Attachment 1- PWS Exhibit C - Example Specialty Care Appt Criteria.xlsx

Cardiology

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: Front Desk 253-968-1100 Option 2 Alternate: N/A

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): Questions/concerns that should be immediately referred to clinic for disposition instead of continuing with appointing agents Refer to Clinic Items - (253) 968-1100 option #2

Non-Madigan Patients:

All appointments are scheduled by the clinic

SECTION 5

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

Appointments within 4hrs of the call. New Referral Required:

If the patient was last seen more than 24 months ago, DO NOT schedule, must have PCM submit a new referral, exception for patients requesting Exercise Treamill Stress Test. EKG:

Walk-In Only Available Hours M-F 0800-1130 & 1300-1530

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 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): Questions/concerns that should be immediately referred to clinic for disposition instead of continuing with appointing agents Patient Care Location (PCL) Information for the Patient Agent Resources

Madigan Cardiology Hours: M-F 0800-1600

"0125 Cardiology 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.

Only for CV Exercise Treadmill Test

CARD PROC : CARD PROC 30 1. Schedule first available appointment, if there are no available appointments within 28 days that meet patient's needs, Offer appointment outside of 28 days, if there are no available appointments or patient refuses, move to Step 2.

2. Attempt Warm Transfer to the clinic at (253) 968-1100 option #2 , if unsuccessful or outside of clinic hours move to Step 3.

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

update referral sub-status to "DOD- Patient contacted will call to schedule" and add comments to referral comments tab.

IRMAC comment: "IRMAC/ INITIALS/ OUTCOME"

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): Information for appointing agents to clarify specific circumstances or special instructions

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

Burgett, Stephanie M CIV DHA DHN INDO PACIFIC (USA): Clinic-specific special instructions that ONLY apply to Active-Duty patients Special Instructions for the Patient For Face-to-Face appointments Please plan to arrive at least 15 minutes prior to your appointment to allow enough time for any necessary paperwork.

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.

Please ensure that you wear gym clothes and running shoes to your appointment.

Also, NO Eating for at least 4 hours prior to your appointment. You may drink fluids.

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

Patients 10 years and older need a valid ID card for check in.

Patients 17 years and younger MUST be accompanied by a parent or guardian with medical power of attorney.

Please do not bring children to your appointment.

Children are not allowed in the exam rooms or to remain in the waiting room unsupervised during your visit.

For scheduling information please go to pacificnw.asymca.org 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/jennifer.sparks/:x:/r/sites/LeadershipSharePoint/Shared%20Documents/Protocol/Criteria/Job%20Aids/General/Appointing%20Business%20Rules.V7.7.25.xlsm Cardiology Provider List

CARDIOLOGY 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.