Attachment 1 - PWS Exhibit B - Example Primary Care Appointing Criteria.xlsx

Hearing Program

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Name, Title, Email and Phone Number of Primary and Alternate clinic POC’s that IRMAC may contact if needed

This information IS NOT given to patients Primary: MAJ Harber, Stacie A Email: stacie.a.harber.mil@health.mil Alternate: Name/Phone/Email

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Detailed Beneficiary Categories and other special eligible populations served by the MTF/clinic

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Information for appointing agents to clarify specific circumstances or special instructions

MEDPROS, Follow-up on MEDPROS, Annual PHA, ETS, Retirement, Chapter, Flight PE, Commissioning PE, and School requirement PE.

Appt/Slot: HEAR GRP / HEAR GRP 60 ONLY Diagnostic and Tinnitus Exam:

For patients needing diagnostic hearing or tinnitus evaluations.

Need to have completed a DD2215/2216 Hearing Exam (HEAR GRP) within the past 3 months prior to booking HEAR SPEC

Appt / Slot Type : HEAR SPEC / HEAR SPEC 60 ONLY

SECTION 6

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Clinic-specific special instructions that ONLY apply to Active-Duty patients Active Duty Instructions

SECTION 7

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Clarification for agents on specific concerns or circumstances that are allowed to be scheduled into a Virtual appointment slot Eligible Reasons for VIRTUAL

SECTION 8

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Column A Clinic Teams with DMIS Must match MHSG naming convention

Column B Clinic Hours and Location

Column C Agent resources with hyperlinks Patient Care Location (PCL) Information for the Patient Agent Resources

Madigan Hearing Program Hours: M, W, TH, & Fri 0645-1530 / Tue. 0645-1500

"1480 Hearing Appointment Request List"

SECTION 9

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Step-by-Step instructions for agents:

For all appointment types available to IRMAC (FTR, 24HR, SPEC, GRP, VIRT)

Copy and paste pre-formatted script from applicable Primary/Specialty Appointing Process tab

Update RED text with your specific clinic information.

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Clarification for agents on specific concerns or circumstances that are allowed to be scheduled into a Virtual appointment slot

HEAR GRP : HEAR GRP 60 1. Schedule first available appointment, if there are no available appointments or patient refuses, move to Step 2.

2. Offer to submit a Standby Appointment Request (SAR) (see SAR Link).

Appointment Request: Specialty Appointment

HEAR SPEC : HEAR SPEC 60

1. Schedule first available appointment, if there are no available appointments or patient refuses, move to Step 2.

2. Offer to submit a Standby Appointment Request (SAR) (see SAR Link).

SECTION 10

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Column A Instructions or policies that apply specifically to in office appointments, i.e. visitor guidance

Column B Instructions or policies that apply specifically to virtual appointments, i.e. private environment requirements Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Clinic-specific special instructions that ONLY apply to Active-Duty patients

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Column A Clinic Teams with DMIS Must match MHSG naming convention

Column B Clinic Hours and Location

Column C Agent resources with hyperlinks Special Instructions for the Patient For Face-to-Face appointments Please plan to arrive at least 15 minutes prior to your appointment at the Madigan Annex, Bldg 9911C to allow enough time for any necessary paperwork.

Enter via ramp 2 or from the main entrance. Parking is available behind Fisher House 1.

If you are more than 10 minutes late, the clinic will attempt to accommodate you; however, the no-show/late-show policy will apply, and you may need to reschedule your appointment.

Due to construction, the Madigan Gate will be closed through early-mid spring of 2026. Please note the dates are subject to change. You may be required to use a different entrance than usual.

We recommend allowing extra time for travel and arrival to ensure you reach your appointment on time.

If Patient or caregiver has COVID or FLU-like symptoms, please wear a mask and notify the front desk right away.

For scheduling information please go to pacificnw.asymca.org

Ask Bremerton Patients:

Would you like information about the shuttle to take you to your appointment at Madigan?

If yes, direct patients to call (360) 475-4000 Opt #8.

To offer availability to other patients, if you need to cancel or reschedule your appointment, please call us back @ 1-800-404-4506 Option 1 to speak with a live agent during business hours or Option 2 to leave a cancellation voicemail, 24 hours a day, 7days a week.

file:///C:/Users/stephanie.burgett/AppData/Local/april.biggs/:u:/r/sites/PugetSoundProtocols/SitePages/RevCycle--Entering-UAR.aspxfile:///C:/Users/janette.l.daniels/:u:/r/sites/PugetSoundProtocols/SitePages/Appointing-Business-Rules.aspx%3fcsf=1&web=1&e=0eltgmhttps://forms.office.com/Pages/ResponsePage.aspx?id=vx9g6uIS50ikeXOWlfWF2zftMniTIrlEqz1a7ok4iNdUM0U0WTRXT0M4V081OUVXTzdVTzVLNzA1OC4ufile:///C:/Users/janette.l.daniels/:u:/r/sites/PugetSoundProtocols/SitePages/Network-Access-Days-to-Care.aspx%3fcsf=1&web=1&e=zD3Ish Provider List Hearing Program PROVIDER LIST Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): On the Provider List Tab in the protocol, maintain an updated list of clinic providers, any provider-specific guidelines that may affect booking, and the clinic team the providers are assigned to-must match MHSG naming convention.