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Best Practices Manual
Edit for V10.0 October 2011
TABLE OF CONTENTS
Introduction to Best Practices ......................................................................... 3
Answering the Telephone ............................................................................... 4
Taking and Assigning the Order ...................................................................... 5
Scheduling the Exam ..................................................................................... 8
Contacting the Applicant ................................................................................ 9
ScheduleEZ and Pre-Scheduled Appointments .................................................. 11
Completing the Exam Service ........................................................................ 12
Measurements ..................................................................................... ……….15
EKG/ECG Standards ............................................................................. ……….16
Computer Status .........................................................................................18
Lab Work .................................................................................................... 19
Mailing ....................................................................................................... 24
Billing ........................................................................................................ 25
Equipment and Maintenance .......................................................................... 26
Quality Assurance ........................................................................................ 27
Examiner Integrity, Professionalism, and Dress Code ........................................ 29
Credentialing and Training Procedures ............................................................ 32
Privacy and Confidentiality ............................................................................ 35
System Information ..................................................................................... 38
Night Processing .......................................................................................... 40
U-Direct Business ........................................................................................ 41
Long Term Care Exam and Senior Assessment Services ……………………………………….. 42
Workplace Services ...................................................................................... 43
Clinical Services........................................................................................... 49
Wellness Services………………………………………………………………………………………………………. 54
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EMSI PHILOSOPHY
Introduction to the Best Practices Manual
This Best Practices document is designed to bring additional continuity to the services
that EMSI offers from all locations; these practices were established and implemented to
assist us in consistently providing high levels of quality throughout our exam network as
well as safety and protection for our customers, clients, examiners and our company.
Maintaining consistently high standards of performance promotes customer confidence,
satisfaction, trust and loyalty which are key elements for business growth.
Details of EMSI’s policies and procedures are in reference documents on FOLD. Also,
detailed explanations of examiner processes and procedures are addressed in required
courses for examiners in EMSI’s on-line training programs.
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ANSWERING THE TELEPHONE
‰ The telephone must be answered politely by the third ring.
‰ The telephone should be answered: “Thank you for calling EMSI – branch partner name (i.e. Johnson
Paramedical, Inc.), this is Rebecca. How may I help you?”
‰ If asking for permission to put someone on hold, wait for a response. A caller should not be placed on
hold unless you have permission to do so.
‰ If a caller is placed on hold for another party, check back with the caller, asking, “Would you like to
continue to hold, or should I take a message?” Do not leave a caller on hold.
‰ Ensure that the telephones are always covered by at least one employee during the business hours of
8am – 5pm, Monday through Friday.
‰ If, in the event, your office encounters a situation in which a staff person is unable to answer the
phone live, a properly worded voicemail greeting is very important as it can be the first contact a
customer has with a branch office; use< “ Thank you for calling EMSI. We are currently servicing
another customer and unable to take your call at this time. Your call is important to us so please your
name, phone number and a brief message, and we will return your call within 4 business hours. If this
is an urgent matter requiring immediate attention, you can reach _______________at ___________.
Again, thank you for calling EMSI.
‰ For examiners receiving calls from EMSI’s clients, the examiner’s voicemail greeting should be
professional, using one of these greetings:
‰ “You’ve reached the voicemail of (examiner’s name) with EMSI. I’m not available but your call is
important to me. Please leave your name, phone number and a brief message, and I will return
your call as soon as possible.”
‰ “You’ve reached the (family’s name)voicemail. We’re not available but your call is important to us.
Please leave your name, phone number and a brief message, and I will return your call as soon as
possible. “
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TAKING & ASSIGNING THE ORDER
‰ HOT (Home Office Ticket) orders should be pulled first thing in the morning by completing a HO
connection.
‰ Telephone orders should be entered into the system at the time of the call.
‰ All orders should be accepted, even if for another office, and transferred to the appropriate branch the
same day. The exception is PartnersPlus (“PP”) business; if PP forwards the case to a branch office that
does not handle that territory, the branch office that received the case must notify PP that same day
and they will be responsible for forwarding the case to the appropriate office. This procedure also
applies when the applicant wants to be seen in another branch office area.
‰ The EMSI branch office name (i.e., EMSI/Dallas), address and telephone number should be provided to
an agent in the event that an exam will be transferred.
‰ Faxed orders should be entered into the system and acknowledged within 24 hours of receipt.
‰ Enter the request order date as it appears on the fax or mail request.
‰ Any variation to the Exam4Win auto-diagnosis should be documented with the name of the authorizing
individual and phone number in a status comment.
‰ Record the requestor’s name on the ticket in “Ticket Contact Name” field. Enter the initials of the
person taking the request in “Private Notes”.
‰ When taking the order, confirm the address to which the exam will be mailed.
‰ Diagnose the ticket when you are entering the information. If the requesting agency/agent notifies
you that the applicant is very overweight, consider the need for the larger adult size blood pressure
cuff (for arm circumference over 13 inches) and whether the applicant will need to be completed inoffice to have access to a higher capacity weighing scale (weight over 300 lbs.). If the exam will be
completed on a mobile basis, alert the examiner that a larger adult size BP cuff will be needed.
‰ Assign the exam at the time that the order is taken (This does not apply to offices that have
centralized scheduling in place.).
‰ Female applicants – A paramedical service requiring an EKG/ECG on a female applicant must be
assigned to a female examiner. Male paramedical examiners are NOT authorized to perform EKG’s on
female applicants under any circumstances - No exceptions. If a female examiner is not available in
the service area, make arrangements to have the EKG/ECG completed at an outside, fixed site medical
facility.
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‰ If receiving a faxed order from EMSI, check to see if there is already an Application ID Number. It
must be entered into the system exactly as it appears on the order you have received, so that your
status and paperwork match exactly with the ticket already created at the EMSI National Service
Center.
‰ Physician Exam Services – Assign physician services to physicians who meet the insurance customer’s
specialty requirements per the spec. Every effort should be made to assign a female physician to
complete a female applicant; in the event that such an arrangement is not possible, and the female is
agreeable to having a male physician perform the medical service, the male physician must comply
with having a third party of the female applicant’s choice present during the exam (if mobile) or
another female medical assistant in the room during the exam (if completed in-office). The third party
requirement for a mobile physician EKG must be discussed with the female applicant at the time of
scheduling. If the physician arrives at the appointment, and the female applicant does not have a third
party present, the physician is prohibited from proceeding with the service – No exceptions.
‰ Stress EKG/Treadmill testing is assigned to a qualified medical facility, clinic or private cardiologist’s
office only, NEVER on a mobile basis.
‰ Chest X-Rays are assigned to a certified fixed site medical facility, NEVER on a mobile basis.
‰ Power of Attorney (POA) – If an individual claims Power of Attorney to sign for an applicant, the
individual must be prepared to provide the examiner with a copy of his/her official letter authorizing
power of attorney. The individual claiming POA must provide photo ID for examiner verification and
recording on the medical detail area of the exam form and labslip, noting the POS status, and signs in
all applicable spaces on the forms/specimen tamper evident tape, noting POA status. The examiner
places the POA letter with the completed exam paperwork and imaged with it in ECHO.
‰ Guardianship – If an individual claims Power of Attorney to sign for an applicant, the individual must
be prepared to provide the examiner with a copy of his/her official letter authorizing power of attorney.
The individual claiming POA must provide photo ID for examiner verification and recording on the
medical detail area of the exam form and labslip, noting the POS status, and signs in all applicable
spaces on the forms/specimen tamper evident tape, noting POA status. The examiner places the POA
letter with the completed exam paperwork and imaged with it in ECHO.
‰ Minor Applicants – If an individual claims Power of Attorney to sign for an applicant, the individual
must be prepared to provide the examiner with a copy of his/her official letter authorizing power of
attorney. The individual claiming POA must provide photo ID for examiner verification and recording
on the medical detail area of the exam form and labslip, noting the POS status, and signs in all
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applicable spaces on the forms/specimen tamper evident tape, noting POA status. The examiner places
the POA letter with the completed exam paperwork and imaged with it in ECHO.
‰ Applicants under the Direct Supervision of a Medical Provider/Facility – If the agent/agency informs the
CSR that the applicant is in a hospital, long term acute care (LTAC)/nursing home, medical/mental
residential institution, assisted living, or other care site, the examiners is prohibited from entering such
sites to complete exam and specimen collection services. If the applicant is receiving hospice, home
health care or other form of care under the supervision of a physician, the examiner is prohibited from
completing the service. For both of these situations, the branch manager and the EMSI NSC Quality
and Performance Excellence Department (214-689-3660) must be promptly notified.
‰ Examiners are prohibited from collecting urine and blood specimens from applicants who have renal
shunts in their arms, vascular access lines and ports/intravenous lines (IV’s), urine/foley catheters or
other catheters of any kind. In such instances, underwriting should be contacted for further directions
regarding the assignment/arrangement for services regardless of the setting.
‰ If the insurance company has requested a Complete Blood Count (CBC) or CBC with Differential,
consult the customer’s spec sheet for special lab instructions. In many instances, such blood testing
requires collecting a separate specimen to be tested locally to obtain viable results.
CBC’s with
differentials must be collected and promptly forwarded to a local lab for slide preparation and to help
ensure reliable differential results.
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SCHEDULING THE EXAM
‰ The first attempt at contacting the applicant should be made within 24 hours of receipt of the request.
Office personnel should make the first call when ticket is keyed to provide the examiner’s and branch
office contact information.
‰
*First calls from the office can immediately identify incorrect or disconnected phone numbers and
potential delays in scheduling.
‰
Ensure that the telephones are always covered by at least one employee during the business hours
of 8am – 5pm, Monday through Friday.
‰
Attempt three times over a 2-day period, using different call times: morning and evening, on all
available numbers and email if provided by the customer. Check special instructions for additional contact
information.
‰ Contact the agent, agency or Home office customer service department to aid in the scheduling
process when:
‰ Applicants are not responsive
‰ Phone numbers are incorrect or disconnected
*Verify with local telephone directory and internet sources such as whitepages.com
for additional contact numbers
‰ If no contact is made after the first 3 days, additional action will be necessary:
•
Mail a postcard to give the applicant a physical reminder to call and schedule an appointment
•
Call the agent or agency to assist with scheduling
•
And continue calling the applicant every 48 hours
‰ Enter status codes and all relevant notes in the system for all attempts to contact the applicant.
Customers read statuses.
‰ Send another postcard at day 10 if no response and contact agent for further assistance.
‰ If unable to schedule within 45 days, close the case and notify the agent unless the spec instructions
advise you not to do so.
‰ Be in charge of revenue growth. Early contact with applicants reduces cycle time. Run reports to know
your business and identify aging cases and where calls need to be made.
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CONTACTING THE APPLICANT
‰ Prepare for the call by reviewing the request.
‰ When contact with the applicant is made, indicate that you are calling from EMSI on behalf of
“ABC” insurance company, and give the name of the agent.
‰ When leaving a message either with the individual or via voice mail, please use the following
script:
Hello, my name is _____ and I am with EMSI calling to (confirm your insurance exam
appointment for ____ at ___ / schedule your insurance exam with ABC Insurance Company.
‰ Determine if a translator will be required. If a translator is required, check the customer’s spec to
find out if there are limitations as to who may be assigned as translator. Arrange for translation
as necessary. You may be able to use a Language Line Service; contact IT Communications at
EMSI NSC for more information – 214-689-4224.
‰ Describe the requirements of the exam (need for private location, photo ID, medical history,
prescription and over-the-counter medications – names, dosages, frequency and reasons, provider
names/addresses/phone numbers, dates and other details of any illnesses, injuries, tests, etc.).
‰ Advise the applicant to drink water prior to the exam regardless of any fasting requirement in
order to provide a urine specimen and be well hydrated for any required blood draw.
‰ Discuss any fasting requirements. If the applicant is a diabetic, instruct the applicant to contact
their attending physician’s office to determine if they are medically able to fast for this blood draw.
Remind the applicant to have his/her healthcare providers’ and primary doctor’s full names,
addresses and phone numbers, and the names/dosages/frequency/reasons of any medications,
including any vitamins, herbs, birth control pills, prescriptions and over-the-counter medications
ready to give the examiner.
‰ Ask if the applicant has had any difficulty with a blood draw in the past, whether she/he has a
history of a bleeding problem, is taking any anti-coagulant medication (blood thinner), and
whether he/she has a history of fainting, epilepsy or seizures. If the applicant states he/she has a
history of hemophilia or other bleeding disorder or has a history of epilepsy or seizures, for safety
reasons, the applicant must be referred to a controlled medical setting for the blood draw for
safety reasons. If the applicant has a history of fainting, they must be reclined for the blood draw.
If the applicant is on anti-coagulant medication (aspirin, heparin, coumadin, etc.) , the
venipuncture site must be held for at least 5 minutes and until all bleeding has stopped.
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‰ Give the applicant a general estimate of the time required to complete the exam, but mention that
it may vary depending upon the length of the applicant’s medical history and the number as well
as types of services required.
‰ Offer in-office, home, or office site for the exam at the convenience of the applicant (Refer to spec
before scheduling an applicant at their place of business. Some accounts prohibit this.).
‰ If an EKG is required and will be completed on a mobile basis, inform the applicant that a place
with appropriate furniture to recline (recliner, sofa, etc.- not a table/desk or floor) will be needed
at the applicant’s home or office to complete the EKG service.
‰ Physician Services on Female Applicants – If a male physician is assigned to complete a medical
exam and/or EKG/ECG on a female applicant, please notify the female applicant that a third party
of her choice must be present during the completion of the service. Physician services completed
at a fixed facility require that a female is present in the room for the physical assessment if the
physician is a male.
‰ Minor Applicants - If the applicant is a minor, the arrangements are made with the parent or legal
guardian. Instruct the parent/legal guardian that he/she must remain physically present in the
room throughout the entire service, and he/she must provide photo ID for examiner verification
and recording in the medical detail area of the exam form and labslip, noting the parent
relationship or guardian status, and sign in all applicable spaces on the forms/specimen tamper
evident tape, noting relationship status.
‰ Examiners are not allowed to complete:
• Venipunctures on minor insurance applicants who are 14 years old or younger must be
assigned to an outside clinic or lab.
• DBS’s (Dried Blood Spot fingerprint collections) on minor insurance applicants who are 4
years old or younger must be assigned to an outside clinic or lab.
‰ Encourage the applicant to schedule the appointment within 72 hours.
‰ Advise the applicant that verification with a photo ID (state issued driver’s license if applicant has
one or state approved photo ID) will be required at the time of the exam.
‰ Provide the applicant with a name and telephone number in case the appointment needs to be
changed.
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ScheduleEZ
‰ Examiners/Branches are expected to post calendar availability and update and maintain their calendar
availability daily to avoid double booking of the exams home office.
‰ Branch/Examiners are expected to accommodate 95% of their original appointments scheduled
through ScheduleEZ.
‰ Branches are to maintain/update their examiners territories, manage their “Just Say Yes” and
Outsources Appointments”.
‰ All unacknowledged appointments are to be addressed at a minimum of 8 business hours.
‰ Just Say Yes appointments are to be worked daily and in tandem with EMSI’s case management
systems.
PRE-SCHEDULED APPOINTMENTS
‰ The branch should confirm the pre-set appointment with the examiner or the receiving transfer office
before the order is assigned or transferred.
‰ Examiner or branch should confirm the pre-set with the applicant unless company instructions advise
you not to do so. Give the applicant time to confirm by calling them at least 24 hours before the
appointment.
‰ Enter appropriate status code and notes in the system: “Left Message” or “Preset Confirmed.”
‰ Every attempt should be made to keep the appointment even if the applicant does not confirm.
Examiners should take a Cancel/Refusal form (available on FOLD) in case an applicant no shows.
‰ If an examiner is unable to keep the appointment, he/she must notify the branch office immediately so
the branch can attempt to find alternate coverage.
‰ If the preset cannot be covered or kept, the applicant must be notified as soon as possible.
‰ The office must be notified of a re-scheduled appointment.
‰ If the examiner is going to be late, he/she must contact the applicant.
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COMPLETING THE EXAM SERVICE
‰ If the applicant is not at the appointed location, at the appointed time, the examiner must wait 15
minutes before leaving the location. Telephone contact should be made to confirm that the applicant
is not at the appointed location, before leaving.
‰ If the applicant no-shows, the examiner must fill out a Cancel/Refusal Form with details and provide to
the branch office. Enter the appropriate status code, No Show by Applicant, Code #280, and notes
with specific details in the system, including a brief description of the appt. location (office or
residence.) .
‰ Examiners must wear an EMSI examiner photo ID badge in plain sight of the applicant for every
service and identify and introduce himself/herself as well and state EMSI company affiliation, the
requesting insurance company and the requesting agent (if one is listed) at the door.
‰ Verification of the applicant’s photo ID is required for completing exam services. Before beginning the
exam, verify and document the identity of the applicant through use of a photo ID in the designated
space provided on the exam form. If the form does not have a designated space, document the ID
information as the first entry in the medical history detail section of the exam form. Photo ID is
documented on the lab/ID authorization as well. If the order is an EKG/ECG only, photo ID (driver’s
license number and state of issue) should be noted on the tracing, along with the applicant’s signature
and date.
‰ Document any discrepancies with ID. If no photo ID is available (driver’s license, passport or other
government/state issued photo ID), document. Never use a credit card as a form of ID. In some
cases, customers specify in their instructions/requirements state not to proceed with the service if
photo ID is unavailable.
‰ To prepare the applicant, the examiner should provide a brief explanation of all procedures that will be
completed.
‰ Fasting instructions apply to both urine AND blood specimens. Follow the customer’s instructions on
the order ticket regarding fasting:
Required Fast: Do not collect specimens if applicant did not fast unless applicant is a diabetic and has
been instructed by physician to not fast.
Preferred Fast: It is okay to collect specimens if applicant did not fast, but should be documented.
‰ The examiner must complete all required measurements, questionnaires, lab ID/authorizations, and
procedures in their entirety. All procedures should be completed in a manner that is conducive to the
privacy and modesty of the applicant. The applicant should never have to be disrobed and exposed for
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procedures. For physician exams and EKG’s, female applicants are always provided drapes and
covered; a third party must be present when a physician performs the physical assessment or EKG.
‰ Ask each exam question individually and word-for-word as it appears on the customer’s exam form.
Never transfer information from one customer’s form to another customer’s form as the questions and
time limits are often different and may cause significant omissions.
‰ Exam forms must be complete, legible and accurate. Remember your 5 “D’s” when obtaining the
health history. Missing one will result in an upset underwriter.
1. Date (onset of conditions/injuries, tests, health provider visits, hospitalizations, recoveries,
recurrences, etc.).
2. Doctor (including all medical providers, clinics, hospitals, etc. – Document provider’s complete
name, address and phone number.).
3. Diagnosis (all conditions, diseases, injuries including all test and biopsy results).
4. Duration (of all conditions, hospitalizations, treatments, etc.).
5. Dosage (all over the counter and prescribed medications/treatments/therapy, including
complete name, dosage, frequency and reason for medication/treatment/therapy).
‰ If additional space is required to record the details of the health history, use another blank copy of the
customer’s Part II exam form – DO NOT USE A GENERIC CONTINUATION FORM, as these are obsolete.
The first page of the exam must be marked, “Pg. 1 of 2”, and the second page is marked “Pg. 2 of 2”.
Both the applicant and the examiner must sign and date all pages. If, in the event, the customer has a
customer specific continuation form, that form can be used instead of another Part II exam form.
‰ Continuity of Information - There may a question or questions that request details relevant to a
condition which was detailed in a previous primary physician visit and/or systems question. To help
avoid fragmentation and duplication of data as well as avoid conflicting responses, organize the facts,
then record the “entire story” for each appropriate system question and refer to the entry when
answering subsequent related questions (For example, “Refer to 3K for details.” Provide additional
information if requested. If in the event, required labslip questions
‰ The EMSI Generic HIV Consent form is obsolete – Use only the state specific HIV consent form the
carrier designates. Refer to the spec for requirements.
‰ Note any required lab, agent or agency codes on the lab ID/authorization form – refer to order ticket
for the customer’s designated lab code.
‰ Ensure that all required applicant and examiner signatures and dates have been obtained before
leaving the applicant.
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‰ The EMSI branch office’s stamp information (EMSI name/Controlling Branch Office Name, Branch
Address, City, State, Zip Code and Phone Number) is required on all documents. For example:
EMSI/Dallas Branch #109
101 Anywhere Road
Dallas, Texas 75082
972-555-1212
‰ Continuity of Information - There may an exam question or questions that request details relevant to a
condition that was detailed in a previous primary physician visit question and/or systems question. To
help avoid fragmentation and duplication of data as well as avoid conflicting responses, organize the
facts, then record the “entire story” for each appropriate system question and refer to the entry when
answering subsequent related questions (For example, “Refer to 3K for details.” Provide additional
information if requested. If in the event, a required labslip medical history question is the same or
similar to an exam question already asked and answered, confirm that the applicant’s answer for the
same condition is consistent with his/her exam answer.
‰ Block printing of the examiner’s full legal name (first and last, no initials, no nicknames) is required
below the examiner’s signature on all documents.
‰ Exam Orders for Infants:
‰ Check your spec to find out if the customer indicates a required exam for the infant
‰ In many cases, the customer’s home office is contacted to confirm they want the exam in the first
place.
‰ If the customer wants the exam, the following steps must be followed:
‰ Notify the parent/guardian he/she will need his/her photo ID (state driver’s license or other
government photo ID) for the examiner to verify and record parental photo ID.Name of
guardian/parent and driver’s license number must be recorded in history detail area or
designated space, noting the relationship.
‰ Have a copy of the infant’s social security card – Must be recorded in history detail area or
designated space
‰ All medical history comes from the parent/guardian – It is essential to have complete physician
names, addresses and phone numbers
‰ Do not attempt to collect a urine specimen or blood specimen
‰ Do not take a blood pressure – record infant in spaces
‰ Take a full minute apical pulse (at heart) with clean, warm stethoscope first
‰ Height - Take a piece of exam table paper (typically the size of paper used on clinic beds) lay
the infant on his/her back – mark paper at head and at end of heel – have parent lift baby and
measure mark to mark for the height.
‰ Weight – Weigh the parent alone, then weigh the guardian while he/she holds baby for a
combined weight (assist them on and off scale). Then subtract the parent alone weight from
the combined weight to obtain the baby’s weight.
‰ Block printing of the examiner’s full legal name (first and last, no initials, no abbreviated, partial or
nicknames) is required below the examiner’s signature on all documents.
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MEASUREMENTS
‰ All measurements such as height, weight, blood pressure and pulse, must be physically taken and
accurately recorded as exact readings. No “rounding off” of readings is allowed unless the work order
ticket specifically requests it.
‰ Weight is physically taken using the examiner’s analog weighing scale of at least 300 lbs capacity and
recorded in pounds while the applicant is without shoes. The applicant is required to initial beside the
recorded weight measurement. If the applicant exceeds 300 pounds, record “300 lb.+, Applicant’s
weight exceeded capacity of mobile scale - Applicant states weight at _____”. The examiner should
not accept any offer from an applicant to use the applicant’s scale in lieu of the examiner’s scale. If
notified about an applicant whose weight exceeds a 300 lb. scale, arrange for applicant to be weighed
on a professional scale. Use of a digital weighing scale is prohibited.
‰ Height is physically measured using a metal tape and recording in exact feet and inches while the
applicant is without shoes, unless otherwise noted on the exam form. The applicant is required to
initial beside the recorded height measurement.
‰ Examiners must have applicants initial both the height and weight measurements that were recorded.
‰ If requested, chest measurements (at level of the nipples) and abdominal (at level of umbilicus/navel)
measurements are taken upon inspiration and expiration on male applicants only - NEVER on females.
‰ Blood pressures must be taken from each arm three minutes apart with a manual cuff and analog
sphygmomanometer. Digital blood pressure equipment is prohibited.
‰ Please check the customer’s instructions and the customer’s form to determine if more than 2 blood
pressures are required.
‰ If any two of the blood pressures exceed 140 systolically or 90 diastolically, 2 more blood pressures
should be taken - one from the left upper arm, and three minutes later, one from the right upper arm,
unless otherwise instructed by the customer. Check the customer’s instructions regarding the systolic
and diastolic results that prompt the taking of additional readings and the customer’s form to
determine if additional BPs are required beyond the additional two BPs for elevation.
‰ Pulse and Irregularities - A radial pulse must be measured for one full minute. Pulse irregularities
are recorded as a numerical entry - the exact number of irregularities/skipped beats per one full
minute. If there are no irregularities, record “0” in the designated space on the form. Do not write,
“None”, or use a dash through the 0 (may be misinterpreted as an”8”).
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EKG/ECGs STANDARDS
‰ Male paramedical examiners are NOT allowed to perform EKG’s on female applicants regardless of
whether the applicants, agents or others insist – No exceptions.
‰ In the event that a male physician is assigned to complete a mobile EKG with a physician’s exam on a
female applicant, the female applicant must be informed at the time of scheduling to confirm that she
is in agreement and that a third party of her choice must be present. If the EKG is being performed at
a physician’s practice, clinic or office, a female medical assistant must be present during the service.
Female applicants should always be properly draped for EKG procedures.
‰ Position - An EKG must be completed while an applicant is reclining in a supine position on a sofa,
recliner, etc. Examiners are not to use chairs, desks, tables or floors to complete EKG’s even if
applicants or others insist.
‰ Standardization – The electrocardiograph must be set at the universal (full) standard of 1.0 mv –
Technically, the calibration pulse should be upright, squared at the top and 10 mm or 1 centimeter in
height (10 small squares on the EKG graph paper) and is required to appear on Leads I and V6. If this
standardization is not inserted automatically by the machine, then the examiner must manually inject
a standard calibration pulse by pressing the STD switch. Make sure the machine is not set on ½
standard which is 5 mm or 5 small squares on the graph paper, ½ the height of a universal standard
calibration pulse, and is the most common incorrect standardization error). If the STD switch is
correctly set at 1.0mv, but the standardization pulse falls above or below 1 cm in height, turn the
standardization knob until the standardization mark is exactly 1 cm in height.
‰ Limb Lead Placement – Before running the tracing, be sure to check correct lead placement for all limb
leads by checking the color-coding/labeling on the leads.
‰ Chest Lead Placement - Use designated landmarks (intercostal spaces) and refer to an anatomical
chest diagram to properly place the chest leads. Restrictive clothing may need to be loosened. Use
additional gel for males with excessive hair, but do not shave the applicant’s chest.
‰ Chart (paper) Speed – The tracing should indicate the electrocardiograph was set on the standard
paper speed of 25mm/sec. – If complexes appear to be spaced widely apart, it could be that the
machine has been inadvertently set on “double” paper speed (50mm/sec). If this occurs, reset the
paper speed to 25mm/sec.
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‰ Baseline/Stylus Heat – Position baseline to contain the complexes within the borders of the EKG paper
and adjust the machine accordingly to avoid the top of the complexes from being “chopped off.” If the
baseline is too thick or too light, adjust stylus heat switch for proper damping in order for the wave
forms to be definable.
‰ Artifact/Interference – Determine source and attempt to correct the interference by unplugging nearby
appliances (lamps, microwaves, computers, fans, etc.) turning off electronic devices (i.e. cell phones,
pagers) and using a three prong outlet for proper grounding of the EKG equipment. Check that the
leads are in good contact with the skin and that the applicant is still and is not chilled.
‰ Mounting Requirement – Determine if the insurance company has a mounting requirement (spec
sheet/order ticket instruction). If mounting is required, standardizations must show on Leads I and V6,
all leads are properly identified, the applicant’s signature and date appears on Lead I. All lead sections
or lead strips must be contained within the mounting sheet so that it can easily be scanned for file
retention. If trimming is required for mounting, be careful not to delete the standard calibration pulses.
‰ Identifying Data – Always print the applicant’s first and last names, date of birth, insurance
company name, and service date. Obtain the applicant’s signature and date on Lead I of the
tracing for identification purposes. Underwriting compares this applicant signature with signatures on
other insurance documents to confirm applicant identity.
‰ Operational Data – On the front side of the tracing, identify who performed the EKG by including
examiner’s printed name and the branch office stamp information that identifies that EMSI
provided the service (important for billing) and include the following items. If the examiner is using a
two sided mounting sheet, this information can be placed there as long as both sides are imaged into
ECHO.
•
The EMSI Name
•
Main branch office name, address and phone number
‰ Imaging – Scan the tracing the same day of completion or within one business day. Before scanning,
be sure that the tracing is dark copied to help ensure that the lighter EKG graph paper’s grid lines used
by underwriting to measure the waves and confirm calibration appear on the imaged tracing. Use the
proper doc type and make sure that it is properly squared and positioned right side up (Remember to
place the branch office stamp information on the same side as the tracing to make sure that it is not
omitted.).
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COMPUTER STATUS
‰ If an exam request is received between 8am and 2pm, contact with the applicant should be the same
day. Requests that arrive after 2pm must be contacted no later than the morning of the next business
day. All attempts to contact should be entered as status in the system.
‰ Notify the problem contact immediately if the telephone number is incorrect or disconnected. Verify
with local directory assistance first.
‰ Notify the agent and status the system as soon as appointment is scheduled.
‰ Notify the agent and status the system as soon as exam is completed.
‰ If U-Direct business, enter one of the following status codes to reflect whether the application package
was picked up or not:
Status code 770
Application package not picked up
Status code 780
Application package picked up
‰ All contact attempts should be documented in the “Status Notes” in the exam system. The receiving
office of a transfer order is responsible for following the status guidelines.
‰ An HO connection should be made a minimum of three (3) times per day to upload status. Suggested
times are a) first thing in the morning to receive new orders, b) late morning - to reflect the latest
status updates, c) around 3 pm for the afternoon’s orders and additional status updates.
‰ If you experience any HO connection issues, contact the IT Service Desk immediately –
[email protected]. If the problem cannot be resolved, you may fax statuses to the
Partners Plus Department to be manually keyed into the system.
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LAB WORK
‰ All applicable Federal and State OSHA and CLIA regulations as well as all state and local health
departments’ regulations must be followed and enforced, including but not limited to the use of
universal precautions, handwashing before, between and after procedures (or alcohol based hand
sanitizer), appropriate use personal protection equipment [fully intact gloves on both hands, masks,
lab coats/fluid proof gowns that cover arms to wrist (end of sleeves meet gloves), etc.] during
collection, centrifugation and transfer of serum procedures, the activation of safer needle (conventional
and butterfly) and lancet devices after each collection procedure, immediate disposal of needles,
lancets and butterfly needles into the an approved sharps containers after the all collections. Needles
must not be re-capped, bent, cut or manipulated in any way and must be disposed of a unit – Do not
attempt to disengage the needle from the tube holder). The sharps container must be within the
examiner’s arm’s reach of the collection procedure. Compliance is required for all biohazard labeling
(coolers for transport, sharps containers, centrifuge, door of lab, specimen bin and refrigerator, nonsharps biohazard waste container, etc.), proper transporting, handling, storage and shipping of
specimens, availability of personal protective equipment (gloves, gowns, masks), sharps containers
and spill kits, disposal of all sharps and non-sharps bio-hazardous waste and documentation (contract
with biohazard waste disposal company/manifest – certificates of disposal /incineration and other
recordkeeping/posting requirements such as OSHA poster, office safety, fire exit diagrams, HAZCOM
and bloodborne standard exposure control plans, logs for disinfection, training, safety checks/drills,
safety incidents/violations, evaluations of sharps safety features, HazCom
communication including
Material Safety Data Sheets, equipment maintenance/calibration logs, etc. . Additional information
regarding standards are available on FOLD and www.osha.gov.
‰ Blood-borne
exposures/needlesticks
–
Immediately
report
any
examiner/staff
blood
exposures/needle or lancet sticks to the EMSI Quality Department – 214.689.3660 for post exposure
follow up and to assist in attempting to obtain the source individual’s test results for further
management and care of the exposed examiner/staff member.
‰ Sharps containers should not be overfilled. When the sharps container is ¾ full, seal it and dispose of
it through a professional bio-hazardous waste company.
‰ Returning needles, butterflies and lancets of any kind (used or unused) to the labs is prohibited.
‰ Hands must be washed before, after and between specimen collections with antibacterial soap and
warm water for 20 seconds. If soap for handwashing facilities is not available, use an alcohol based
gel/hand sanitizer/cleaner.
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‰ Gloves (fully intact) are required to be worn on all fingers of both hands for all blood collection
procedures. Although urine and oral fluid specimens are not considered Other Potential Infectious
Material (OPIM) by OSHA (unless blood is visibly present in the specimen), EMSI requires that
examiners wear fully intact gloves on both hands during these collection procedures as well and it
assists in the prevention of specimen contamination. Gloves must be changed between each collection.
‰ Examiners should protect unused kits and collected specimens from extreme heat and extreme cold to
help protect the integrity of specimens to help ensure reliable test results. Blood specimens should be
stored in coolers (labeled with biohazard symbol) with refrigerant during warmer weather and stored in
containers with insulation during extreme winter weather.
‰ Examiners should not use expired lab kits or any expired laboratory supplies. Any expired lab kit
supplies should be reported to branch management.
‰ Examiners should not pre-fill the lab ID/authorization form prior to the completion of the specimen to
avoid inaccurate documentation and misspellings. Carefully record numbers – Do not place a slash
through a “0” or “7” and stay within the margins of the boxes for documentation.
‰ Always verify photo identification and record the applicant’s driver’s license number and state of issue
in the designated spaces on the labslip.
‰ Two Applicant Identifier Requirement on All Insurance Specimens: It is a CAP Laboratory and
Improvement requirement that all labs require the examiner to have two unique applicant identifiers
on every specimen vial/container in order to process:
‰ 1. Barcode (must match the labslip barcode number)
‰ 2. Applicant’s full name (first and last). Initials, nicknames, abbreviated or partial names are not
acceptable.
‰ Always record “Date and Time of Last Food/Drink” for all specimen collections, including urine
collections (HOS Only).
‰ Regardless of whether the exam is for a specimen collection only or in connection with another exam
service, ask the applicant his/her current vitamins, herbs, prescriptions and over-the-counter
medications, all medical history, and moving violation questions. Record answers on the labslip. The
default is to answer these questions. They should only be skipped if there are instructions on the work
order ticket to skip them. If the applicant refuses to answer any of the questions, record “refused” in
the designated space on the labslip. Note: This does not mean the examiner should routinely record
physical measurements or vitals.
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‰ If an Amplified service is ordered, take and record physical measurement and vitals (height, weight,
blood pressures, pulse, and pulse irregularities). If male, also complete chest and waist
measurements. Record the physical measurements and vitals on the labslip in the designated spaces.
If “Duplicate Measurements” are ordered, examiner must record the information on both the exam
form and the labslip. Obtain the applicant’s initials beside the height and weight measurements. ‰ Hand the lab ID/authorization form (labslip) to the applicant and give them ample time to read the
Notice and Consent section of the labslip prior to completing the blood draw, and make sure to give
the applicant the copy of the HIV/AIDS brochure information the lab supplies for their information and
education (mandated by many states). The Quest/ExamOne lab kit instructions require the examiner
to affix a barcode label to the HIV/AIDS brochure prior to giving to the applicant.
‰ If the applicant has a blood pressure that exceeds 180/114 (180 systolically or 114 diastolically) or a
blood pressure below 80/50 (80 systolically or 50 diastolically), do not perform a blood collection by
venipuncture.
‰ Ask if the applicant the four blood draw screening questions: 1) Any difficulty with a blood draw in the
past, 2) any history of a bleeding problem, 3) any use of any anti-coagulant medication (blood
thinner), and 4) whether he/she has a history of fainting, epilepsy or seizures. If the applicant states
he/she has a history of hemophilia or other bleeding disorder or has a history of epilepsy or seizures,
for safety reasons, the applicant must be referred to a controlled medical setting for the blood draw.If
the applicant has a history of fainting, they must be reclined for the blood draw. If the applicant is on
anti-coagulant medication (aspirin, heparin, coumadin, etc.), the venipuncture site must be held for at
least 5 minutes and until all bleeding has stopped.
‰ If the applicant is having his/her blood drawn while sitting in a chair, use a chair that has arms, and
there must be a surface so that the arm can be well supported in an extended position for the blood
draw.
‰ Tourniquet should be latex free, cleaned after every use; if the tourniquet becomes stained, discard it
and use a new tourniquet. A tourniquet can only be applied for a maximum of one minute above the
antecubital area of the arm. Never use a blood pressure cuff as a tourniquet.
‰ Examiners must wear fully intact gloves on both hands and instruct the applicants on all insurance
urine (HOS) collections to provide a midstream urine specimen. Both examiners and applicants must
take precautions to avoid contamination by not touching the inside of any urine collection cups,
tubes/vials, or any of their lids.
‰ When both urine and blood specimens are collected at the same appointment, always collect the urine
before collecting the blood specimen for safety reasons.
‰ Lab specimen collections must be completed by following chain of custody requirements (i.e.,
labeling/barcoding of all tubes/containers, taking and recording urine temperature, sealing of
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specimens with tamper evident tape, then signing of tamper-evident tape and forms.). Seal the
tamper evident tape onto the urine vial(s) before the applicant signs the tape because the initialing is
the acknowledgment by the applicant that the tamper evident tape was sealed to the urine vial in
his/her presence.
‰ Examiners must be prepared and equipped with extra specimen tubes/vials, standard venipuncture
needles, butterfly needles and lancets. All equipment/supplied used must not be used beyond the
expiration date. Expired supplies must be properly disposed.
‰ Inspect all needles for burrs, bends and other defects prior to each venipuncture. Immediately report
any needle defects to Quality and Performance Excellence at 214.689.3660.
‰ If the applicant/client requests the use of a butterfly needle, use a butterfly without any attempt to
justify use of the standard needle in any way.
‰ Selected puncture sites must be prepared by swabbing in a circular pattern from the center outward
with an sterile alchohol pad. If the examiner touches the site after it has been cleaned, this procedure
must be repeated.
‰ The angle of the needle insertion for a blood draw should be about 22 to 25 degrees.
‰ If the applicant complains of pain, tingling, numbness or lightheadedness, or requests that you remove
the needle, remove the needle immediately.
‰ Use a gauze pad to hold the venipuncture site after the needle is withdrawn. Never use cotton balls for
holding a venipuncture site to reduce the chance of pull on the fibrin clot on the vein that can lead to
bruising and hematomas.
‰ If the examiner has difficulty completing the blood draw, attempt to draw no more than twice, once
from the antecubital area of each arm – NEVER from the hand, wrist or other site. A new, sterile
needle must be used for each stick.
After two unsuccessful tries, reschedule the applicant in an
outside clinic or lab. Again, EMSI allows only one attempt in the antecubital area of each arm,
regardless of whether the applicant insists on additional sticks – No exceptions. Each venipuncture site
used must be documented (L arm antecubital, R arm antecubital) on the exam form and labslip. If only
an amplified service, or blood draw is completed, record arm site on the lab ID/authorization form.).
‰ Inspect the needle for burr, bends and other defects prior to each venipuncture. Immediately report
any defects to Quality and Performance Excellence at 214.689.3660.
‰ The examiner is solely responsible for holding the pressure on the venipuncture site immediately after
the collection procedure with the arm in an extended, level supported position for a total of 3 minutes
and longer if necessary until all bleeding has stopped (For an applicant who has taken or is routinely
taking aspirin or an anticoagulant such as heparin or coumadin, the venipuncture site should be held
by the examiner for 5 minutes and longer if necessary until all bleeding has stopped.). The applicant
should not be asked to hold the site.
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‰ After confirming that bleeding has stopped, apply a adhesive bandage and instruct the applicant to
keep in place for at least 30 minutes to one hour and refrain from strenuous activity or heavy lifting of
the affected arm for at least 4 hours.
‰ For DBS fingersticks, only three fingersticks are allowed. Make sure to have the client wash his/her
hands in warm water prior to completing a DBS procedure.
‰ Specimens should be collected, centrifuged and processed within EMSI stated guidelines in EMSI’s online Blood Collections training course and HSD Protocol.
‰ To assist in the maintenance of specimen integrity and avoid potential low glucose, values, glycolysis,
hemolysis, and other conditions that may be reported as Not Suitable for Analysis (NSA) or Specimen
Unsuitable for Analysis (SUFA), specimens should be centrifuged within 2 hours or as soon as possible
after the specimen collection and placed in an upright position after collection in a cooler with
refrigerant. After centrifugation, do not allow the blood tube of serum to set on top of the red blood
cells for an extended length of time before transferring the serum into the serum transfer tube.
‰ Lab work must be processed and shipped the same day as the collection or within 24 hours (one
business day).
‰ Place only the applicant’s last name on the kit before placing in the lab pack. No other identifying
information, such as social security numbers, should be placed on the outside of the kit.
‰ Make sure that all documents sent to the lab are placed within the lab kit, in an envelope or folded in
some manner to ensure that no PHI/identifiable information can be seen through the clear packaging
of the FedEx shipping pack/bag.
‰ Specimens are to be picked up by authorized courier only – NEVER deposit in a drop box or leave on a
doorstep for pickup.
‰ The names of the applicants must be listed on the back of all airbill records for shipment of the
specimens to the lab. The airbill records must be kept on file for a minimum of three (3) months. The
tracking number on the airbill record must be documented on the exam or order ticket. All examiners
must submit all copies of the airbill records and all completed exam paperwork to the branch for
scanning into ECHO.
‰ Quality assurance reviews must be performed on lab kits and paperwork for the first two weeks on all
new examiners, and longer if deemed necessary.
Periodic reviews of the examiner’s performance
should be conducted on an on-going basis.
‰ Report any defective lab equipment or supplies, including the name of the involved lab, type of
component, manufacturer/brand name, serial/lot numbers and expiration date to the EMSI Quality
Department - 214.689.3660.
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MAILING
‰ Mailings should take place within 24 hours of being completed/received and processed.
‰ Computer specifications on mailing should be followed. Any exceptions or variations should be
documented on the ticket and entered into Exam4Windows as status.
‰ Express mailing or fax requirements of customers must be consistently followed.
‰ Many customers request that all paperwork be included in the FedEX clinical lab pack. This may also
refer to U-Direct customers requiring that the application be placed in the lab pack. It is not necessary
to copy an application; placing it in a lab pack will suffice as long as it has already been imaged into
ECHO.
‰ Many customers request that all paperwork be included in the FedEX clinical lab pack. This may also
refer to U-Direct customers requiring that the application be placed in the lab pack. It is not necessary
to copy an application; placing it in a lab pack will suffice as long as it has already been imaged into
ECHO.
‰ When shipping documents (labslips, exams, EKG tracings, etc.) to the lab in the clear FedEx clinical lab
pack bag, make sure the applicant’s/client’s private information (PHI) cannot be seen through the
clear bag. Place any and all documents out of sight in the respective lab kits; if there is not a
corresponding lab kit or the documents are too bulky for the kit, place the documents in an envelope
or fold and staple them in such a manner to ensure that they will not unfold and reveal PHI.
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BILLING
‰ Run the Exams Ready to Bill report in Exams4Windows before creating a billing file in order to ensure
dollar amounts for variable rates are filled in completely.
‰ Confirm that the services performed were correct.
‰ Confirm services are billed under the examiner/collector that completed the service.
‰ Ensure that the correct bar code from the lab ID/authorization form is entered into the system.
‰ Ensure that all required agency codes, agent codes, policy numbers, etc., have been obtained and
entered into Exam4Windows. Refer to the spec for clarifications.
‰ Billing should be done on a daily basis. You can bill more than once in a day, so don’t hesitate to run
billing once in the morning and again in the evening.
‰ Billing over 90 days old is subject to charge back by the customer.
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EQUIPMENT AND MAINTENANCE
‰ To prevent and reduce the spread of flu and other illnesses among applicants, clients, customers,
examiners and branch office staff, have and bottles of alcohol based hand sanitizer available for use at
or near the counter in the office reception/waiting and staff work areas.
‰ EKG Machines – Should remain clean (electrocardiograph machine, cables, connecting leads, clips and
electrodes), and be inspected/serviced every 6 to 12 months or more often to ensure correct
calibration and proper functioning with each use.
‰ Mobile Weighing Scales – Must be at least 300 lb. to 350 lb. capacity. Calibrate mobile scales every 3
months against an in-office, professional upright physician scale, and more frequently if needed. Must
be analog style scale; digital weighing scales are prohibited.
‰ In-Office Weighing Scales – Must be physician quality upright scale of at least 350 lb. capacity and
calibrated by a professional every 6 months to 1 year.
‰ Blood Pressure Equipment – An aneroid sphygmomanometer with arm blood pressure cuff in the
appropriate size is required along with a stethoscope. Maintain clean equipment. Check annually or
more often as needed. Electronic/Digital BP equipment of any kind is prohibited. Appropriate size cuffs
(adult, adult large, pediatric, etc.) should be available to help ensure accurate BP result.
‰ Cloth measuring tape for male chest and abdominal measurements and metal measuring tape for
measuring height should be clean and in good condition.
‰ Tourniquets – A clean, latex free tourniquet should be used. Replace as necessary. NEVER use a blood
pressure cuff as a tourniquet.
‰ All equipment should be clean, well maintained, in good working condition and be replaced when
necessary.
‰ All fax/scanning/imaging equipment should be set at full, standard size to prevent faxing or
imaging/scanning reduced size copies too illegible to read. Fax equipments should provide good copy
quality without any vertical streaks. Be careful to scan all duplexed documents.
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QUALITY ASSURANCE
‰ All completed exams should have the Branch Office stamp information on them which includes the
EMSI name, branch ID #,, address and telephone number. If a formal stamp of this information is not
available, it can be neatly written in the appropriate space on each exam document (exam, labslip,
notice and consent, EKG, etc.).
‰ Review exams for:
¾
Completeness/All questions answered:
Applicant’s photo ID recorded in medical history
section, all boxes marked, conditions/tests circled, required medical detailing provided, family
history detailing complete, required number of BP readings, designation of which arm used for
each BP reading, full minute pulse reading, numerical recording for pulse irregularities, as well
as questions regarding obvious abnormalities, awareness of additional medical history, third
party
present,
language/interpreter,
lab
specimen
collection
info/barcode
applied,
documentation of specific arm used (L arm antecubital, R arm antecubital) for any blood
specimen collection, and and applicant full name and barcode labeling of every specimen vial
and container, etc.
¾
Accuracy: including all corrections initialed and dated (legal requirement on documents),
spelling/terminology, acceptable abbreviations, exact physical measurements (BP, Pulse,
Height, Weight, etc. - no rounding off recordings, applicant initials beside weight and height
measurements).
¾
Full legal name signatures (and any titles), dates as well as any City and State required
documentation (including on any authorization with exam) – no nicknames, initials or partial
names.
¾
Examiner’s block printed full legal name (first and last names) (below examiner’s signature) on
all documents, including EKG tracings.
¾
Complete MD/medical provider/facility information, including complete provider name, address
(including zip code) and phone number.
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¾
Corrections require drawing a single line through the incorrect information and must be initialed
and dated by both the examiner and applicant. Additions to the form require the examiner’s
and applicant’s initials as well (and date if added after the document has already been signed.).
Never block out or blot out an incorrect entry with ink, or liquid correction fluid. .
¾
Legibility (For clarity of faxing and imaging documents, examiners must print neatly and large
enough using a black ball point pen. Do not record medical history using cursive script).
¾
Correct postage amount, if mailed.
‰ Files for exam documents need to be retained by the office for two years – whether a physical or
imaged document. Physical copies of imaged documents must be kept for 90 days. These files are
maintained in a confidential manner according to all privacy/security of information guidelines.
‰ Files (if not imaged) are kept by month, alphabetically, and destroyed monthly, after two years, by a
professional company. Certificates of destruction must be kept for six months.
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EXAMINER INTEGRITY, PROFESSIONALISM, DRESS
CODE AND EMSI CODE OF ETHICS
‰ All examiners are required to read the EMSI Code of Ethics and sign a Professional
Acknowledgment that includes a confirmation by the examiner that he/she has read the Code of
Ethics. The Code of Ethics and Professionalism Acknowledgment is on FOLD.
‰ Examiners should conduct themselves in a professional manner and complete services maintaining
the privacy and modesty of the applicant/client and the security of their personal, confidential
information. The examiners should be well groomed, courteous, pleasant and efficient. An
examiner’s actions should be respectful of the applicant’s time, privacy, safety and dignity.
‰ The applicant may choose to have a third party of his/her choice present (spouse, relative, friend,
etc). For the sake of privacy; however, agents and agency personnel are not allowed to be present
in the room or within hearing range during the completion of an exam service. If an agent insists,
branch office management should be notified to promptly communicate the situation to the home
office of the insurance company or designated party.
‰ Examiners should not complete exam services on coworkers or other representatives of EMSI, nor
should they perform services on individuals who are their family members, relatives, personal
friend, business associates, etc. As soon as an assignment with this type of conflict of interest is
known, branch office management should be notified to ensure that service is re-assigned to
another examiner/examining company.
‰ Examiners are the third party collectors of information for the home office underwriting
departments of insurance companies. Examiners are not to discuss with the applicants their
insurability or risk, how their history or physical measurements will be possibly viewed by
underwriting, which lab tests will be conducted, or provide a medical opinion or advice, etc. If an
applicant poses such questions, please refer him/her to the agent or insurance company.
‰ Discussion during the exam service should be limited to the explanation and completion of the
services requested. Examiners must not make comments about the applicant’s residence, children,
etc. nor should the examiner discuss his/her own personal life. Examiners are prohibited from
discussing, endorsing or soliciting any products and/or services of any kind with insurance
applicants.
‰ Examiners are prohibited from accepting gifts from agents, agency personnel or applicants.
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‰ Examiners are considered the “eyes and ears” for the insurance customer and are obligated to
provide complete and accurate information concerning applicants. Any unprofessional, impropriety,
suspected misrepresentation or fraud should be reported to branch office manager and/or the
Regional Vice President or Regional Manager.
‰ Smoking in or near an applicant’s office or home is inappropriate and prohibited. Examiners’
clothing and person should not smell of smoke. Cigarettes and any other form of tobacco should
not be carried into an applicant’s home for the protection of applicants, their co-workers or family
members who may be allergic and for professionalism.
‰ No food or drink should be taken into appointments for the reasons stated above.
‰ Examiners are obligated to use safe practices during procedures and report any accidents, unsafe
practices, unsafe conditions, incidents and accidents to their branch office management and seek
emergency service if deemed necessary.
‰ Examiners have the right to use their best judgment to refuse to complete a service if they suspect
dishonesty, fraud or applicant substitution, feel there are unsafe conditions at exam sites, homes,
offices, are being harassed or endangered by applicants or applicants’ family members or agents,
have knowledge that an applicant has a contagious disease/infection or there is known
infection/disease in the applicant’s environment. Any of these conditions/situations should be
reported to branch office and/or regional management.
‰ If an agent or agency requests a blank copy of a customer’s exam form, inform the individual that
you are not authorized to provide and refer him/her to the insurance company’s home office.
‰ Immediately report all incidents and blood collection related complaints as well as examiner related
blood-borne exposures/injuries to the EMSI Quality and Performance Excellence Department at
214.689.3660. Instructions for handling incidents and blood-borne exposures are available on
FOLD.
‰ Dress code must be professional and appropriate for the community within which the examiner is
working. The following general guidelines should be adhered to:
‰ Clean, neat and well groomed (including hair, hands, and nails. For professional, blood-borne and
general safety, long hair should be tied back and avoid long fingernails or artificial nails.
Note:
Recent research has revealed that artificial nails and nails with fingernail polish have contributed to
the spread of infection in hospitals and is now prohibited.).
‰ EMSI Badge with examiner’s picture displayed.
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‰ Pager (if applicable).
‰ Business casual attire for males and females.
‰ Lab coat, and/or uniform for all collectors - Scrubs acceptable if approved by local manager.
During collections and processing, long sleeved lab coats should be buttoned and the gloves should
cover the cuffs of the lab coats/gowns to help ensure coverage of the skin of the arms during these
procedures.
‰ Closed toed and heeled shoes cleaned and polished – No open-toed shoes, open-heeled
shoes/slings/mules or sandals for blood-borne safety and professional reasons.
‰ Jeans, tee shirts, tank tops/sleeveless shirts, shorts, capri’s and/or wind (jogging) suits are not
appropriate attire for completing Exam or Health Services business.
‰ No dangling or excessive jewelry for safety and professional reasons.
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CREDENTIALING AND TRAINING PROCEDURES
‰ All EMSI examiners (contract or employee) must credentialed and approved through EMSI’s
Credentialing and Training Department at the EMSI National Service Center prior to performing
services for EMSI. Each branch office must submit the proper application and related documents to the
NSC Credentialing and Training Department.
‰ New Hire paperwork slightly differs between contract stores, salaried stores and independent
contractors. Please note that there is a separate packet for Physicians regardless of the type of store.
You may obtain the appropriate packet on FOLD or by contacting the Training and Credentialing
Department at the National Service Center. To ensure that you’re packet is expedited through the
credentialing process, please review and employ the following guidelines:
•
•
Utilize the Checklist/Cover Page – DO NOT submit this to the NSC until each item notated on the
checklist has been addressed
Each branch office must submit to the EMSI National Service Center Training and Credentialing
Department the following:
ƒ
Completed Checklist
ƒ
Completed Datasheet
ƒ
Copy of Criminal Court Record check – unless ordered through the NSC Training and
Credentialing Department.
ƒ
Copies of all supporting documentation requested on the checklist:
o
Professional license
o
Auto Liability
o
Driver’s License
o
Phlebotomy Verification
The EMSI National Service Center HR Department will verify the MD license and that it is free from any
sanctions, restrictions, limitations, probation or suspensions.
‰ Criminal Court Record Verification - Every one of your examiners (employee or contract) should have
the proper paper work on file with EMSI for payroll & insurance purposes. Please refer to the
Examiner or Contractor Checklist on FOLD for a complete list of required paperwork.
‰ All examiners who completed blood collections services in the California must be certified in the State
of California and submit a copy of their certificate along with their application requirements and
documents. The Credentialing Department will verify certification and good standing using the State of
California Phlebotomy Certification website.
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‰ You should receive notification of the examiners credentialing status within approximately 48 hours of
original paperwork submission. If you do not, please contact the Credentialing Department at the NSC
for more information.
‰ Terminating an Employee or Contractor - It is essential to submit the proper paperwork upon
termination of an employee or contractor. Submission of termination paperwork allows the NSC to
maintain accurate records for your office. The termination paperwork has been provided here for your
convenience.
‰ Transferring an Employee or Contractor- When transferring an employee or contractor, it is critical
to submit the proper paperwork detailing which examiner is being transferred to which office. This
process affects the payroll process from an examiners standpoint as well as the branch office and NSC.
The paperwork needed to successfully complete an employee transfer is already contained in the new
hire packets; however, not all of the new hire paperwork is required for a transfer. The type of transfer
determines the type of paperwork required to complete the transfer. For example, if an examiner is
transferring from a salaried store to a contract store, they would need to submit the first page of the
application and the Contractor Acknowledgement form. Refer to the Additional Number Form for details
on the exact paperwork and documentation needed for a specific type of transfer. You can access the
Additional Number Form on FOLD or by contacting the Training and Credentialing Department at the
National Service Center.
‰ EMSI Training- www.emsi-training.com – The EMSI Training website has been developed to
improve and maintain quality of service in both branch offices for our clients as well as to assist EMSI
in remaining compliant with Federal OSHA and DOT Regulations.
‰ Upon completion of the credentialing process and receipt of approval, each examiner should receive
login and password information for the new employee or contractor. That employee or contractor is
then allotted a certain timeframe in which to access the EMSI training website and complete the
trainings.
‰ Examiners are required to successfully complete EMSI’s Orientation, General Corporate Privacy and
Security, Paramed Exam, Blood Specimen Collections, EKG, Long Term Care/Senior Assessments, and
U-Direct Service Courses. Evidence of successful completion is the course certification issued after
passing (usually 80 – 90%) the course certification exam.
‰ The EMSI General Corporate Privacy and Security Refresher Questionnaire must be completed on an
annual basis in May on an annual basis.
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‰ Examiners who are completing services that require completion of customer specific, government
program or product specific can obtain information specifics on FOLD in the following documents:
‰ EMSI Training Course List
‰ Who Needs to Take Training Courses
‰ Training Policy
‰ Trainings such as Collection and BAT are federally regulated trainings and must be taken on a a biannual basis. You will receive an auto-generated email notifying you of upcoming certification
expirations.
‰ Any training that is allowed to expire will result in a deactivation of the examiner’ employee/contractor
number which will prevent them from conducting or billing for services.
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PRIVACY AND CONFIDENTIALITY
‰ Policies and procedures related to privacy and confidentiality may be located on FOLD under
Resources and Privacy/Security.
‰ EMSI’s Privacy Policy can be located on the first page of the EMSI Website in the lower corner.
‰ The Privacy Officer can be contacted by dialing 254-299-4578.
‰ Report Unauthorized Disclosures of applicant information to the EMSI Privacy Officer
IMMEDIATELY. Examples of Unauthorized Disclosure could include such issues as:
1.
2.
3.
4.
Reports mailed to the incorrect carrier.
Copies of an applicant’s information faxed to the incorrect carrier or to a wrong number.
Authorizations for records sent to the incorrect doctor.
Applicants or agents who are exposed to information regarding other applicants.
‰ Keep file cabinets in areas that are secure and are not accessible by applicants or other visitors to
the office.
‰ Applicant/subject information for any of EMSI’s customers is strictly prohibited from being placed in
any computerized system not sanctioned by EMSI.
‰ Escort any visitors, applicants, agents, brokers, etc., while in the office.
‰ Keeping Copies of Orders – Including Imaged Documents:
1. APS – copies of records 30 days after completion
2. APS – copies of the APS order, authorization and check information for 2 years after
completion
3. Exams - 2 years after completion. Hard copies are not necessary as long as they are
imaged.
4. Inspection Reports – Seven years after completion
5. Health Services – 2 years after completion Long Term Care – 2 years after completion
6. Clinical Services – 3 years after completion
7. See the section entitled, “Workplace Services” for retention of information concerning the
retention policy.
‰ Place only the applicant’s last name on the outside of the kit before placing the kit in the lab pack.
‰ Shred all trash that contains information on an applicant (i.e. duplicate orders, cancelled tickets,
notes that contain applicant information, billing research, etc.) to the extent the individual could no
longer be identified. Keep copies of the Certificate of Destruction for 180 days.
‰ If an applicant requests a copy of their exam or requests changes to be made to the exam, refer
them to the carrier or the brokerage if the case was done under an ADM account number.
‰ Execute Business Associate Agreements with Examiners, Physicians, and Clinics that perform
services on behalf of EMSI.
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‰ Ensure examiners keep paperwork secure while in the field, in their home, or in an applicant’s
home.
‰ Ensure applicants do not have access to paperwork from previous exams.
‰ Keep paperwork and computer screens out of view by:
1. Applicants in Your Office
2. Janitorial Services
3. Equipment Maintenance Personnel
4. Visiting Agents
5. Bio Waste Handlers
‰ Ensure satellite examiners place overnight courier packages in a secure drop off container. Note
that specimens may not be placed in drop boxes or left outside of the office.
‰ Follow the Minimum Necessary Rule by not discussing cases outside of the office or with individuals
who do not have a need to know about the case (i.e., other examiners or family members). This
includes discussing work related issues on social networking sites such as Facebook, Twitter, etc.
‰ When discussing cases in the office, follow the Minimum Necessary Rule by only speaking with
those associate who have a need to know and speaking in a tone where an applicant or visitor
cannot overhear.
‰ An EMSI cover sheet that contains a confidentiality notice must accompany all faxes including all
internal faxes to other EMSI branch offices and the National Service Center or Customer Service.
‰ The Internet is not a secure form of transmission therefore, images of Exams, Attending Physicians
Statements, Inspections, etc. should not be sent via email unless you are sending the information
to another EMSINet.com address or you are utilizing encryption software.
‰ A Confidentiality Notice must be present on the bottom of all email correspondence.
‰ The Company prohibits employees from soliciting applicants, claimants or subjects or distributing
literature in connection with non-work related causes, commercial pursuits, groups, or interests.
‰ APS Authorizations
1. When obtaining an APS, always present the authorization provided by the carrier first,
unless you know the facility will not accept the form.
2. If a facility will not accept the carrier’s form, verify what form will be accepted, EMSI’s or
the facility’s own forms, before having the applicant complete the document.
‰ When leaving a message for the applicant follow the Minimum Necessary Rule and, do not provide
or attempt to verify any additional information such as: Date of Birth, Social Security Number,
Policy Amount, and Agent Name.
‰ Follow directions on the spec sheet when supplying copies of Exams, APS, and Inspections to
agents, agencies or brokers. Copies can only be provided if it specifically states such on the spec
sheet.
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‰
Adhering to a “Clean Desk” Policy is a fundamental step in keeping information secure. A few
examples of steps you can take toward a Clean Desk policy are:
1. Place sensitive documents or computer backup tapes in secure drawers or file cabinets.
2. Do not leave information on a desks, fax machines, printers or copiers
3. Secure workstations before walking away
4. Utilize screen savers with password protection
5. Lock drawers, file cabinets, etc. and of course, your office at the end of the day.
‰ Subpoenas
1. All subpoenas must be served either in person, or via certified mail.
2. Keep the envelope in which the subpoena was mailed.
3. Whether properly or improperly served, immediately call the EMSI Corporate Privacy
Officer to advise of subpoena receipt.
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SYSTEM INFORMATION
(This information pertains to Contract AND Company Owned Stores)
‰ No hardware or software additions or changes can be done to any server, PC or other equipment
supporting EMSI software without approval from the EMSI IT Support Desk Manager.
‰ No Operating System changes or upgrades are to be done without approval from the EMSI IT Support
Desk Manager other than the system patches and security updates distributed by Microsoft through
their web site. The Microsoft website should be checked monthly for any new security updates and/or
patches to each computer’s operating system.
‰ Virus software must always be installed and running on all servers and workstations. Virus file
updates from the vendor must be downloaded at least once each week. If you do not see the virus
software icon in the bottom right hand corner of any screen in your office, please contact the EMSI IT
Support Desk for remediation.
‰ A UPS (Uninterruptible Power Supply) must be in place and running on all servers at all times. You
must also have “Surge Master II” brand power surge protectors connected between any computer
equipment and wall outlets. Do not use “power strips”.
‰ DSL, T1 or Cable service is required for all offices using imaging and is highly recommended for all
offices for Internet data communications.
‰ Wireless connections “inside” the office are prohibited. This is considered a security violation.
Wireless internet service providers (“outside the office”) are allowed, but the EMSI Security Officer
should be consulted.
‰ Since all correspondence from the National Service Center is to be sent via e-mail, offices should check
their EMSI e-mail accounts at least twice per day.
‰ PUB CD’s are to be run as soon as they are received at the office. When running a PUB CD,
Exam4Windows must be closed on all computers to ensure the updates are installed correctly.
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‰ All questions or problems with any computer or EMSI program should be called into the EMSI IT
Support Desk immediately for assignment to an IT employee so that your issue can be logged and
tracked. Calls are to be made to the EMSI IT Support Desk only. Do not contact any IT personnel
directly. Contact: 1-800-901-9622 or [email protected]
‰ When office equipment (copiers, fax machines, phone equipment, computer monitors, computer hard
drives, etc.) are no longer needed, please follow the steps outlined below to properly and legally
dispose of the old equipment.
‰ Prepare a detail inventory list which includes a description of the hardware, make, model and serial
number
‰ Call Chelle Jezek at 214-689-8014 or email Chelle at [email protected] to coordinate proper
removal and destruction of old hardware.
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NIGHT PROCESSING
‰ Be certain that all programs are closed before you leave at night. To verify this, you can look at the
task bar located at the bottom of the screen. System backup processing must be run every night
without fail. This is your only method of recovering Exam data files after system failures such as a
disk head crash.
‰ Make sure you rotate your backup tapes before starting the back up procedure. You should have at
least three (3) backup tapes for nightly processing.
‰ If you have an imaging unit, ensure you are running the backup routine on this computer as well.
‰ Verify the backup ran successfully each morning before starting to work in the system.
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U-DIRECT EXAM BUSINESS
‰ Review HOT Maintenance procedures when Order is received, which includes checking Tab 6 & 7 for
special instructions.
‰ Review all U-Direct memos for customer specific instructions.
‰ Agents must be notified if a pre-set appointment is being changed.
‰ Confirm appointments, provide fasting instructions and verify if applicant packet has been received (if
applicable). Remember that most customers require EMSI to go to the pre-set appointment even if we
have not spoken to the client. Messages left for the client should indicate, “I will be at your home/work
on (date/time) unless I hear from you.” Leave them your most direct contact number.
‰ Gather signatures from the applicant and make sure that all forms and documents are collected per
the customer’s instructions.
‰ Return application packet to the correct mailing address.
‰ Keep the customer updated with all status. Notify the EMSI National Service Center at
[email protected] immediately with any problems, delays, no-shows, etc.
‰ Select a CSR in your location as an “U-Direct Business Expert” to become familiar with the specific
customer instructions and this business process.
‰ Include the U-Direct on-line course in all examiner training. U-Direct reference information is also
available on FOLD.
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LONG TERM CARE (LTC) AND SENIOR
ASSESSMENT SERVICES
‰ Examiners must take the EMSI Long Term Care and Senior Assessments on-line course and
successfully pass the certification exam prior to completing LTC exams or senior assessments.
‰ When completing a LTC exam or senior assessment – print answers legibly, leaving no unanswered
questions or missing details.
‰ Pay special attention to the details needed regarding name of medication, dosage, frequency and
reason for medication.
‰ The Delayed Word Recall (DWR) time frame must be followed exactly. A 5 to 10 minute gap (8 minute
ideal) and the recording of exact DWR times are essential in the proper delivery of the DWR.
‰ After the DWR flashcards are used to show the applicant for making sentences, put them away out of
sight of the applicant. Do not share the DWR word list with other individuals including agents or
agency staff. If, in the event, the examiner has a standard set of DWR flashcards, it is important for
the examiner to remove the DWR flashcard sheet from the exam form before distribution and imaging.
‰ Long term care assessments must be completed in the applicant’s home or living environment unless
otherwise instructed per the customer. Underwriter approval must be obtained through the Partners
Plus Department before any exception can be made.
‰ Many senior assessments are completed as a supplemental service to a paramedical exam or
physician’s exam. Check the customer’s spec or order ticket instructions to confirm whether the senior
assessment must be completed at the applicant’s residence.
‰ When completing long term care/senior assessments on a husband and wife, a different word recall list
must be used for each individual. The interviews should be completed separately out of hearing of the
other spouse.
‰ Other individuals should be excused from the room at the time of the LTC/senior assessment. There
should be no distractions, interference or coaching from others.
‰ Quality assurance reviews must be performed on all newly certified examiners.
Long Term Care/Senior Assessments contact: Partners Plus
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WORKPLACE SERVICES
I. TRAINING and CERTIFICATION REQUIREMENTS
All Health Services employees must complete the certification programs listed below, before services are
provided to any clientele.
EMSI training and certification programs meet or exceed the current requirements of the Federal
Regulations on Mandated Drug and Alcohol Testing, otherwise known as 49 CFR Part 40, set forth by the
Department of Transportation (DOT).
Personnel
that
complete
services
shall
be
of
good
moral
character,
possess
a
professional
demeanor/appearance and be a graduate of an accredited high school or acceptable equivalent.
Urine Specimen Collection Web-Based Training-TRAINER
All trainers have:
‰ Completed the EMSI Web-Based Urine Specimen Collection Trainer exam with a score of 90 or
higher.
‰ Completed the 5 error free demonstrations (mocks), as outlined in 49 CFR Part 40 Regulation
40.33 which were observed “real time” by a certified trainer who completed the Web-Based mock
submission section of the Web-Based training program.
‰ Received a certificate of completion by mail, once the above mocks were submitted and reviewed
by the training/certification department.
‰ Carry a copy of certificate with them when performing collections on behalf of EMSI
‰ Complete refresher training every two years, per EMSI policy
Urine Specimen Collection Web-Based Training-Collector
All collectors have:
‰ Completed the EMSI Web-Based Urine Specimen Collection Collector exam with a score of 90 or
higher.
‰ Completed the 5 error free proficiency demonstrations (mocks), as outlined in 49 CFR Part 40
Regulation 40.33 which were observed “real time” by a certified trainer who completed the WebBased mock submission section of the Web-Based training program.
‰ Received an original certificate of completion via e-mail or from the certified trainer.
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‰ Carry a copy of certificate with them when performing collections on behalf of EMSI
‰ Complete refresher training every two years, per EMSI policy
Profile IIA (Medtox)
All Collectors have:
‰ Reviewed the Profile IIA certification booklet.
‰ Completed the test and answer sheet and either faxed them to 651-286-6297 or e-mailed to
[email protected].
‰ Received a certificate of completion either by fax or email directly from Medtox after scoring 80%
or higher.
‰ Faxed the certificate to the EMSI training/certification department at the NSC: 214-689-4251.
Hair Specimen Collection (Psychemedics)
All collectors have:
‰ Reviewed the Psychemedics certification booklet.
‰ Completed the test and answer sheet (pgs. 17-20) and faxed it to 310-216-6662.
‰ Received a certificate of completion via mail from the EMSI training/certification department, after
scoring 80% or higher.
Breath Alcohol Technician Training CD – New BAT
All BATS have:
‰ Completed Day 1, the web-based BAT Training and certification exam on TheAcademy.com with a
score of 85% or higher. Request a login and password from our EMSI Training Department –
214.689.3650.
‰ Completed Day 2: Hands on Equipment Training. Used and completed the proficiency check sheet
during a one-on-one training session set up with a certified EMSI BAT trainer or an Alpha Pro
Solutions regional training seminar.
‰ Faxed the proficiency check sheet and 7 proficiency demonstrations (mocks) to the training and
certification department at the NSC: 214-689-4251.
‰ Received a certificate by mail from the EMSI training/certification department.
‰ Carry a copy of certificate with them when performing collections on behalf of EMSI
‰ Complete refresher training every two years, per EMSI policy
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Breath Alcohol Technician Training CD – Refresher BAT
All BATS have:
‰ Completed Day 1, the web-Based BAT Training exam on TheAcademy.com with a score of 85% or
higher. Request a login and password from our Training Department – 214.689.3650.
‰ Completed Day 2: Hands on Equipment Training. Used and completed the proficiency check sheet
during a one-on-one training session set up with a certified EMSI BAT trainer or an Alpha Pro
Solutions regional training seminar.
‰ Faxed the proficiency check sheet and 3 proficiency demonstrations (mocks) to the training and
certification department at the NSC: 214-689-4251.
‰ Received a certificate by mail from the EMSI training/certification department.
‰ Carry a copy of certificate with them when performing collections on behalf of EMSI
‰ Complete refresher training every two years, per EMSI policy
II.
BREATH ALCOHOL TESTING
‰ A current copy of the Federal Regulations on Mandated Drug and Alcohol Testing (49 CFR Part 40)
is accessible during all collection events.
‰ ALL BATS currently meet training requirements outlined in 49 CFR PART 40.
‰ ALL BATS have a copy of their certificate with them when conducting breath alcohol tests.
‰ Employer copies of Breath Alcohol Testing Forms are mailed on a daily basis.
‰ To ensure the EMSI discount is received, the Intoximeter Fax Order Form is used when ordering
following: 105L Scotty DRYGAS tank, DRYGAS Regulator, and True-Cal device.
‰ The Lifeline Supply Order Form is used when ordering the following: EBT Mouthpieces, EBT Printer
Labels, EBT tamper evident tape (yellow).
‰ EMSI Supply Order Form is used when ordering: DOT and Non-DOT Breath Alcohol Testing Forms.
These forms are ordered through the PLS Warehouse. If a login is needed, contact the EMSI
Purchasing Department – 214.689.3600.
‰ I never use expired Scotty DRYGAS Tanks.
‰ I never use malfunctioning EBT/ASIV equipment.
‰ ALL EBT Equipment Issues are reported to IT Support @ 800-901-9622
‰ An accuracy check on EBT Equipment is performed every 7 days, before the collector leaves to
perform each BAT test to ensure the equipment is working correctly, and after every positive
Breath Alcohol Test.
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III.
DRUG SCREEN COLLECTIONS
‰ A current copy of the Federal Regulations on Mandated Drug and Alcohol Testing (49 CFR Part 40)
is accessible during all collection events.
‰ ALL Collectors currently meet training requirements outlined in 49 CFR PART 40.
‰ The “EMSI Donor Information and Instruction Sheet” Poster is hung in specimen collection area.
‰ ALL Collectors have a copy of their certificate with them when conducting drug screen collections.
‰ ALL collector and MRO copies of Custody and Control Forms are faxed (DOT only) & mailed (DOT
and Non-DOT) on a daily basis.
‰ The Lifeline Supply Order Form is used when ordering following: Bio Hazard 10x12 bag, Bluing
Tablets, Temperature Strips, Red Security Tape.
‰ The EMSI Supply Order Form is used when ordering the following: DOT Driver Med Exam
Certificates, DOT Driver Med Exam Report, EMSI ID Card, OHTD Billing (order) Ticket and Paramed
Exam Form. EMSI ID Cards are ordered through PLS Warehouse.
‰ The Lab Supply Ordering Reference and Lab Supply Order Form are used when ordering the
following: Lab and client specific Custody and Control Forms (CCFS), drug screen collection kits and
pre-printed AIRBILLS.
IV.
Direct Observation Urine Collections
There are now two types of Direct Observation procedures. As the collector, it is your
responsibility to know the difference between the two.
 Collector must mark proper sections of chain of custody to reflect direct observation and if observer is
used must write observer name on CCF
 Observer MUST be the same gender of the donor. No Exceptions.
 If observer is used, the person must be certified by EMSI and must have completed supplemental
Direct Observation Observer training on the EMSI training web site.
 If observer is used, collector is responsible for providing proper instructions to the observer
 Direct Observation Checklist is required on every direct observation test.
 Standard Direct Observation Collection
9
9

Required for all Non-Federal Collections requiring Direct Observation (including FD & AT)
Collector is required to view urine coming from donor into the collection cup
Federal Test “Up Down Turn Around” (aka “DOT UDTA”)
9
Required for all Federal Return to Duty Collection
9
Required for all Federal Follow-up Collections
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9
Required for all Federal collections that turn into a DO due to donor attempting to
adulterate or tamper with specimen

Collector (or observer) must instruct donor to:
9
Lift shirt/blouse up above naval
9
Lower pants and underwear down to mid thigh
9
Donor must turn around completely in front of collector/observer
9
Collector must watch urine come from donor’s body into collection container.
IV.
DOT REQUIREMENTS FOR RECORD RETENTION
How Long do I Retain Records:
1
Year
‰ Negative alcohol tests (results less than 0.020)
‰ Negative drug tests
‰ ATF for cancelled alcohol tests
‰ CCF for cancelled drug tests
2 Years
‰ EBT inspection, maintenance and calibration records/documentation
5 Years
‰ ATF for positive alcohol test results (results 0.020 or greater)
‰ CCF for positive drug tests
‰ ATF for alcohol test refusals
‰ CCF for drug test refusals (includes substituted or adulterated)
‰ CCF and ATF for Follow-Up drug and alcohol tests
How to Store Records Listed Above
‰ Records, including Custody and Control Forms (CCF) & Alcohol Testing Forms (ATF) have controlled
access (locked file cabinet).
‰ Records remain confidential & inaccessible to unauthorized personnel.
‰ Organized – Paper or Electronic File System
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‰ Written authorization from donor is obtained for Release of Information
‰ Records are retrievable, at principal place of business, in time required by agency. Some Within 2
Business Days
V.
EMERGENCY SERVICE NETWORK
‰ The EMSI “On-Call” list, detailing the office personnel who will take emergency service calls, was
completed
and
fax
to
the
National
Service
Center
at
214-689-3671.
‰ ALL “On-Call” personnel are trained and certified as both a collector and a Breath Alcohol
Technician (BAT).
‰ ALL “On-Call” personnel are aware they are listed and agree to respond to requests 24/7/365.
‰ ALL “On-Call” personnel have pagers and/or cell phones in good working order and are properly
maintained.
‰ ALL phone numbers and pager numbers of personnel listed are correct.
‰ ALL “On-Call” personnel have proper kits, Custody and Control Forms (CCF’s), and other necessary
supplies on hand or in personal car in the event they are called after hours for Emergency Request.
‰ The office has fully functional EBT unit(s) and is properly maintained at all times.
‰ EBT units are readily accessible to those listed “On-Call”.
‰ A current copy of the Federal Regulations on Mandated Drug and Alcohol Testing (49 CFR Part 40)
is accessible during all collection events.
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CLINICAL SERVICES
I.
PERSONNEL & TRAINING
All personnel performing services for clinical trials or academic research training have:
‰ Met EMSI’s standard credentialing and hiring processes
‰ Completed Human Subject Training
‰ Completed Protocol Specific Training
‰ Completed EMSI’s standard OSHA Training
‰ Documentation and Checklists showing completion of each training program is readily available
‰ Have documented Standard Operating Procedures in Place for all aspects of your office, and
ensure each examiner is fully knowledgeable about them
II.
DRESS CODE
Personnel should always:
‰ Be Clean and Well Groomed
‰ Wear Business Casual attire, or scrubs if approved by local manager, and a clean white lab
coat.
‰ Shoes Cleaned and Polished
‰ Wear EMSI Badge with picture displayed
‰ Have a Pager or cell phone
III.
APPOINTMENTS & SCHEDULING
‰ Appointment Dates and Times are normally pre-scheduled and should never be rescheduled for
clinical or academic studies.
‰ Before assigning personnel to the appointment, ensure that they have completed the protocol
specific training. If this is their first experience with this particular protocol, they must contact
the National Service Center 48 hours prior to the visit to complete the In Service Training (via
telephone). They are to have all applicable forms and documents in front of them, and be able
to devote their full attention to the training (i.e.: not driving). If the training is a web portal at
www.emsi-training.com,
this
must
be
successfully
completed
48
hours
prior
to
the
appointment.
‰ Upon receiving S2 appointment notification form, it is the branch’s responsibility to pull the
appropriate EMSI Field Service Protocol from S2 and distribute it to the assigned examiner. It
is also the branch’s responsibility to pull the appropriate EMSI Site Contact Report or EMSI
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Phlebotomist Checklist from the FOLD system (forms online) and distribute to the assigned
examiner.
‰ Call the subject to confirm the appointment 24-48 hours prior to the appointment unless the
protocol specifies otherwise.
‰ Prepare for the call by reviewing the service request and customer protocol. Carefully review
the S2 appointment notification form, including the “Special Instructions” field, where critical
appointment details may be specified.
‰ When contact with the subject is made, indicate that you are calling from EMSI on behalf of
“ABC” clinical trial or academic protocol name.
‰ Describe the requirements of the exam.
‰ Advise the subject to drink water prior to the exam regardless of any fasting requirement.
‰ Discuss any fasting requirements. Ask if they have had any difficulty with a blood draw in the
past and follow general guidelines as appropriate.
o
If on any anti-coagulant medication (“blood thinner”), proceed with draw. Keep pressure on
site for a minimum of 15 minutes after draw.
o
If history of diabetes, ask if they are taking insulin. Fasting time for those taking insulin
should never exceed recommendation of their personal physician. If they don’t know, they
should not exceed a few hours. Make a notation on the paperwork.
o
Medications should always be continued as usual.
‰ Provide the subject a general estimate of the time required to complete the appointment.
IV.
KITS & SUPPLIES
‰ Supplies (kits and paperwork) for clinical and academic studies are always subject specific and
cannot be interchanged with other studies and/or subjects.
‰ In the rare event that kits and paperwork must be picked up from the investigative site ensure
that all of the required contents are included in the kits.
‰ If the samples require dry ice, you should review protocol for specific dry ice handling
instructions prior to purchase.
‰ If the samples require ice packs, make sure required pack(s) are properly frozen and taken to
appointment as well as used for shipping.
V.
COMPLETING SERVICES
The following are standard practices that should be followed while completing services for clinical
and academic studies, however examiners should always follow procedures as outlined in the study
specific protocol.
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‰ If the subject is not at the appointed location, at the appointed time, the examiner must wait
15 minutes, then telephone contact should be made to confirm that the subject is not at the
appointed location.
The examiner must then contact the National Service Center or their
branch office for further instructions prior to leaving.
‰ Before beginning, verify and document the identity of the subject through use of a photo ID.
‰ Due to confidentiality issues, never record a subjects driver’s license or social security number
on the exam forms, you will always use the subject ID assigned by the study.
‰ Due to confidentiality issues, never have a subject sign their EKG tracing.
‰ Due to confidentiality issues, never write the subject/participant name on the shipping
containers/envelopes.
‰ The examiner should provide a brief explanation of all procedures that will be completed.
‰ Follow the EMSI Field Service Protocol exactly as written.
‰ If the examiner has difficulty completing the blood draw, attempt to draw no more than twice.
If a second attempt is required, use a different examiner if possible. After two tries, contact the
National Service Center or Branch Office. DO NOT attempt to draw 3 times.
‰ Exam forms must be complete, legible and accurate. Data points must be recorded in the
format requested (military time, European date format, initials should always be first, middle ,
last, etc.)
‰ In the event a mistake is made on a form, the examiner should make 1 strikethrough mark of
the incorrect information and have the subject and examiner initial the change.
Under no
circumstances should mistakes be “blackened” out or covered with liquid paper.
‰ All measurements such as height, weight, blood pressure and pulse, must be physically taken
and accurately recorded. No “rounding off” or short cutting is allowed.
‰ Weight is recorded in pounds, using a scale of at least 300 lb. capacity. If the subject exceeds
300 pounds, record “300 lb.+; Subject’s weight exceeded capacity of mobile scale - subject
states weight at _____”.
‰ Height is measured using a tape and recording in exact feet and inches while the subject has no
shoes on, unless otherwise noted on the exam form.
‰ Pulse and Irregularities - A radial pulse must be measured for one full minute.
Pulse
irregularities are recorded as “none” (or “0), or the recording of the exact number of
irregularities/skipped beats per one full minute.
‰ Blood Pressure Equipment
o
Use a quality aneroid sphygmomanometer & stethoscope
o
Regularly check for accuracy
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o
Digital BP equipment is prohibited
o
If arm circumference exceeds 13”, an adult large BP cuff must be used
‰ One Blood pressure reading should be taken from each arm. If either blood pressure reading
exceeds 140/90, two additional readings should be taken - one from each arm.
However,
always follow project specific protocol (Examples: if customer requires 3 readings, always take
3 readings, if customer requires all readings be taken from left arm, follow that rule).
VI.
SPECIMEN COLLECTION & PROCESSING
‰ Federal and State OSHA regulations must be followed and enforced.
‰ Specimens should be collected, centrifuged and processed within stated guidelines of the study
specific protocol.
‰ Lab work must be processed and shipped the same day as collection, or as otherwise stated in
the study specific protocol.
‰ The names of the subjects must be listed on the back of all air bill records for shipment of the
specimens to the lab. The air bill records must be kept on file for a minimum of three (3)
months.
‰ Quality assurance reviews must be performed on lab kits and paperwork for the first two weeks
on all new examiners.
‰ Follow the study specific protocol for instructions of storage of specimens.
VII.
PAPERWORK PROCESSING
‰ Paperwork must be processed and properly distributed as per the EMSI Field Service Protocol
the same day as the collection
‰ Follow the study specific protocol for detailed paperwork processing instructions
‰ Express mailing or fax requirements of customers must be consistently followed.
‰ Review all paperwork for:
−
Completeness
−
Accuracy
−
Signatures
−
Any corrections are initialed and dated by Examiner and Subject
−
Legibility
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VIII. BRANCH OFFICE QUALITY ASSURANCE
‰ Files need to be retained by the office for three years – whether a physical or imaged
document.
‰ Files should be kept by Client, Protocol Name/Number and then subject study id number, date
of service.
‰ Keep files in separate file cabinets in areas that are secure (locked) and are not accessible by
unauthorized staff.
‰ Ensure examiners keep paperwork secure at all times while in their possession (field, home,
subject’s home, etc.).
‰ Keep paperwork and computer screens out of view by:
−
Employees without a need to know
−
Vendors – such as janitorial, maintenance/repair, delivery & service personnel
−
Visitors
‰ Report Unauthorized Disclosures of subject information to the EMSI Privacy Officer immediately.
‰ Do not discuss cases outside of the office or where a subject or visitor can overhear.
‰ A cover sheet that contains a confidentiality notice must accompany all faxes.
‰ A Confidentiality Notice must be present on the bottom of all email correspondence.
‰ Ensure satellite examiners place UPS or Federal Express packages at a secure drop off location,
i.e., a staffed facility such as UPS, FedEx or Mail Boxes, Etc, prior to final express pick-ups for
the day. The drop off station must ship the same day.
‰ Ensure examiners have a private restricted access area to process samples.
‰ Have a secured storage facility for specimens and require sign in/sign out of all personnel
accessing that area.
‰ Do not leave specimens unattended in an unsecured location while waiting to be picked up by
the courier service.
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WELLNESS SERVICES
I.
PERSONNEL & TRAINING
All personnel performing services for HSD Wellness have:
‰ Met EMSI’s standard credentialing and hiring processes, prior to attending an event.
‰ Completed EMSI Wellness Screening Course - EMSI web based training.
‰ Completed MHIQ Healthways Screening Course – EMSI web based training.
‰ Completed Lead Examiner Certification Training (required for all “leads”) – EMSI web based
training.
‰ Completed Protocol Specific Training per requirements of specific customers.
II.
EXAMINER CODE OF CONDUCT AND DRESS CODE
Examiners and appropriate staff should always:
‰ Conduct themselves in a professional manner.
‰ Direct all questions to NSC; do not direct questions to site rep or client
‰ No smoking on site.
‰ No eating or drinking in screening area(s).
‰ Be clean and well groomed.
‰ Wear EMSI badge with picture displayed.
‰ All Wellness clients have the same dress code: business casual attire, or scrubs with a clean
white lab coat.
‰ Closed toe shoes must be clean and polished.
III.
APPOINTMENTS & SCHEDULING
‰ Call the Site Contact to confirm the screening event 24-48 hours prior to scheduled start time.
‰ Discuss the area that will be used for the event, and where to set-up.
‰ Verify if supplies will be on site, or if they were shipped to your office.
IV.
COMPLETING SERVICES
‰ According to client specific protocol, arrive 30 to 60 minutes prior to start time of the event to
allow for set-up of the site.
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‰ Follow the protocol or EMSI standard operating procedures for biometric measurements and
phlebotomy.
‰ All measurements such as height, weight, blood pressure and pulse must be physically taken
and accurately recorded according to client specifications.
‰ Ask if the participant has had any difficulty with a blood draw in the past, whether he/she has a
history of a bleeding problem, is taking any anti-coagulant medication (blood thinner), and has
a history of fainting, epilepsy or seizures. If the participant states he/she has a history of
hemophilia or other bleeding disorder, epilepsy or seizures, for safety reasons, the participant
must be referred to a controlled medical setting for the blood draw. If the participant has a
history of fainting, he/she must be reclined for the blood draw. If the participant is on anticoagulant medication (aspirin, heparin, coumadin, etc.), the venipuncture site must be held by
the examiner for at least 5 minutes and until all bleeding has stopped.
‰ Only a total of two venipuncture attempts are allowed. If the examiner has difficulty completing
the blood draw, attempt to draw no more than twice, once in the antecubital area of each arm Never in the wrist or hand. When possible, the second attempt should be completed by a
different examiner.
V.
SPECIMEN COLLECTION & PROCESSING
‰ Federal and State OSHA regulations must be followed and enforced.
‰ Specimens should be collected, centrifuged and processed within stated guidelines of the study
specific protocol.
‰ Lab work must be processed and shipped the same day as collection, or as otherwise stated in
the study specific protocol.
VI.
PAPERWORK PROCESSING
‰ Paperwork must be processed the same day as the collection.
‰ Review all paperwork for:
−
Completeness
−
Accuracy
−
Signatures
−
Legibility
‰ Follow the wellness specific protocol for detailed paperwork processing instructions.
‰ Express mailing or fax requirements of customers must be consistently followed.
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