Observations
Based on a review of letters of agreement and an interview with the project director the facility failed to provide a written agreement with a licensed hospital or physician, for 24-hour emergency medical coverage.
The findings include:
Letters of agreement were reviewed on October 14, 2010. The project director was interviewed on October 14, 2010 and confirmed the lack of a written agreement for 24- hour emergency medical and 24 hour emergency psychiatric coverage.
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Plan of Correction
POC: 0167
ON November 3, 2010 NHS Susquehanna mailed letters of referral agreements for 24-hour emergency psychiatric and medical coverage to the following area hospitals: Geisinger Medical Center in Danville, PA; Sunbury Community Hospital, Sunbury, PA and Evangelical Community, Lewisburg, PA. Include with the letters of agreement were self addressed postage paid envelopes to facilitate response time. Below you will find a copy of the referral agreement.
NHS SUSQUEHANNA CENTER COUNSELING
117 E. INDEPENDENCE ST., SHAMOKIN, PA 17872
REFERRAL AGREEMENT
This agreement represents a 24 hour/7 day referral agreement between NHS Susquehanna Center Counseling and _____________________ to provide both medical and psychiatric services. This agreement is effective on 11/3/10 to be held in good standing until one or the other withdraws from the agreement by written retraction. NHS Susquehanna Center Counseling and ____________________________ agree as follows:
1. This agreement will not bind either agency to use the services of the other
exclusively, nor will it obligate either agency to provide services for the
other.
2. When a client is referred from one agency to the other, the agency to
which the referral is being made agrees to provide services to the client as
promptly as possible, provided that customary eligibility requirements of
the receiving agency are met.
3. If the requirements are not met and the referred client is not accepted, the
agency to which the referral was made will notify the referring agency
immediately.
4. At the time of referral, the referring agency will provide all pertinent
information required to determine appropriate treatment and continuing
care. This information will be provided as soon as possible after the
referral. Signed "Release of Information" consent forms will be provided
prior to transfer of records.
5. Both NHS Susquehanna Center Counseling and _____________________ agree that any records and/or information regarding referral clients will be
handled according to the guidelines of the Federal and State Confiden-
tiality laws. They will resist in "judicial proceedings" any efforts to obtain
access to any information pertaining to clients other than expressly pro-
vided for in applicable Federal and State laws.
6. We mutually agree that unauthorized disclosure of client information is a
Federal criminal offense punishable by a fine.
7. All records of each agency shall remain property of that agency.8. NHS Susquehanna Center Counseling and _____________________agree to inform each other of policy changes that will have a direct impact on the nature of this agreement.
NHS SUSQUEHANNA CENTER COUNSELING
____________________________________ _______________
Michael Pawlicki, MS Date
Program Director
____________________________________ _______________
Date
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