Patient resources

Sharp Community is committed to ensure access to appropriate medical services within our network. Access to health care must be provided in a timely manner as identified by the situation. Basic health care services and specialized health care services will be readily accessible and available to each patient.

Normal working hours

Except in an emergency, physicians and patients are encouraged to make and keep appointments. Each physician office has a policy to see patients within 30 minutes of their scheduled appointments. Sharp Community physicians maintain reasonable hours of operation and the provision of after-hours services.

Primary care appointments should be made within the following time frames.

• Emergency - immediate

• Urgent - within 24 hours

• Routine primary care - within seven calendar days

• Preventive care - within 30 calendar days (20 days for senior members)

Specialty care appointments that require prior authorization should be made within the following time frames:

• Routine referrals - reviewed within five business days

• Urgent referrals - reviewed within 72 hours

After-hours care

After-hours coverage (nights and weekends) may be accessed by calling your doctor's office. Their answering service will tell you what to do next. You may be directed to urgent care or an emergency room if your doctor finds it necessary.

Emergency services

If you believe you need emergency care, contact your primary care physician (PCP), who will determine what treatment is required. If you believe a delay could seriously jeopardize your health, seek treatment first, then notify your PCP as soon as possible. Your PCP is responsible for follow-up and coordination of your care after the emergency has been resolved.

Calling 911

If you or someone else’s health is in immediate danger, call 911. The following symptoms and conditions may mean someone needs emergency care:

• Difficulty breathing or shortness of breath

• Pain or discomfort in your chest

• Severe stomachache

• Fainting or sudden dizziness, weakness, or changes in vision

• Change in mental status, including confusion or difficulty awakening

• Sudden or severe pain anywhere in the body

• Bleeding that won't stop

• Severe vomiting, nausea

• Coughing up blood

If you call 911 from a cell phone, your call is directed to the 911 dispatch center for the California Highway Patrol (CHP). The CHP will forward your call to the appropriate agency. Be aware, when you call on your cell phone, the CHP cannot detect your location as with a residential or business 911 call. It's important to know your location when calling from a cell phone.

Insurance typically covers you for the care needed to stabilize your condition. Your PCP should be seen if more care is needed. Please notify your PCP within 48 hours of a visit to an emergency room or trauma center. If you go to an emergency room without being directed there by your doctor, your condition will be evaluated to determine whether emergency care was required. If it is determined that emergency care was not required, you will be financially responsible for these services.

People with disabilities

Sharp Community provides service locations that are accessible to and usable by people with disabilities in accordance with Section 504 of the Rehabilitation Act of 1973.

Mental health, alcohol and drug addiction

For mental health services, please contact your health plan.

This form lets you name another individual as agent to make health care decisions for you if you become incapable of making your own decisions, or if you want someone else to make those decisions for you now even though you are still capable. You may also name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you.

• Advance health care directive

Financial incentives statement

Sharp Community Medical Group practitioners make utilization management decisions based only on appropriateness of care and service and existence of coverage. Practitioners and individuals who conduct utilization review are not rewarded for denials of coverage or service care and there are no financial incentives for utilization management decision makers to encourage decisions resulting in underutilization.

United Healthcare Medicare Advantage criteria

United Healthcare uses InterQual criteria when Original Medicare criteria are absent or require supplementation. The following link will provide you access to the proprietary, nationally recognized third-party criteria, InterQual, that may be used when conducting medical necessity reviews for requested Medicare Advantage services. This link is being provided in accordance with regulatory requirements.

• InterQual

Physicians are required to have patients sign a consent for any surgical or diagnostic procedures performed in their office.

The consent process includes these steps:

• Physician will discuss expected or possible risks of a procedure with the patient.

• Physician or staff will complete the appropriate consent form for the procedure.

• Patient will sign and date the consent form.

• Witness will sign and date the consent form. Note: A witness can be anyone who is not involved in the procedure.

• If the patient refuses treatment, the patient must sign the refusal to consent to treatment form.

All consents are maintained in the patient's medical record.

The Customer Services Department of Sharp Community Medical Group, available Monday to Friday, 7:30 am to 5 pm, provides a variety of services to our customers, including providing a resource for information, assistance and problem resolution.

Sharp Community is committed to providing the highest level of customer service to its patients. The Customer Services Department of Sharp Community is the your key contact for any questions, information, or problem resolution that is not directly related to your health status.

Customer Services representatives are available to help with the following concerns:

• Provide guidance in primary care physician (PCP) selection, and correspond with the contracted Health Plan regarding these activities

• Explain health plan benefits and coverage, including coordination of benefits

• Confirm eligibility and benefits information as provided by the Health Plan

• Provide assistance to patients who wish to terminate their relationship with their physician

• Educate members regarding Sharp Community Medical Group

• Work with other key staff to resolve member concerns and issues

The Sharp Community Medical Group Member Services staff is committed to the following standards of conduct:

• Respond to each member concern in an effective, efficient and professional manner

• Develop a strong working relationship with the staff, as well as with the health plans, providers and their staff

• Maintain member confidentiality

Language services are provided to members that request assistance, free of charge, in the requested language via bilingual staff or an interpreter.

The Sharp Community Medical Group Utilization Management (UM) staff is available eight (8) hours a day during normal business hours and days to receive communication from the Customer Service Department regarding UM issues.

It is the policy of Sharp Community Medical Group to require primary care sites to maintain an infection control policy.

Offices are required to:

• Conduct initial training and continuing education for all health care workers, including students and trainees, on the epidemiology, modes of transmission and prevention of HIV and other blood-borne infections, and the need for routine use of universal blood and body-fluid precautions recommended by the Centers for Disease Control and Prevention for all patients

• Follow all OSHA guidelines as presented in Cal/OSHA Standards Manual

• Maintain OSHA Guideline Book in office

• Monitor adherence to recommended protective measures; when monitoring reveals a failure to follow recommended precautions, counseling, education and/or retraining should be provided

• Provide equipment and supplies necessary to minimize the risk of infection with HIV and other blood-borne pathogens

Sharp Community Medical Group complies with applicable Federal Civil Rights laws and does not discriminate on the basis of color, national origin, age, disability, or sex. As a participating provider with Sharp Community, our providers must not discriminate against Sharp Community members because of race, creed, religion, ancestry, marital status, sexual orientation, gender identity, national origin, age, sex, or physical or mental handicap, in accordance with Title VI of the Civil Rights Act of 1964, et seq., Section 2000d Rules and Regulations, or as otherwise provided by law or regulation.

Discrimination on the grounds of race, color, creed religion, age, sex, national origin, marital status, sexual orientation, gender identity or expression, or physical or mental handicap includes, but are not limited to the following:

• Denying any member a covered service or availability of a facility.

• Providing to a member any covered service which is different, or is provided in a different manner or at a different time as that provided to other Sharp Community Medical Group members except where medically indicated.

• Subjecting a member to segregation or separate treatment in any manner related to the receipt of any covered services.

• Restricting a member in any way in the enjoyment of any advantage or priority enjoyed by others receiving services.

• Treating a member or eligible beneficiary differently from others in determining whether he or she satisfies any admission, enrollment, quota, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any covered service.

If English is not your first language, we're happy to assist you in your native language.

This notice has important information. You may need to take action by certain dates to keep your health coverage or help with costs. For help in your language at no cost, you can call the number on your ID card.

Download our PDF to view this statement in other languages.

• Patient bill of rights

• Patient bill of rights (Spanish)

Every Sharp Community Medical Group office maintains an effective records system that conform to the laws and regulations of the State of California governing retention of active records, retirement of inactive records, data entry procedures, and the release of medical information. Each office maintains a medical records system that provides procedures for collecting, processing, maintaining, storing, retrieving and distributing medical records of enrolled members.

The patient's medical record is an important source of vital information and must be complete and up-to-date to assure continuity of care. Clinical records provide appropriate and adequate clinical documentation of all care received to facilitate continuity of care for all medical problems addressed in the clinical record. Each office location is required to maintain adequate storage facilities for medical records to ensure patient confidentiality is maintained. Handling, storage, and destruction of medical records must be HIPAA compliant. Offices maintain a consistent identification system for patient records and ensure timely retrieval of the chart when requested.

Confidentiality of medical records

The physicians of Sharp Community Medical Group ensure the confidentiality and the appropriate release of information concerning their patients' medical records.

Member medical records will be kept confidential and the information will be released only according to approved policy and procedure.

The office staff and providers may release medical record information only if a signed consent has been obtained from the member, the parent or legal guardian, or the person legally responsible for making medical decisions for the member.

Any person making copies of member record information will note the release in the departmental, medical or computer record and sign and date the entry.

In an effort to offer you the best possible health care, Sharp Community Medical Group has developed patient satisfaction surveys. These surveys offer us valuable feedback to continually identify and implement improvement opportunities.

Weekly, Sharp Community sends randomly selected patients a survey from both their primary care provider and their specialty care provider. These questionnaires measure the services each patient received from Sharp Community physicians and their staff.

The patient experience survey allows us to measure:

• The accessibility of our care.

• The service received from physician staff prior to meeting with your physician.

• The time you spent with your physician.

• Our sensitivity to your needs.

• And your overall level of satisfaction of our services

We at Sharp Community look forward to your honest responses. Your participation is essential in our efforts to continually provide excellent services to you.

A good doctor patient relationship is essential for your continuing good health. You can help develop an optimal relationship by preparing in advance for your scheduled office visits.

If you are preparing for your first visit with a new doctor:

Make sure that your previous medical records are available for review by your new primary care physician. You may arrange to have copies of these records sent from your previous provider directly to your newly selected physician. Your new physician will need to know your past medical history including information regarding past illnesses, conditions and treatments. The doctor will also want to know all about the prescriptions, over-the-counter and herbal medications you are currently taking or may have taken in the past. Be sure to tell your physician about any allergies you may have or any adverse reactions to medications that you have experienced.

If you are being seen for an illness or injury, your physician may ask or need to know:

• How long you have been ill or when the injury occurred? Is there a known cause for your problem? What do you think is the cause of you problem?

• What are the names of the medications you are taking? What dose and how often do you take them? Remember to include any herbal remedies and over-the-counter medications on your list.

• Do you have any allergies?

• If you are in pain, is it steady or periodic; sharp, achy or dull?

• Is your condition getting better or worse? Is there any known cause of this perceived change?

• Have you had this illness/injury before? How was it treated?

• Have you had any changes in body temperature, heart rate or breathing?

• Are you being treated for any other medical conditions?

• Are there any other symptoms or important information your physician should know?

Your physician should tell you:

• What your diagnosis is and how can it be treated or prevented.

• Medication: what you should and should not be taking, how much and how often. If there are any common side effects you should be aware of. If you should avoid certain foods, juice or alcohol while taking the medicine?

• Whether your illness or injury restricts you from any normal daily life activities?

• If you are awaiting test results, who should call whom and when?

Remember that patient involvement always results in better care and a more satisfying physician-patient relationship. If you have any questions, feel comfortable asking your physician.

If you have a prescription benefit, remind your doctor which insurance company is responsible for your coverage. This will allow your doctor to determine if the medication you need is covered by your health plan. Remember that investigational medications or medicines taken for cosmetic purposes are not covered under your prescription benefit.

For patients with new health insurance plans or insurance policies that begin on or after September 23, 2010, the following preventive services must be covered without copayment or coinsurance or meeting a deductible, when these services are delivered by a network provider.

Covered preventive services for adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked

• Alcohol Misuse screening and counseling

• Aspirin use to for men and women of certain ages

• Blood Pressure screening for all adults

• Cholesterol screening for adults of certain ages or at higher risk

• Colorectal Cancer screening for adults over 50

• Depression screening for adults

• Type 2 Diabetes screening for adults with high blood pressure

• Diet counseling for adults at higher risk for chronic disease

• HIV screening for all adults at higher risk

• Immunization vaccines for adults — doses, recommended ages and recommended populations vary

  • Hepatitis A

  • Hepatitis B

  • Herpes Zoster

  • Human Papillomavirus

  • Influenza (Flu Shot)

  • Measles, Mumps, Rubella

  • Meningococcal

  • Pneumococcal

  • Tetanus, Diphtheria, Pertussis

  • Varicella

• Obesity screening and counseling for all adults

• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk

• Tobacco Use screening for all adults and cessation interventions for tobacco users

• Syphilis screening for all adults at higher risk

Covered preventive services for women, including pregnant women

The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.

• Anemia screening on a routine basis for pregnant women

• Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer

• Breast Cancer Mammography screenings every one to two years for women over 40

• Breast Cancer Chemoprevention counseling for women at higher risk

• Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*

• Cervical Cancer screening for sexually active women

• Chlamydia Infection screening for younger women and other women at higher risk

• Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt "religious employers".*

• Domestic and interpersonal violence screening and counseling for all women*

• Folic Acid supplements for women who may become pregnant

• Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*

• Gonorrhea screening for all women at higher risk

• Hepatitis B screening for pregnant women at their first prenatal visit

• Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*

• Human Papillomavirus (HPV) DNA Test every three years for women with normal cytology results who are 30 or older*

• Osteoporosis screening for women over age 60 depending on risk factors

• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

• Sexually Transmitted Infections (STI) counseling for sexually active women*

• Syphilis screening for all pregnant women or other women at increased risk

• Tobacco Use screening and interventions for all women and expanded counseling for pregnant tobacco users

• Urinary tract or other infection screening for pregnant women

• Well-woman visits to get recommended services for women under 65*

Covered preventive services for children

• Alcohol and Drug Use assessments for adolescents

• Autism screening for children at 18 and 24 months

• Behavioral assessments for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Blood Pressure screening for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Cervical Dysplasia screening for sexually active females

• Congenital Hypothyroidism screening for newborns

• Depression screening for adolescents

• Developmental screening for children under age three

• Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Fluoride Chemoprevention supplements for children without fluoride in their water source

• Gonorrhea preventive medication for the eyes of all newborns

• Hearing screening for all newborns

• Height, Weight and Body Mass Index measurements for children at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Hematocrit or Hemoglobin screening for children

• Hemoglobinopathies or sickle cell screening for newborns

• HIV screening for adolescents at higher risk

• Immunization vaccines for children from birth to age 18 — doses, recommended ages, and recommended populations vary:

  • Diphtheria, Tetanus, Pertussis

  • Haemophilus influenzae type b

  • Hepatitis A

  • Hepatitis B

  • Human Papillomavirus

  • Inactivated Poliovirus

  • Influenza (Flu Shot)

  • Measles

  • Meningococcal

  • Pneumococcal

  • Rotavirus

  • Varicella

• Iron supplements for children ages six to 12 months at risk for anemia

• Lead screening for children at risk of exposure

• Medical History for all children throughout development at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Obesity screening and counseling

• Oral Health risk assessment for young children ages: zero to 11 months, one to four years, five to 10 years

• Phenylketonuria (PKU) screening for this genetic disorder in newborns

• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk

• Tuberculin testing for children at higher risk of tuberculosis at the following ages: zero to 11 months, one to four years, five to 10 years, 11 to 14 years, 15 to 17 years

• Vision screening for all children

For more information on this and other Health Care Reform topics visit HealthCare.gov.