FHCHC DPP OGTT Prepara.on Checklist 1 Month -- 1 Week Before Screening Have all referral forms been collected? Have all paAents been scheduled for 8:30am or 9:00am screening slots in PCN? Have all screening, child educaAon, medical visit, and vitals rooms been reserved? Has a clinician(s) assistant been requested and assigned by the Clinicians Assistant Manager?
FHCHC DPP OGTT Prepara.on Checklist 1 Month -- 1 Week Before Screening Have all referral forms been collected? Have all paAents been scheduled for 8:30am or 9:00am screening slots in PCN? Have all screening, child educaAon, medical visit, and vitals rooms been reserved? Has a clinician(s) assistant been requested and assigned by the Clinicians Assistant Manager?
FHCHC DPP OGTT Prepara.on Checklist 1 Month -- 1 Week Before Screening Have all referral forms been collected? Have all paAents been scheduled for 8:30am or 9:00am screening slots in PCN? Have all screening, child educaAon, medical visit, and vitals rooms been reserved? Has a clinician(s) assistant been requested and assigned by the Clinicians Assistant Manager?
1
Month
-‐
1
Week
Before
Screening Yes No Have
all
referral
forms
been
collected? Have
all
referrals
been
entered
into
DPP
spreadsheet? Have
all
paAents
been
scheduled
for
8:30am
or
9:00am
screening
slots
in
PCN? Have
all
paAents
received
a
call
to
confirm
aJendence?
1
Week
Before
Screening Yes No
Have
all
paAents
been
sent
appointment
cards
in
the
mail? Have
the
screening,
child
educaAon,
medical
visit,
and
vitals
rooms
been
reserved? Has
a
Clinician's
Assistant
been
requested
and
assigned
by
the
Clinicians
Assistant
Manager? Has
screening
lunch
been
ordered?
Has
a
phlebotomist(s)
been
scheduled? Has
a
clinician(s)
been
scheduled
for
the
screening?
Note:
ideal
is
2
family
nurse
prac55oners Has
Glucola
been
ordered?
Has
the
billing
department
been
noAfied
of
the
screening
date? Has
a
billing
department
staff
member
been
scheduled
to
manage
the
check-‐in
desk?
2
Days
Before
Screening Yes No
Have
all
new
PECS
forms
been
printed
and
highlighted? Have
all
previously-‐printed
but
yet
unused
PECS
forms
been
collected? Have
all
paAent
labels
been
printed?
Has
a
billing
department
staff
member
been
confirmed
for
managing
the
check-‐in
desk? Have
all
lab
forms
been
filled
out
with
test
requisiAons,
diagnosis,
paAent
informaAon,
billing
informaAon? Have
all
charts
been
pulled?
Has
FaciliAes
been
requested
to
supply
2
sharps
containers,
and
set
up
screening,
child
educaAon,
medical
visit,
vitals
rooms
and
check-‐in
area? Has
the
clinician(s)
pre-‐interviewed
all
paAents
over
the
phone?
1
Day
Before
Screening Yes No
Has
billing
department
printed
billing
forms? Have
all
reminder
calls
been
made
to
paAents? Have
2
copies
of
the
PaAent
Vital
Sheet
been
created? Have
5
copies
of
the
paAent
list
been
printed
from
PCN? Have
the
Appointment
Lists
been
distributed
to
the
Billing
Department,
clinician(s),
DPP
staff? Has
the
Phlebotomist(s)
been
confirmed? Has
the
Clinician's
Assistant
been
confirmed? Has
the
Screening
Material
Box
been
assembled?
-‐
Pt.
Folders-‐English
or
Spanish
-‐
Waist
Circumference
Tape,
Blood
Pressure
Cuff's
(2)
-‐
Calculator,
Name
Tags,
Insulin
Tubes
w/Numbers
&
Date