Effective immediately, any Female and Male Medical Exam templates previously posted on the Family PACT website are no longer to be used for medical record documentation. These templates are not considered adequate for medical record documentation for services billed for reimbursement under the Family PACT Program.
The Family PACT Standards require medical documentation to support services billed for reimbursement. Medical record documentation shall reflect the clinical rationale for providing, ordering or deferring services to clients according to Family PACT Standards, including, but not limited to, client assessment, diagnosis, treatment and follow-up.
Medical record documentation shall reflect the scope of education and counseling services provided to clients according to Family PACT Standards, including, but not limited to, individual client assessment, topics discussed and name and title of counselor.
All medical record entries must be legible and the clinician must be clearly identifiable. In accordance with W&I Code, section 24005(p), each provider of health care services rendered to any program beneficiary shall keep and maintain records of each service rendered, the beneficiary to whom the service was rendered, the date and any additional information that the department may by regulation require.
Family PACT Program, Policies, Procedures and Billing Instructions Manual Sections:
Copies of the sterilization Consent Form (PM 330) can be downloaded (in English and Spanish) from the Forms page of the Medi-Cal website or ordered by calling the Telephone Service Center (TSC) at 1-800-541-5555. Providers must supply their NPI number when ordering the form(s). The following information also may be requested:
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