C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-4, subsec. 144-101-II-4.06

Current through 2024-51, December 18, 2024

Subsection 144-101-II-4.06 - POLICIES AND PROCEDURES

4.06-1Professional Staff

A physician is a doctor of medicine or osteopathy who possesses a current license to practice medicine or osteopathy in the State or Province in which the services are provided.

4.06-2Member Records

There shall be a specific record for each member that shall include, but not necessarily be limited to:

A. The member's name, address, and birth date;

B. The member's social and medical history, as appropriate;

C. Operative reports or procedure/treatment descriptions, as appropriate;

D. A description of any tests ordered and performed and their results;

E. A description of treatment or follow-up care and dates scheduled for revisits;

F. Any medications and/or supplies dispensed or prescribed;

G. Any recommendations for and referral to other sources of care;

H. The dates on which all services were provided;

I. Written progress notes, which shall identify the services provided, pathology specimens obtained, and where sent, as applicable;

J. Informed consents; and

K. Assessment appropriate to the nature and scope of the procedure performed and the specific medical condition of the individual patient.

4.06-3Program Integrity

See Chapter I of the MaineCare Benefits Manual, for Program Integrity procedures.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-4, subsec. 144-101-II-4.06