido recomendado y documentado por el proveedor para que ocurra dentro de 180 días de la fecha de terminación del contrato. *El médico de cabecera brindará el informe al empleado cubierto dentro de veinte (20) días calendario de la solicitud. Si el médico de cabecera no hace el informe, la determinación hecha por el empleador o aseguradora aplicará. *Si el empleador, aseguradora o trabajador lesionado se opone a la determinación médica del médico de cabecera, este proceso de resolución de disputas seguirá las reglas bajo el Código Laboral §4062. Más detalles relacionados al procedimiento de la Sección §4062 serán brindados en el inicio de cualquier disputa. *Si el médico de cabecera está de acuerdo con la determinación del empleador o la aseguradora que la condición médica del empleado cubierto lesionado no cumple las condiciones detalladas en el Código Laboral, sección 4616.2(d)(3), el empleado elegirá un nuevo proveedor de dentro de la MPN durante el proceso de resolución de disputas. *Si el médico de cabecera no está de acuerdo con la determinación del empleador o la aseguradora que la condición médica del empleado cubierto lesionado no cumple las condiciones detalladas en el Código Laboral, sección 4616.2(d)(3), el empleado cubierto lesionado seguirá recibiendo tratamiento del proveedor terminado hasta que se resuelva la disputa. *BROADSPIRE estará de acuerdo con procesar cuentas autorizadas según una tasa acordada o al programa de honorarios del estado. BROADSPIRE no estará de acuerdo con procesar cuentas para cuidado no autorizado. *BROADSPIRE hara disponible copias de sus politicas y procedimientos COCP al solicitarlas.
Zurich American Insurance Company Medical Provider Network – Red de Proveedores Médicos
Plan de Transferencia de Cuidado
Reseña del Empleado
Zurich American Insurance Company, administrado por BROADSPIRE, ha establecido una Medical Provider Network – Red de Proveedores Médicos ( siglas en Ingles MPN) para cualquier lesión ocasionada en el trabajo sostenida por sus empleados. Bajo Título 8 CCR 9767.9, si un empleado sostiene una lesión de compensación laboral antes de la implementación de la MPN, el trabajador lesionado puede calificar para seguir recibiendo tratamiento del proveedor fuera de la red bajo circunstancias específicas. Esta reseña brindará información sobre el Plan de Transferencia de Cuidado de la MPN (siglas en Ingles TOCP) y las responsabilidades bajo este plan.
Zurich American Insurance Company debe presentar una copia de su TOCP al Estado para aprobación. Bajo este TOCP, BROADSPIRE es responsable de brindar información sobre su TOCP en el momento de implementación o cuando el empleado es contratado por la organización. Si en cualquier momento el empleado desea recibir más información sobre el TOCP, el empleado puede comunicarse con su empleador para una copia de esta reseña.
Si un empleado sostiene una lesión ocasionada en el trabajo y está recibiendo tratamiento de un proveedor antes de la implementación de la MPN del empleador, el empleador enviará una notificación para avisar al trabajador lesionado que puede calificar para seguir recibiendo tratamiento con el proveedor fuera de la red. A continuación se encuentran las excepciones:
*Si el trabajador lesionado se encuentra en las circunstancias siguientes, el trabajador lesionado puede seguir recibiendo tratamiento aunque el proveedor no sea parte de la MPN. Las condiciones incluyen:
*Una aguda condición médica. Una aguda condición médica que involucra el inicio repentino de síntomas debido a una enfermedad, lesión, u otro problema médico que requiere rápida atención médica y tiene una duración de no más de 90 días. BROADSPIRE autorizará conclusión de tratamiento por la duración de menos de 90 días. *Una seria condición crónica. Una seria condición crónica que se debe a una enfermedad, lesión catastrófica u otro problema médico, o desorden médico que es serio en naturaleza y sigue sin cura completa o se empeora sobre un período de tiempo extendido durante 90 días y requiere tratamiento continuo para mantener remisión o evitar deterioro. BROADSPIRE autorizará conclusión de tratamiento para hasta un período de tiempo de un año y hará arreglos para una transferencia segura a otro proveedor dentro de la MPN, tan pronto como sea factible. El período de un año para conclusión de tratamiento comienza con el recibo del empleado cubierto lesionado de la notificación de la determinación que el empleado sufre una seria condición crónica. *Una enfermedad terminal es una condición sin cura o irreversible que tiene alta probabilidad de provocar la muerte dentro de un año o menos. BROADSPIRE autorizará conclusión de tratamiento para la duración de la enfermedad terminal. *Realización de un cirugía u otro procedimiento que es autorizado por la aseguradora o empleador como parte de un curso de tratamiento documentado y ha sido recomendado y documentado por el proveedor que ocurrirá dentro de 180 días de la fecha efectiva de cobertura de la MPN. BROADSPIRE afirmará tratamiento continuo para un límite de tiempo específico después que se hayan cumplido los límites de tiempo regulados.
*Con la notificación de un proveedor fuera de la red, BROADSPIRE avisará al trabajador lesionado de las condiciones y límite de tiempo para continuar servicios con el proveedor fuera de la red, donde sea apropiado. *En el evento que haya condiciones que permitirían que el trabajador lesionado siguiera recibiendo tratamiento de un proveedor fuera de la red, BROADSPIRE se comunicará con el proveedor para afirmar la voluntad del proveedor de seguir tratamiento. *Dentro de la comunicación al trabajador lesionado, BROADSPIRE avisará al trabajador lesionado del límite de tiempo que será autorizado para seguir tratamiento con el proveedor fuera de la red. Nada prohibirá que BROADSPIRE extienda el límite de tiempo para tratamiento continuo. *Con la autorización para tratamiento continuo con el proveedor, BROADSPIRE estará de acuerdo con procesar cuentas autorizadas fuera de la red según. BROADSPIRE no estará de acuerdo con procesar cuentas para cuidado no autorizado a una tasa acordada o al programa de honorarios del estado. *Si el proveedor no está dispuesto a continuar tratamiento para el trabajador lesionado, BROADSPIRE avisará al trabajador lesionado para que busque tratamiento dentro de la MPN. *Si el trabajador lesionado no tiene una condición que le permitiría seguir recibiendo tratamiento del proveedor fuera de la red, BROADSPIRE avisará al trabajador lesionado para que busque tratamiento adicional dentro de la MPN. *Si BROADSPIRE decide transferir el trabajador lesionado a la MPN, BROADSPIRE notificará al trabajador lesionado sobre la duración de conclusión de tratamiento. Todas las notificaciones serán enviadas a la residencia del trabajador lesionado y al médico de cabecera. Todas las notificaciones serán en inglés y español y u sará términos no profesionales hasta el máximo punto posible. *Si el trabajador lesionado disputa la determinación médica, él/ella debe solicitar un informe del médico de cabecera que detalla las condiciones. El médico de cabecera brindará el informe al trabajador lesionado dentro de veinte (20) días calendario de la solicitud. Si el médico de cabecera no hace el informe, la determinación hecha por BROADSPIRE aplicará. *Si BROADSPIRE o el trabajador lesionado se opone a la determinación médica del médico de cabecera, la disputa relacionada a la determinación médica hecha por el médico de abecera relacionada a la transferencia de cuidado será resuelta conforme al Código Laboral, sección 4062. *Si el médico de cabecera está de acuerdo con la determinación de BROADSPIRE que la condición médica del empleado cubierto lesionado no cumple las condiciones detalladas en las subdivisiones, la transferencia de cuidado seguirá adelante durante el proceso de resolución de disputas. *Si el médico de cabecera está de acuerdo con la determinación de BROADSPIRE que la condición médica del empleado cubierto lesionado no cumple las condiciones, la transferencia de cuidado no seguirá adelante hasta que se resuelva la disputa. *BROADSPIRE hará disponibles copias de sus políticas y procedimientos TOCP al solicitarlas.
Safely Surrendered Baby Law
-
Safely Surrendered Baby Law
FAQ – Hospital Personnel
The Safely Surrendered Baby Law allows a parent or person with lawful custody to surrender a baby confidentially, without fear of arrest of arrest or prosecution for child abandonment. This law allows for at least a 14-day cooling off period, which begins the day the child is voluntarily surrendered. During this period, the person who surrendered the child can return to the hospital to reclaim the child.
How Does It Work?
A parent who is unable or unwilling to care for an infant can legally and confidentially surrender their baby within 3 days of birth. Babies may be surrendered to any public or private hospital emergency room in California. A bracelet will be placed on the baby for identification and a matching bracelet will be given to the parent. The bracelet will help identify the child if the parent changes their mind during the cooling off period. A baby can be safely surrendered 24 hours a day, 7 days a week. (In Los Angeles County, County fire stations and city stations have agreed to participate have been designated).
How are Safe Surrender Sites Identified?
Each hospital (and participating fire station) is required to post a sign utilizing a statewide logo adopted by the State Department of Social Services in a visible location. Surrender site locations are listed at www.babysafe.ca.org
Does the Parent Have to Give Any Information to the people Taking the Baby?
No. Nothing is required. Hospital personnel will give the parent a medical information questionnaire designed to gather family medical history, which would be useful in caring for the child. It is up to the parent if they wish to give any additional information concerning the baby.
Hospital Staff must make a good faith effort to have the surrendering party complete a medical questionnaire, which was created for safe surrender purposes and includes legally required language outlining the importance of providing medical information. The questionnaire shall not require any identifying information. The questionnaire may be declined or voluntarily completed on site or hospital personnel may provide the surrendering party with a return envelope to later complete and return the questionnaire to the hospital.
What type of medical care if provided to the surrendered infant?
Hospital staff shall ensure that a medical screening examination and any necessary medical care is provided to the infant. Hospitals that do not routinely provide newborn care should have procedures in place to ensure the infant is examined by qualified medical professionals and that all necessary newborn screening tests are performed (e.g., by calling in a qualified medical professional or transferring the infant to another hospital).
Is the consent of the parent or other relative needed to provide the infant with medical care?
No.
How are the infant’s medical costs covered?
Surrendered infants are eligible for Medi-Cal.
What else is required of hospital staff? How is the baby “tracked”?
Hospital staff are required to place a coded, confidential ankle bracelet on the infant. They also must make a good faith effort to provide the surrending parent with a copy of the bracelet, in the event the surrendering party wants to “reclaim” the infant at a later time.
What if a parent changes his/her mind and wants to “reclaim’ the infant?
The law allows for a 14-day “cooling off” period, in which the surrendering party may return to the surrender site to reclaim the child. If the parent/surrending party requests the hospital to ruent the child within 14 days, one of two situations may occur:
1. If the hospital still has custody of the child, and the Department of Children and Family Services (DCFS) has not file a court petition, hospital personnel shall either return the child to the surrendering party or, if any hospital personnel knows or reasonably suspects that the child has been the victim of abuse or neglect, contact DCFS. The voluntary surrender of the child is not in and of itself sufficient evidence of abuse or neglect.
2. If DCFS has already filed a court petition, the hospital shall direct the parent/surrendering party to the DCFS Hotline. The law requires DCFS to conduct an assessment fo the indivudal’s ability to parent and make a recommendation regarding return of the child to the court. If the court orders return of the child and the hospital still has physical custody of the child, the hospital should obtain a copy of the court order before releasing custody of the infant.
Where are the medical questionnaire, return envelope, and ankle bracelet (including bracelet copy) kept?
Each hospital may choose an appropriate location to store these materials at the facility. Hospital staffs are encouraged to familiarize themselves with the location of these Safe Surrender items at their facility, so they may access them on short notice in the event of surrender.
What else is hospital staff required to do?
The hospital must contact the Department of Children and Family Services (DCFS) Child Protection Hotline, at 1-800-540-4000, within 48 hours, of receiving physical custody of child.
What information should the hospital provide to the DCFS about the mother/child? What information should remain confidential?
In addition to the medical questionnaire, non-identifying information regarding the circumstances of the surrendered, mother’s and child’s medical condition/treatment, etc. shall be provided to the DCFS. However, the law specifically states that “any personal identifying information that pertains to a parent or individual who surrenders a child shall be edited from any medical information provided to “DCFS. Any identifying information “obtained as a result of the questionnaire or in any other manner, is confidential “and shall not be released to the DCFS (Health and Safety Code, Section 1255.7). This includes maintaining confidentiality in birth records prepared by hospital Birth Clerks.
What form should Birth Clerks complete in the instance of a Safely Surrendered Baby?
They should complete the Certificate of Finding of Unknown Child (VS 136) which is entered into the electronic birth registration system (AVSS). When hospital staff erroneously provides the DCFS with identifying information, the infant’s adoption becomes unnecessarily complicated and may be significantly delayed.
What should hospital staff do if a woman gives birth in the hospital and states she is unable or unwilling to care for the child? Can she surrender her child?
While the law does not specifically address hospital births,, current State policy allows for surrender of babies born in hospitals when the parent specifically requests that law be applied. To be considered a safe surrender, the mother does not need to use specific verbiage, but she must be able to describe the concepts of the SSB Law. If a mother clearly states that she is aware of her right to safely surrender her infance and does not wish to work with the social staff, the case should be treated as a safe surrender. However, if a woman gives birth in the hospital and indicates she is unable or unwilling to care for her infant, the preferred option continues to be voluntary relinquishment for adoption and a social worker should assist the mother in making the best plan available for herself and the child. Hospital social work staff should work in consultation with the DCFS Adoption staff to assist the mother. During Regular Business Hours, the Department of Children and Family Services can be reached at 1-888-811-1121, extension 2. All other hours, they can be reached at 1-800-540-4000.
Who Can I Contact for More Information?
If you or someone you know wants to surrender a baby, please take the child to any hospital emergency room. Remember: no shame, no blame, no names…it’s the law. For more information, please visit the website at http://www.babysafe.ca.gov/. Free presentation arrangements can be made through the Inter-Agency Council on Child Abuse and Neglect (ICAN) at 1-626-455-4586.
Safely Surrendered Baby Law
FAQ – Hospital Personnel
The Safely Surrendered Baby Law allows a parent or person with lawful custody to surrender a baby confidentially, without fear of arrest of arrest or prosecution for child abandonment. This law allows for at least a 14-day cooling off period, which begins the day the child is voluntarily surrendered. During this period, the person who surrendered the child can return to the hospital to reclaim the child.
How Does It Work?
A parent who is unable or unwilling to care for an infant can legally and confidentially surrender their baby within 3 days of birth. Babies may be surrendered to any public or private hospital emergency room in California. A bracelet will be placed on the baby for identification and a matching bracelet will be given to the parent. The bracelet will help identify the child if the parent changes their mind during the cooling off period. A baby can be safely surrendered 24 hours a day, 7 days a week. (In Los Angeles County, County fire stations and city stations have agreed to participate have been designated).
How are Safe Surrender Sites Identified?
Each hospital (and participating fire station) is required to post a sign utilizing a statewide logo adopted by the State Department of Social Services in a visible location. Surrender site locations are listed at www.babysafe.ca.org
Does the Parent Have to Give Any Information to the people Taking the Baby?
No. Nothing is required. Hospital personnel will give the parent a medical information questionnaire designed to gather family medical history, which would be useful in caring for the child. It is up to the parent if they wish to give any additional information concerning the baby.
Hospital Staff must make a good faith effort to have the surrendering party complete a medical questionnaire, which was created for safe surrender purposes and includes legally required language outlining the importance of providing medical information. The questionnaire shall not require any identifying information. The questionnaire may be declined or voluntarily completed on site or hospital personnel may provide the surrendering party with a return envelope to later complete and return the questionnaire to the hospital.
What type of medical care if provided to the surrendered infant?
Hospital staff shall ensure that a medical screening examination and any necessary medical care is provided to the infant. Hospitals that do not routinely provide newborn care should have procedures in place to ensure the infant is examined by qualified medical professionals and that all necessary newborn screening tests are performed (e.g., by calling in a qualified medical professional or transferring the infant to another hospital).
Is the consent of the parent or other relative needed to provide the infant with medical care?
No.
How are the infant’s medical costs covered?
Surrendered infants are eligible for Medi-Cal.
What else is required of hospital staff? How is the baby “tracked”?
Hospital staff are required to place a coded, confidential ankle bracelet on the infant. They also must make a good faith effort to provide the surrending parent with a copy of the bracelet, in the event the surrendering party wants to “reclaim” the infant at a later time.
What if a parent changes his/her mind and wants to “reclaim’ the infant?
The law allows for a 14-day “cooling off” period, in which the surrendering party may return to the surrender site to reclaim the child. If the parent/surrending party requests the hospital to ruent the child within 14 days, one of two situations may occur:
1. If the hospital still has custody of the child, and the Department of Children and Family Services (DCFS) has not file a court petition, hospital personnel shall either return the child to the surrendering party or, if any hospital personnel knows or reasonably suspects that the child has been the victim of abuse or neglect, contact DCFS. The voluntary surrender of the child is not in and of itself sufficient evidence of abuse or neglect.
2. If DCFS has already filed a court petition, the hospital shall direct the parent/surrendering party to the DCFS Hotline. The law requires DCFS to conduct an assessment fo the indivudal’s ability to parent and make a recommendation regarding return of the child to the court. If the court orders return of the child and the hospital still has physical custody of the child, the hospital should obtain a copy of the court order before releasing custody of the infant.
Where are the medical questionnaire, return envelope, and ankle bracelet (including bracelet copy) kept?
Each hospital may choose an appropriate location to store these materials at the facility. Hospital staffs are encouraged to familiarize themselves with the location of these Safe Surrender items at their facility, so they may access them on short notice in the event of surrender.
What else is hospital staff required to do?
The hospital must contact the Department of Children and Family Services (DCFS) Child Protection Hotline, at 1-800-540-4000, within 48 hours, of receiving physical custody of child.
What information should the hospital provide to the DCFS about the mother/child? What information should remain confidential?
In addition to the medical questionnaire, non-identifying information regarding the circumstances of the surrendered, mother’s and child’s medical condition/treatment, etc. shall be provided to the DCFS. However, the law specifically states that “any personal identifying information that pertains to a parent or individual who surrenders a child shall be edited from any medical information provided to “DCFS. Any identifying information “obtained as a result of the questionnaire or in any other manner, is confidential “and shall not be released to the DCFS (Health and Safety Code, Section 1255.7). This includes maintaining confidentiality in birth records prepared by hospital Birth Clerks.
What form should Birth Clerks complete in the instance of a Safely Surrendered Baby?
They should complete the Certificate of Finding of Unknown Child (VS 136) which is entered into the electronic birth registration system (AVSS). When hospital staff erroneously provides the DCFS with identifying information, the infant’s adoption becomes unnecessarily complicated and may be significantly delayed.
What should hospital staff do if a woman gives birth in the hospital and states she is unable or unwilling to care for the child? Can she surrender her child?
While the law does not specifically address hospital births,, current State policy allows for surrender of babies born in hospitals when the parent specifically requests that law be applied. To be considered a safe surrender, the mother does not need to use specific verbiage, but she must be able to describe the concepts of the SSB Law. If a mother clearly states that she is aware of her right to safely surrender her infance and does not wish to work with the social staff, the case should be treated as a safe surrender. However, if a woman gives birth in the hospital and indicates she is unable or unwilling to care for her infant, the preferred option continues to be voluntary relinquishment for adoption and a social worker should assist the mother in making the best plan available for herself and the child. Hospital social work staff should work in consultation with the DCFS Adoption staff to assist the mother. During Regular Business Hours, the Department of Children and Family Services can be reached at 1-888-811-1121, extension 2. All other hours, they can be reached at 1-800-540-4000.
Who Can I Contact for More Information?
If you or someone you know wants to surrender a baby, please take the child to any hospital emergency room. Remember: no shame, no blame, no names…it’s the law. For more information, please visit the website at http://www.babysafe.ca.gov/. Free presentation arrangements can be made through the Inter-Agency Council on Child Abuse and Neglect (ICAN) at 1-626-455-4586. No Discrimination in Services
-
NON-DISCRIMINATION IN SERVICES POLICY
Epic Travel Staffing shall not discriminate in the prevision of services because of race, color, religion, national original, ancestry, ethnic group identification, sex, age, condition of physical or mental handicap (as defined in 41 CFR 60-741.2), in accordance with requirements of Federal and State laws, or in any manner on the basis of the client‘s/patient’s sexual orientation.
Discrimination of services is defined as, but is not limited to, the following; denying any person any service or benefit or the availability of the facility; providing any service or benefit to any person which is not equivalent, or is provided in a non-equivalent manner, or at a non- equivalent time, from that provided to other; subjecting any person to segregation or service; restricting any person in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit; and treating any person differently for others in determining admission, enrollment quota, eligibility, membership, or any other requirements or conditions which persons must meet in order to be provided any service or benefit. Epic Travel Staffing shall take affirmative action to ensure that intended beneficiaries of Emeralds services are provided without regard to race, color, religion, national original, ethnic group identification, ancestry, sex, age, condition of physical or mental handicap, or sexual orientation.
Complaints regarding discrimination in provisions of services shall be directed to Mark Stagen, CEO, Epic Travel Staffing, 4640 Admiralty Way, Suite #600; Marina Del Rey, CA 90292, 800-917-5055. Individuals dissatisfied with Epic Travel Staffing resolution of services by Epic Travel Staffing personnel may direct the matter to Director, Department of Health Services, Director, 313 N. Figueroa Street, Los Angeles, 90012.
Further, Individuals dissatisfied with the County’s resolution or decision with respect to the complaint of alleged discrimination may appeal the matter to the State Department of Health Services’ Affirmative Division.
I acknowledge that I have received and read the information on the Non-Discrimination in Services Policy. Notice regarding Federal Earned Income Credit
- NOTICE TO EMPLOYEES REGARDING THE FEDERAL EARNED INCOME CREDIT
Epic Travel Staffing shall notify its employees, and shall require each subcontractor to notify its employees, that they may be eligible for the Earned Income Tax Credit under the Federal Income Tax laws. Such notice shall be provided in accordance with the requirements set forth in Internal Revenue Services Notice 1015. www.irs.ustreas.gov
ADVANCE EARNED INCOME CREDIT (EIC) PAYMENT
An Employee who is eligible for the income credit (EIC) and has a qualifying child is entitled to receive EIC payments with his or her pay during the year. To get these payments, the Employee must provide to the Employer a properly completed W-5, Earned Income Credit Advance Payment Certificate, either using the paper form or using an approved electronic format. The employer is required to make advance EIC payments to employees who give the Employer a completed and signed Form W-5. Certain Employees who do not have a qualifying child may be able to claim the EIC payments.
*I ACKNOWLEDGE THAT THIS MEMO IS FOR INFORMATIONAL PURPOSES ONLY.
For most current information regarding Earned Income Credit (EIC) Payments please visit the Department of the Treasury Internal Revenue Services website:www.irs.ustreas.gov
(INSERT AGENCY ‘S NAME)
NON-DISCRIMINATION IN SERVICES POLICY
(Insert Contractor’s or Subcontract’s Name) shall not discriminate in the prevision of services because of race, color, religion, national original, ancestry, ethnic group identification, sex, age, condition of physical or mental handicap (as defined in 41 CFR 60-741.2), in accordance with requirements of Federal and State laws, or in any manner on the basis of the client‘s/patient’s sexual orientation.
Discrimination of services is defined as, but is not limited to, the following; denying any person any service or benefit or the availability of the facility; providing any service or benefit to any person which is not equivalent, or is provided in a non-equivalent manner, or at a non- equivalent time, from that provided to other; subjecting any person to segregation or service; restricting any person in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit; and treating any person differently for others in determining admission, enrollment quota, eligibility, membership, or any other requirements or conditions which persons must meet in order to be provided any service or benefit. (Contractor/Subcontractor’s) shall take affirmative action to ensure that intended beneficiaries of (Contractor’s/Subcontractor’s) services are provided without regard to race, color, religion, national original, ethnic group identification, ancestry, sex, age, condition of physical or mental handicap, or sexual orientation.
Complains regarding discrimination in provisions of services shall be directed to (Contractor/Subcontractor’s Executive Director), (Contractor/Subcontractor’s address), (Contractor/Subcontractor’s telephone number). Individuals dissatisfied with (Contractor/Subcontractor’s) resolution of services by (Contractor/Subcontractor’s) personnel may direct the matter to Director, Department of Health Services, Director, 313 N. Figueroa Street, Los Angeles, 90012.
Further, Individuals dissatisfied with the County’s resolution or decision with respect to the complaint of alleged discrimination may appeal the matter to the State Department of Health Services’ Affirmative Division.
Contractor may use the above sample policy for purpose of documentation of notification of all its officers, employees, and agents providing services.
Employment Acknowledgment:
Identification Policy
- When reporting to your assignment you will need to present proof of identity upon arrival. This should include a current form of government ID with your picture, as well as proof of RN licensure, A.H.A. BLS card, and any other certifications required for your assignment.
(please type full name)
MM slash DD slash YYYY