Exhibit 13-1

RECOMMENDED MEDICAL RECORDS GUIDELINES

The following standards for medical records have been adopted from the National Committee for Quality Assurance (NCQA), and Medicaid Managed Care Quality Assurance Reform Initiative (QARI) as the minimum acceptable standards within most health plans.

1. Organization - Medical records must be organized systematically and uniformly to allow for efficient and rapid review. Papers must be firmly attached. Individual unit medical records are recommended as opposed to family medical records. If family records are utilized, each patient's component of the record must be clearly distinguishable and organized.
2. Patient Identification - Each page in the medical record must contain patient name or patient identification number.
3. Personal/Biographical Data - Personal/Biographical data must be noted. This may include address, employer, date of birth, sex, marital status, home and work telephone numbers.
4. Provider Identification - All entries including dictation must be identified by the author and authenticated by his or her entry. Authentication may include signatures or initials thereby verifying that the report is complete and accurate.
5. Entry Date - All entries must be dated.
6. Legible - The medical record must be legible to someone other than the writer.
7. Problem List - Significant Illnesses and medical conditions should be indicated on the problem list. If the patient has no known medical illness or condition, the medical record must include a flow sheet for health maintenance.
8. Allergies -
   • Allergies/No known allergies (NKA) must be documented in a uniform location on the medical record.
   • Medication allergies and other adverse reactions must be listed if present. List no known allergies (NKA) if applicable.
9. Past Medical History (for patients seen three or more times) - Past medical history should be easily identifiable and include serious accidents, operations, illnesses and familial/hereditary disease.
10. Smoking/Alcohol/Substance Use (for patients seen three or more times) - Notation concerning cigarettes, alcohol, and substance use must be present.
11. Physical Exam (Complete) -
    • All body systems to be reviewed within two years of the first clinical encounter.

      HEENT	Lungs	Neck
      Heart	Neuro	Back and Extremities

    • Height, weight, blood pressure and temperature must be documented on the initial visit.
12. History and Physical - Subjective and objective information is obtained and noted for the presenting complaints.
13. Working Diagnosis - Working diagnosis is consistent with findings (physician's medical impression).
14. Plan/Treatment - Documentation of plan of action and treatment are consistent with diagnoses.
15. Patient Education/Instructions - Documentation present as applicable.
16. Consults/X-ray/Lab/Imaging Reports/Referrals/Records - Reports are filed in the medical record and. initialed by the primary care physician thereby signifying review. Consultation and abnormal lab imaging study results should have an explicit notation in the medical record of follow-up plans and notification to patient of all results (i.e. positive and negative). Referrals, past medical records, hospital records, e.g., operative and pathology reports, admission and discharge summaries, consultations and ER reports should be filed in the medical record.
17. Follow-up/Return Visits - Encounter forms or notes have a notation concerning follow-up care, call or visit. Specific time to return is noted in weeks, months, or as necessary. Unresolved problems from previous visits are addressed in subsequent visits.
18. Medical Care/Services/Consults - A general overview of the medical care/services and consults ordered will be reviewed. If any potential quality issues are identified, the reviewer should refer to the practice or health plan's designated Medical Director for further direction.
19. Immunization Record -
    • For all adult patients age 21 and older, records must indicate patient's immunization status for Td.
    • For patients age 65 and older, record must indicate immunization status for influenza and pneumococcal.
    • For all patients age 21 and over and at high risk, record must indicate immunization status for influenza, pneumococcal and/or hepatitis B.
    • For patients under age 21, there must be a complete immunization record documented. If there is no record, documentation must be present regarding immunization status e.g., "Up To Date" (UTD), stating who reported the status and that a copy was requested for the medical record.
20. Preventive Services (for adult patients seen three or more times) - Record should indicate preventive services are offered according to defined Adult Screening Guidelines for Asymptomatic Men and Women. (For patients under age 21, preventive health services must be provided according to the State's mandated periodicity schedule.)
21. Advance Directives (for patients age 21 and older only) - There should be evidence that the Patient has been asked if they have an Advance Directive (written directions about their health care decisions) Yes/No response should be documented. If response is "yes," a copy must be included in the medical record.