List all relevant records with descriptions that have been provided pursuant to the Complainant 2 symptoms at 6 weeks pregnant 600mg gabapentin mastercard. Description of the method used medications bad for kidneys order gabapentin 800 mg on-line, along with any relevant search terms used medications borderline personality disorder buy cheap gabapentin 100mg on-line, to search for the relevant records medicine used for anxiety gabapentin 300mg lowest price. Please refer to the File Nuniber when submitting any new information and/or supporting documents pertaining to this complaint treatment 3 degree heart block cheap gabapentin 100mg. The Legislative Research Center provides 24-hour access to Board of Supervisors legislation medicine qhs purchase gabapentin 100 mg online, and archived matters since August 1998. Disclosures: Person of information that is provided in communications to the Boord of Supervisors is subject to disclosure under the Co/ifornio Public Records Act ond the Son Francisco Sunshine Ordinance. Members of the public ore not required to provide personal identifying information when they communicate with the Boord of Supervisors and its committees. This means that personal information-including names, phone numbers, addresses and simi/or information that o member of the public elects to submit to the Boord and its committees-may appear on the Boord of Supervisors website or in other public documents that members of the public may inspect or copy. Cheryl Leger Assistant Clerk, Board of Supervisors Tel: 415-554-7724 ~ Click here to complete a Board of Supervisors Customer Service Satisfaction form. Disclosures: Personal information that is provided in communications to the Board of Supervisors is subject to disclosure under the California Public Records Act and the San Francisco Sunshine Ordinance. Members of the public are not required to provide personal identifying information when they communicate". This m eons that personal information-including names, phone numbers, addresses and similar information that a member of the public elects to submit to the Board and its committees-may appear on the Board of Supervisors website or in other public documents that members of the public may inspect or copy. If we require further extension, we will provide you that update within that time period and will provide responsive materials to your request as they become available within that time frame. Thank you, Abigail San Francisco Department of Homelessness and Supportive Housing P1~29 Learn: hsh. If you receive this e-mail in error~ notify the sender and destroy the e-mail immediately. List all relevant records with descriptions that have been provided pursuant to the Complainant request. Cheryl Leger Assistant Clerk, Board of Supervisors Tel: 415-554-7714 Click here to complete a Board of Supervisors Customer Service Satisfaction form. Disclosures: Personal information that is provided in communications to the Boord of Supervisors is subject to disclosure under the California Public Records Act and the San Francisco Sunshine Ordinance. Members of the public are not required to provide personal identifying information when they communicate with the Board of Supervisors and its committees. This means that personal information-including names, phone numbers, addresses and similar information that a member of the public elects to submit to the Board and its committees-may appear on the Board of Superv. Subsequently I and two other colleagues representing our Contracts and Housing divisions worked to compile the required responsive documents. Picarello, this request should be directed to the Department of Housing and Homelessness. Thanks, Patrice Brown, #S230 Submits immediate disclosure request to incorrect dept.! But to qualify under that section, the request must be "simple, routine and readily answerable. For this reason, we are not treating your request as one appropriately filed as an "immediate disclosure" request, but as one which is subject to the normally applicable 10-day response time, which will be July 26th, 2019. If we require further extension, we will provide you that update within that time period and will provide responsive materials to your request as they become available within that time frame. Greetings, August 9 is not an arbitrary date, and is 14 days after the standard 10 due date of July 26, which is the allotted time for extensions per Cal. Best, 24-Jul Tanya Ellis Responds to clarify extension deadline Hi: I am at a loss about most items he is requesting. This one was recieved on one of the days you were out of the office and I responded and then you took it from here. Thomas Picarello 31-Jul Thomas Picarello Sends response Morning, I got the following response from t~e requester and want to make sure! Are the documents you sent me, reflective of his request for complaints that span the last 3 years We do not maintain records of all the grievances tenants submit directly to our contracted Housing Providers. Per our contracts, our Providers must have an Agency Grievance Policy and Procedure. If you receive this e-mail in error, notify the sender and destroy the e-mail immediately. Your request was sent as an "Immediate Disclosure Request" under San Francisco Administrative Code Section 67. U) "Fiscal Year" shall mean each period of twelve (12) calendar months commencing on July l and ending on June 30 during all or any portion ofwhichthis Agreement is in effect. The terms "as directed," "as required" or "as permitted' and similar lcrms shall refertothe direction, requirement, or permission oftheAgency. The terms "approval,' 'acceptable" or "satisi11ctory" or similar terms shall mean approved by, or acceptable to , or satisfactory to the Agency. City shall have no obligation to make appropriations for this Agreement in lieu of appropriations for new or olher agreements. Grantee acknowledges that City budget decisions arc subject to the discretion of its Mayor and Board of Supervisors. Gnmtec assumes all risk of possible nonappropriation or non-certification of funds, and such assumption is part of the considoration for this /greei11ent. Except as may be provided by City ordinances governing emergency conditions, City and its employees and officers are not authorized to request Grantee to perform services or 10 provide matcdals, equipment and supplies that wm! City is not required to honor any offered or promised additional funding which exceeds the mllximum provided in this Agreement which requires lav1ful approval and ccrtif! This Agreement shall automatically terminate, without penalty, liability or expense of any kind to City, at the end or any Fiscal Ycar if funds are not appropriated for the next succeeding Fiscal Year. This Agreement sh(:lll become effective when the Controller has certified to the avnih1bility of funds ns set forth in Section 2. The Grant Plan shall be implemented only by competent personnel under the direction and supervision of Grantee. Grantee shull at all times be govemcd by a legally constituted and fiscally responsible board or diredors. Grantee has the burden of demonstrating to City that each element of vvork or property funded in vvholc or part with the Grant Funds is directly and integrally related to the Grant Plan as approved by City. In addition, Grantee shall furnish any services funded in whole or part with the Grant Funds under this Agreement solely within San Francisco, unless City otherwise gives its prior written consent, which City may give or. St1ch acknowledgment shall conspicuously state that the activities arc sponsored in whole or in part through a grant from the Agency. Ex~ept as set forth in this Section, Grantee shall not usc the name oft he Agency or City (as a reference to the municipal corporation as opposed to location) in any Publication without prior written approval of City. Contingent amount: Up to Three Hundred Eighty Six Thousand, Nine Hundred Ninctv Five Dollars, ($386,995) for the period from July 1, 2017 to . Grantee further understands that no payment of any portion of this contingency amount will be made tmlcss and until such Jl. The Agency shall111ake disbursements of Grant Funds no more than once during each month ror the term of the grant. Grantee acknowledges that this ceJiifieation of eligibility to receive federal funds is a n1aterial term of the Agreement. Such reports, including any copies, shall be submitted on recycled paper and printed on doubli~~-sidccl pages, to the maximum extent possible. Grantee shall establish and maintain accurate Jiles and records of all aspects of the Grant Plan and the matters funded in whole or in part with Grant Funds during the te! Without limiting the scope of the foregoing, Gn111tec shall establish and maintain accuril. Le financial books and accounting records relating to Eligible Expenses incurred and Grant Funds received and expended under this Agreement, together with all invoices, documents. The dghts of City pursuant to this Section shall remain in effect so long as Grantee has the obligation to maintain such files. Notwithstanding the foregoing, Grantee may retain and use copies for reference and as documentation of its experience and capabilities. Grantee or any sub grantee creates artwork, copy, posters, billboards, photographs, videotapes. If it is ever del ermined that any such creations arc not works for hire under applicable law, Grantee hereby ussigns all copyrights thereto to City, and agrees to provide any material, execute such documents and take such otht:r actions as may be necessary or desirable to effect such assignment. Grantee may retain and usc copies of such creations for reference 8ncl ns documentation of its experience nnd t8pabilitics. Grantee shall obtai1i all releases, assignments or other ogrocmcnts from subgrantcos or other persons or entities implementing the Grant Plan to ensure that City obtains the rights set forth in this Article 6. If at any time this Agreement entitles Gnmtce 1cl the possessiLln, occupancy or use of Cjty real property for private gain, the following provisions shall apply: (a) Grantee, on behalf of itscl rand any subgrantces. Grantee is a nonprofit corporation, duly organized flnd validly existing and in good standing under the laws or the jurisdiction in which it Vas formed. Grantee has duly executed and delivered this Agreement and this Agreement emistitules n legal, v<ilid and binding obligntion of Gmntec, cnrorccable flgainst Grantee in accordance with the terms hereof. The Indemnified Jlnrty shall give Grantee prompt notice of any Loss under Section 9. Nothing in this Agreement shall constitute n waiver or limit[llion of any rights that any Indemnified Parly may have under applicable law with respect to such damages. Should any ofthe insurance required hereunder be provided under fl form ofeoverage that includes a general annual aggregate limit or provides that claims investigation or legal defense costs be included in such general minual aggregate limit, such general nnnunl aggregate limit sh1111 be double the occurrence or claims limits specified above. Failure to maintain insurance shall constitute a material breach of this Agreement. Grantee fails to provide or maintain in effect any policy of insmance required in Article l 0. Grantee fails to perform or breaches any of the terms or provisions of A1tiole 16. Grantee (i) is generally not paying its debt:; as they become chJe, (ii) files, or consents by answer. City shall have the option, in its sole discretion, to terminate this Agreement, at uny time during the term hereof, for conven iencc and without cause. Upon receipt ofthe notice, Grantee shall commence and perlorm, with diligence, all C~ctions necessary 011 the pa1i of Grantee to cfTcctthe termination of this Agreement 011 the elate specilied by City and to minimize the liability of Grantee and City lo third parties as 8 result of termination. Such actions shall include, without limitation: (1) Halting the performance of all sorvices and other Wllrk undor this. Upon such assignment City shall have the right, in its sole discretion, to settle or pay any or all claims arising out of the termination of such orders and Stl bgrants. Within 30 clays after the specified termination date, Grantee shall submit to City nn invoice, whicli shall set forih each of the following as a separate line item: C! July 2014 P1365 (l) the reasonable cost to Grantee, without profit, for all services and other Vork City directed Grantee to perform prior lo the specified termination date, Cor >vhivh services or work City has not already tendered payment. Vilh this Agreement; (3) any invoiced costs or expenses excluded pursuant to the immediately preceding subsection (d): and (4) in inslances in which. City may terminate this Agreement by giving a written termination notice lo GrantcG and, on the date specified in such notfce, this Agre. City may offset against all or any portion of undisbmscd Crant hmds hereunder or against any payments due to Grantee under any other agreement between Grantee und City the amount of any outstanding Loss i1icurred by any Indemnified Pa1iy, including any Loss inctiiTed as a result of the Event of Default. Lo all other remedies availnblc to City at law or in equity by statute or otherwise and the exercise of any such remedy shallnoi preclude or in any way be deerned to waive any other remedy.
Target Population the Grantee will serve formerly homeless adults who are 62 years of age or older and without this type of housing medicines360 buy gabapentin 800mg fast delivery, would be homeless medicine to stop vomiting gabapentin 400 mg low cost, including those with disabilities medications causing hyponatremia 800 mg gabapentin mastercard. Description of Services Grantee shall provide the following services during the term of this grant: the Granteewill provide supportive services and 47 single occupancy units of safe symptoms 32 weeks pregnant purchase gabapentin 800mg free shipping, secure and affordable housing medications similar to abilify gabapentin 800 mg fast delivery. Support services staff will offer onsite services and/or referrals to all tenants who display indications of housing instability symptoms 8 weeks cheap gabapentin 800 mg amex. The Grantee will conduct an annual Tenant Satisfaction Survey that will be publicized and offered to all tenants. Service and Outcome Objectives See the Permanent Supportive Housing Reporting table on page 7 for details on monthly, quarterly, and annual objectives. At least 90% of surviving tenants will maintain their housing for minimum of 12 months, move to other permanent housing, or be provided with more appropriate placements (e. Reporting Requirements See the Permanent Supportive Housing Reporting table on page 7 for details on monthly, quarterly, and annual reports. Total 7/1/14 - 6/30/15 $9,333 $6,879 $55,044 $4,796 $16,711 $31,144 $11,300 $452 $17,400 14 Utilities(Eiec, Water, Gas. Submittal of the invoice by designated authorized personnel with proper login credentials constitutes an electronic signature and certification of the invoice. However, Grantee must keep and make available as requested such supporting documentation for all expenditures for which reimbursement is requested for all costs so claimed. All charges incurred shall be due and payable only after services have been rendered, except as stated otherwise. Appendix C (11-20-12) Page 1 of3 P1408 o Documentation should be submitted with the invoice for all payroll expenses paid to budgeted personnel for the period covered by the invoice. The Agency, at its sole discretion, shall make available to the Grantee upon written request an advance amount not to exceed two (2) months or 1! Requests for advance payment will be granted on a case-by-case basis and are not intended to be a regular "automatic" procedure. Once the grant is certified, the Grantee, prior to distribution of any advanced payment, must fulfill the following conditions: 1. The Grantee shall submit a written request with a narrative justification that fully describes the unique circumstances to the Program Manager and Contract Manager for review and approval. Final invoice from the preceding fiscal year must be received prior to advance dis1;ribution. Timely and Complete Submission of Time Study- Failure to submit required time study by specified deadlines may result in withholding of grant payments. I eVentually crawled back bptQ my couch and remained ilwre, with my foQt thrOb b~ng; until! The term "Agreement" shall mean the Agreement dated July 1, 2014 between Grantee and City. Terms used and not defined in this Amendment shall have the meanings assigned to such terms in the Agreement. Specific Terms, (b) is hereby replaced in its entirety to read as follows: (b) "Agency" shall mean Department ofHomelessness and Supportive Housing. Duration of Term, of the Agreement currently reads as follows: the term of this Agreement shall commence on the later of (a) July 1, 2018 and (b) the effective date specified in Section 3. Such section is hereby replaced in its entirety to read as follows: the term of this Agreement shall commence on the later of (a) July 1, 2018 and (b) the effective date specified in Section 3. The maximum amount of Grant Funds disbursed hereunder shall not exceed Four Million, Two Hundred Fifty Six Thousand, Nine Hundred Fifty Two Dollars ($4,256,952)for the period from July 1, 2014 to June 30,2018. Such section is hereby replaced in its entirety to read as follows: the amount of the Grant Funds disbursed hereunder shall not exceed Six Million Eighty Four Thousand, Five Hundred Seventy Five Dollars ($6,084,575) for the period from July 1, 2014 to June 30, 2020, plus any contingent amount authorized by City and certified as available by the Controller. The maximum amount of Grant Funds disbursed hereunder shall not exceed Six Million, Six Hundred Ninety Three Thousand, Thirty Three Dollars ($6,693,033) for the period from July 1, 2014 to June 30, 2020. Grantee further understands that no payment of any portion of this contingency amount will be made unless and until such funds are certified as available by Controll~r. This Agreement and the Application Documents set forth the entire Agreement between the parties, and supersede all other oral or written provisions. If there is any conflict between the terms of this Agreement and the Application Documents, the terms of this Agreement shall govern. The following appendices are attached to and a part of this Agreement: Appendix A, Services to be Provided from July 1, 2014 to June 30, 2018 for Arnett Watson Apartments Appendix A-1, Services to be Provided from July 1, 2014 to June 30, 2018 for Essex Hotel Appendix A-2, Services to be Provided from July 1, 2014 to June 30, 2018 for Zygmunt Arendt House Appendix A-3, Services to be Provided from July 1, 2018 to June 30, 2020 for Arnett Watson Apartments Appendix A-4, Services to be Provided from July 1, 2018 to June 30, 2020 for Essex Hotel Appendix A-5, Services to be Provided from July 1,2018 to June 30, 2020 for Zygmunt Arendt House Appendix B-1, Budget for Arnett Watson Appendix B-2, Budget for Essex Hotel & Zygmunt Arendt House Appendix C, Method of Payment Appendix:0, Interests in Other City Grants Appendix E, Permitted Subcontractors Appendix F, Additional Federal Funding Award Requirements Appendix G, Dispute Resolution Procedure 2. Each of the modifications set forth in Section 2 shall be effective on and after the date of this Amendment. Except as expressly modified by this Amendment, all of the terms and conditions of the Agreement shall remain unchanged and in full force and effect. The goals of these services are to empower tenants to become self-sufficient and retain their housing or move to other appropriate housing; promote community building and tenant participation; and maintain a safe, supportive and stable environment that fosters independence. Description of Services Grantee shall provide the following services during the term of this grant: A. Outreach: Grantee shall make efforts to contact, interact, inform and invite tenants to make use of support services to assist with and address individual needs or issues. These efforts shall include written messages, in person interactions, phone messages. Intake and Assessment: Grantee shall provide one or more meetings or interviews with a tenant to establish strengths, skills, needs, plans and goals that are useful to the tenant and shall help the tenant maintain housing. Case Management: Grantee shall provide on-going meetings and counseling services with a tenant to esta:blish goals, support individualized action and service plans, and track progress toward meeting the goals. Grantee shall assist clients to identify and access services available within the community that meet specific needs or support progress toward identified goals. Mediation with Property Management: Grantee shall provide assistance in communicating with, responding to and meeting with property management. This can include helping a client understand the meaning of messages/letters/warnings from property management,assisting a tenantto write requ~sts, responses or complaints, and participating in meetings between the tenant and property management to assist the tenant in communicating with property management. Conflict Resolution: Grantee shall offer to meet with two or more tenants to assist in problem solving and resolution of conflicts. Support Groups, Social Events and Organized Tenant Activities: Grantee shall provide clients with opportunities to participate in organized gatherings for peer support, to gain information from presenters and each other, to forni social coimections with other tenants/staff, or to celebrate/commemorate significant individual, holiday and community events. Clinical Services: Grantee shall provide on-site support services staff will have access to bi-monthly supervision for case consultation. After Hours Emergency Back-up: Grantee Program Manager shall work with property management staff to implement emergency backup policies, procedures, and training. Support Services: Grantee support services staff shall outreach to all tenants who display indications of housing instability. Grievance Procedure: Grantee agrees to establish and maintain a written Tenant Grievance Procedure which shall include the following elements as well as others that may be appropriate to the services: 1. The name or title of the person or persons authorized to make a determination regarding the grievance; 2. The opportunity for the aggrieved party to discuss the grievance with those who will be making the determination; and 3. The right of a client dissatisfied with the decision to ask for a review and recommendation from upper level management who have purview over the aggrieved service within the agency. Annual Tenant Survey: Grantee shall conduct and analyze an annual anonymous Tenant Satisfaction Survey. Support services staff will contact every tenant at least three times during the first 60 days following placement in housing to engage the tenant in services. Percentage of project participants that achieve housing stability in an operating year, by remaining in permanent housing or exiting to permanent housing, is at least 80 percent. The percentage of participants that increase income from entry to follow up/exit is at least 20 percent. The percentage of participants that obtained or maintained mainstream cash income sources at follow-up or project exit is at least 56 percent. Grantee shall provide a monthly report summarizing the contract activities, referencing the tasks as described in the Service Objectives and Outcome Objectives sections. Grantee shall provide a quarterly report of activities, referencing the tasks as described in the Service Objectives and Outcome Objectives sections. Number of households that received direct services and number of direct service contacts. Grantee shall provide an annual report summarizing the contract activities, referencing the tasks as described in the Service Objectives and Outcome Objectives sections. This report will also include accomplishments and challenges encountered by the Grantee. Number of households showing housing instabllity that remained stably housed; and 4. Grantee shall participate in quarterly Time Study reports and Eviction and Exit Survey reports. Examples of critical incidents include death, fire, acts of violence, significant damage to the building, or incidents involving emergency. Grantee or Contractor agrees to meet the requirements of and participate in the evaluation program and management information systems of the City. The City agrees that any final reports generated through the evaluation program shall he made available to Contractor within thirty working days of receipt of any evaluation report and such response will become part of the official report. Program Monitoring: Program monitoring will include review of client eligibility, client files, and back-up documentation for reporting progress towards meeting service and outcome objectives. Purpose of Grant the purpose ofthe grant is to provide supportive services to adults residing in the 84 single occupancy units at the Essex Hotel. The goals of these services are to empower tenants to become self-sufficient and retain their housing or move to other appropriate housing; promote community building and tenant participation; and maintain a safe, supportive and stable environment that fosters Independence. Target Population Grantee shall serve formerly homeless adults and adult couples residing at the Essex Hotel. Case Management: Grantee shall provide on-going meetings and counseling services with a tenant to establish goals, support individualized action and service plans, and track progress toward meeting the goals. This can also include assistance in identifying, applying for and establishing appointments with available services such as food programs, medical clinics and in~home support. Referrals: Grantee shall assist clients to identify and access services available within the community that meet specific needs or support progress toward identified goals. This can include helping a client understand the meaning of messages/letters/warnings from property managem~nt, assisting a tenagt to write requests, respons~s or complain~s, and partidpating in meetings between the tenant and property management to assist the tenant in communicating with property management. Conflict Resolution: Grantee shall offer to meet with two or inore tenants to assist in problem solving and resolution of conflicts. Support Groups, Social Events and Organized Tenant Activities: Grantee shall provide clients with opportunities to participate in organized gatherings for peer support, to gain information from presenters and each other, to form social connections with other tenants/staff, or to celebrate/commemorate significant individual, holiday and community events. Wellness Checks: Grantee shall use passive observation of the tenant population and coordinating with property management to identify clients who have not been seen or have shown signs of concern to staff on at least a weekly basis. Monthly Community Meetings: Grantee shall conduct monthly community meetings for tenants. Support Services: Support services staff will outreach to all tenants who display indications of housing instability. This includes but is not limited to discontinuance from benefits, non-payment of rent, lease violations or warnings from Property Management, and conflicts with staff or other tenants. Grievance Procedure: Grantee agrees to establish and maintain a written Tenant Grievance Procedure which shall include the following elements as well as others that may be appropriate to the services: 1. Grantee shall provide a quarterly report of activities, referencing the tasks as descrihed in the Se. Number of Households that Received Direct Services and Number of Direct Service Contacts C. Examples of critical incidents include death, fire, acts of violence, significant damage to the building, or incidents involving emergency responders. The City agrees that any final reports generated through the evaluation program shall be made available to Contractor within thirty working days ~f receipt of any evaluation report and such response will become part of the official report. Program Monitoring: Program monitoring will include review of client eligibility, client files, and back-up documentation for repmiing progress towards meeting service and outco me objectives. Purpose of Grant the purpose of the grant is to provide supportive services to older adults residing inthe 47 single occupancy studio units at the Zygmunt Arendt House. The goals of these services are to empower tenants to become self-sufficient and retain their housing or move to other appropriate housing; promote community building and tenant pmiicipation; and maintain a safe, supportive and stable environment that fosters independence. Target Population Grantee shall serve formerly homeless older adults who are 62 years of age or older. These efforts shall include written messages, in person interactions, phone messages and calls, and emails as available and appropriate to reach the individual tenant. Benefits Advocacy and Assistance: Grantee shall provide assistance and referral to support a tenant to obtain or maintain benefits and solve problems related to county, state and federal benefits programs. This can include helping a client understand the meaning of messages/letters/warnings from property management, assisting a tenant to write requests, responses or complaints, and participating in meetings between the tenant and property management to assist the tenant in communicating with property management. Service Requirements A Support Services: Support services staff will outreach to all tenants who display indications of housing instability. Grievance Procedure: Grantee agrees to establish and maintain awritten Tenant Grievance Procedure which shall include the following elements as well as others that may be appropriate to the services: 1.
Complete a patient valuables control log that is kept near the storage place for patient valuables (e treatment 002 order gabapentin 600 mg free shipping. Deposit the envelope in a secured container in the presence of a witnessing hospital staff member medications prescribed for anxiety discount 400 mg gabapentin overnight delivery. This tool provides procedures and guidance on when the need to lock-down a facility exists for any reason treatment 3rd degree hemorrhoids buy gabapentin 300 mg low cost. This type of situation could involve mass contamination medicine used to treat chlamydia generic gabapentin 100 mg free shipping, picketing chi infra treatment discount 800 mg gabapentin free shipping, demonstrations treatment arthritis generic gabapentin 100 mg amex, acts of violence, sit-ins, passive resistance, civil disobedience, gang activity or other disturbances. Instructions Consider the following lock-down policy and procedure for a facility during a mass medical emergency to isolate and control access to the site. California Department of Public Health 150 Lockdown Policy and Procedure Sample I. Regardless of how peaceful the intent or how righteous the cause of a civil disturbance, because of the strong emotional nature of the issues involved, these manifestations, on many occasions, end in rioting, violence and destruction/looting of property. Based on the nature of the disturbance, it will be managed by security staff until the decision is made that management of the situation requires the activation of the Facility Incident Command System. Upon becoming aware of a civil disturbance situation, the facility administrator or senior administrative person in the facility will be notified immediately. Contaminated individuals/equipment entering the facility may require the total closure of operations of all or part of the facility. The decision to initiate lock-down will be made by the administrator, if available, based on information provided by security and other staff members. In accordance with the policy established in the emergency management plan, the following individuals, in order of position rank, may initiate lock-down in the absence of the administrator. Upon specific guidance from the administrator or designee, the operator will announce the civil disturbance three times via the public address system. The proper announcement is: <<Code Name for Lock-Down>> "Nature and Location of Disturbance" Repeat the statement every 15 minutes for the first hour, or as often as the incident commander directs. When directed by the incident commander, the operator will contact the appropriate law enforcement office and request immediate assistance. The operator will contact <<Facility Name>> Relations at the phone numbers provided for that purpose. Upon announcement of lock-down, the Incident Command Center and other designated portions of the Incident Command System organization will be activated. This will normally include, at a minimum, a portion of the planning section and the public information officer. In the case of a civil disturbance, the senior security representative present will immediately assess the situation and provide that information to the administrator or incident commander. In the case of a mass contamination situation, the infection control coordinator, or designated clinical staff member will assess the situation and recommend appropriate action. If required, security augmentation will be initiated either through recall of off-duty security, appointing other available staff to perform security duties or by obtaining augmentation from security companies. Security will immediately commence locking all exterior doors and will advise staff to close ground-floor window coverings if possible. Staff guarding other exterior doors will be instructed to not allow anyone in or out of those doors. A security representative or other designated individual will allow individuals with legitimate reason into and out of the single entry point based on the situation. A security officer will be stationed in the primary treatment area (emergency department or urgent care). If anyone exits the building, a staff or security member must ensure the door is firmly closed and locked after the individual. Security representatives will provide escorts for staff members to and from the parking areas. In the case of mass contamination, anyone leaving the building, including security representatives, must be determined to be free of contamination before being allowed to reenter the building. All information from local law enforcement, fire department and other sources will be provided to the Incident Command Center. Actions to be taken will be based on the evaluation of this information by the Incident Commander. The incident commander will determine what information will be disseminated to facility staff. The public information officer will coordinate all releases of information to the media. In the case of mass contamination, the decontamination procedures will be initiated. In the event of an extended disturbance causing all or part of the staff to remain in the facility, provisions will be made for housing and feeding these individuals. Patients, visitors and staff will be moved from the immediate area of the disturbance if at all possible. In patient care areas, access will be limited to staff and others authorized by the incident commander to be in those areas. Based on guidance provided by the incident commander, visiting hours may be reduced or eliminated and any visitors will be strictly controlled. Staff will be informed to avoid the area and to not involve themselves in the disturbance. The following checksheet should be filled out by security, or other appropriate staff, to confirm that lock-down has been completed. California Department of Public Health 155 Paper-Based Intra-Hospital Patient Tracking Process Description the process outlined is an example of the type of process that could be instituted at a facility for the purpose of tracking patients as they move through a facility when electronic systems are unavailable. Instructions Facilities should consider the intra-facility tracking process as an option for tracking patients if no current process exists. California Department of Public Health 156 Paper-Based Intra-facility Patient Tracking Process Policy A manual method for tracking patients as they move through the hospital may be required during a healthcare surge when computer systems are unavailable. Prior to the healthcare surge, a hospital will maintain a supply of index cards and determine a method for housing those cards (e. At the point of a healthcare surge, a designated person will be responsible for completing a card for each patient currently in-house. A card will also be initiated at the point of registration for every patient that is treated, triaged, admitted or discharged once the healthcare surge begins. At midnight each night, a designated staff person or person(s) will makes rounds in the patient care areas to collect newly created cards and ensure that the current location of the patient is documented on the card. At the same time, the location of each patient who already had a card will be verified. The updated and newly collected cards will be filed back into the index card box or other collection device by the patient care area so updates can easily be made the following day. California Department of Public Health 157 Patient Tracking Form Description Form used for the purposes of tracking individuals seeking medical attention within a facility and disposition of those transferred to other facilities during a healthcare surge. If the incident affects the larger community, the name may be given by a local authority (e. Record location and time of diagnostic procedures, time patient was sent to surgery, disposition of patient and time of disposition. For example, the fourteenth day of February in the year 2006 is written as 2006-02-14. Use the international standard notation hh:mm, where hh is the number of complete hours that have passed since midnight (00-24), and mm is the number of complete minutes that have passed since the start of the hour (00-59). Use international standard notation hh:mm, where hh is number of complete hours that have passed since midnight (00-24), and mm is number of complete minutes that have passed since the start of the hour (00-59). Instructions Complete all applicable fields upon deposit/removal of patient valuables. This preliminary analysis phase assesses the potential risk and impact on hospital operations, identifies recovery requirements and lists alternative strategies. The plan should take personnel cross-training into account in order to avoid the situation where only one person knows the equipment or other needs of the departments and their processes. Constant testing and adjusting are needed in order to ensure its continued viability. The Sample Business Continuity Checklist summarizes areas to consider when developing a business continuity plan. California Department of Public Health 163 Areas to Consider When Developing a Business Continuity Plan Identify essential functions within facility that must be maintained during an emergency. The template provides a sample for a business continuity plan that hospitals can use as the basis for developing a business continuity plan at their facility. The template contains key elements that will enable an organization to perform its routine day-to-day operations in the event of an unforeseen incident. Business continuity planners should follow the template and collect the elements as instructed below. The elements include critical personnel and entity contact information, roles and responsibilities, critical vendor contact information, critical recovery functions, minimal resource requirements for the functions, dependent activities/entities of the function, vital records information, site requirements for business relocation, emergency notification protocols, security strategies, designated plan coordinator and review date. Instructions Business continuity planners of each organization should reference this template and consider using it to help identify key elements to be included in the plan. California Department of Public Health 165 Sample Business Continuity Plan Template Section 1: Critical Contact Information: Identify personnel, vendors and entities* that are critical to maintaining business operations following a disaster. Critical Personnel and Entities Work Phone Cell Phone Home Phone Personal e-mail Site and Alternate Site Responsibilities Position Critical Position #1: Alternate 1: Alternate 2: Alternate 3: Critical Position #2: Alternate 1: Alternate 2: Alternate 3: Critical Position #3: Alternate 1: Alternate 2: Alternate 3: Critical Position #4: Alternate 1: Alternate 2: Alternate 3: Name Critical Vendors Vendor Vendor Name Alternate Contact: Comments: Location Contact Work Phone Cell Phone California Department of Public Health 166 Vendor Location Contact Work Phone Cell Phone Vendor Name Alternate Contact: Comments: Vendor Name Alternate Contact: Comments: Vendor Name Alternate Contact: Comments: Section 2: Essential Functions and Recovery Objectives: Identify the essential functions that are critical to business continuity and the corresponding rational for selecting these functions. Recovery objectives outline why continuity of these functions will promote overall business continuity following a catastrophic event. Essential Functions Function 1 Function 2 Function 3 Function 4 Function 5 Function 6 Function 7 Recovery Objectives California Department of Public Health 167 Section 3: Minimum Resource Requirements: Identify the minimum resources needed to complete the critical functions identified above. Y/N Y/N Y/N Y/N Y/N Y/N Y/N Essential Function Function 1 Function 2 Function 3 Function 4 Function 5 Function 6 Function 7 Comments California Department of Public Health 169 Section 5: Vital Records: Identify the type or category of vital record (e. Name/# Description Location Section 6: Alternate Site for Function: Identify alternate site(s) for essential hospital function(s). The number and location of alternate sites will depend on the hospital and the emergency. Some functions can be moved to other locations within the hospital, and others may need to be moved to an entirely new facility. Functions Function 1 Function 2 Function 3 Function 4 Function 5 Function 6 Function 7 Alternate Site California Department of Public Health 170 Section 7: Designated Plan Coordinator: Identify a business continuity plan coordinator. Name Work Phone Pager or Cell Home Phone Personal Email Alternates: Section 8: Review Date: Record the last date the business continuity plan was reviewed. The plan should be reviewed periodically based on staff / vendor turnover and other changes within the environment. Conducting a Hazard Vulnerability Analysis involves identifying all hazards that may affect a hospital and its surrounding community, assessing the probability of hazard occurrence and the consequence for the organization associated with each hazard and analyzing the findings to create a prioritized comparison of hazard vulnerabilities. The vulnerability is related to both the impact on organizational function (staff, suppliers, operational systems, infrastructure, and the like) and the likely service demands created by the hazard impact. The diagram below is an example of a natural disaster type Hazard Vulnerability Analysis. This analysis identifies the risk of the catastrophic emergency by quantifying the probability of the natural disaster occurring and then estimating its potential severity. This diagram can be adapted to assess vulnerability for other emergencies such as bioterrorism, pandemic influenza, technological or chemical hazards. Hospitals can use this information to assess which hazards are most likely to impact their specific facility and focus preparedness and mitigation activities on those hazards with the highest relative threat. Instructions Registration personnel should complete all available fields upon patient registration. Although during disaster time periods insurance verification and eligibility requirements may be relaxed, the information should be resumed as soon as possible. California Department of Public Health 179 Sample Registration Log Description Form is used to log all patients registered and includes fields medical record number, disaster incident #, last name, first name. A disaster incident number is a unique identifier established at the county level for persons being treated at facilities during healthcare surge. The short form medical record can be initiated during a healthcare surge and should be utilized to capture pertinent assessment, diagnosis and treatment information. Instructions this document should be completed for individuals seeking medical attention. If patient labels or stickers are used within an organization, and they are available, a label can be affixed in place of handwriting the information. Re-Assessment this section is to be completed as a secondary assessment prior to a procedure. California Department of Public Health 184 Standard Operating Procedure Template for Equipment, Plant and Utilities Description It is essential to involve facility engineering personnel in the patient management planning processes in order to ensure maintenance of a safe environment for both hospital personnel and patients. Areas within the expertise of engineering that must be included in the planning process are: alarm systems, electrical backup power, elevators-vertical transport, room/hood exhaust, steam distribution, internal transport system, medical gases system, roads and grounds, waste and debris, and water delivery/portability. Development of these procedures is critical to the recovery of business operations. Instructions Review procedure and consider following it for the development of patient management planning processes.
Code for Record I (a) Sequela of cerebral infarction I693 Code to sequela of cerebral infarction (I693) since "sequela of" is stated symptoms yeast infection 600 mg gabapentin sale. Codes for Record I (a) Hemiplegia 1 year G819 (b) Intracranial hemorrhage I692 Code to sequela of other nontraumatic intracranial hemorrhage (I692) since the residual effect (hemiplegia) has a duration of one year treatment nail fungus 400 mg gabapentin free shipping. Codes for Record I (a) Brain damage G939 (b) Remote cerebral thrombosis I693 Code to sequela of cerebral thrombosis (I693) since the cerebral thrombosis is reported as remote medicine names discount 800mg gabapentin with mastercard. Code for Record I691 I (a) Old intracerebral hemorrhage Code to sequela of intracerebral hemorrhage (I691) since the intracerebral hemorrhage is stated as old symptoms kidney stones order 600mg gabapentin otc. Code for Record I693 I (a) Cerebrovascular occlusion 6 years Code to sequela of cerebrovascular occlusion since the duration is one year or more symptoms questionnaire effective 800 mg gabapentin. O970-O979 Sequela of obstetric cause Use this category for the classification of a direct obstetric cause (conditions in O00-O927) if: (a) A statement of a late effect or sequela of the direct obstetric cause is reported treatment 24 seven order gabapentin 300mg visa. Application of Rule 3 following modification After application of the modification rules, selection Rule 3 should be reapplied. However, Rule 3 should not be applied if the originating cause selected by application of the modification rules is correctly reported as due to another condition, except when this other condition is ill-defined or trivial. Although cerebral embolism can be considered a direct consequence of the endocarditis, it is reported due to arteriosclerosis aorta on this certificate. However, it is recognized that certifiers do not always report a single condition on the lowest used line, nor do they always enter the related conditions in a proper order of sequence. Therefore, it is necessary to edit the conditions reported during the selection process. Also included are instructions for use in the United States designed to bring assignments resulting from reporting practices particular to the United States into closer alignment with the intent of the International Classification procedures. The interpretations and instructions in this section are general in nature and are to be used whenever applicable. Frequently on the medical certificate, one condition is indicated as due to another, but the first one is not a direct consequence of the second one. For example, hematemesis may be stated as due to cirrhosis of the liver, instead of being reported as the final event of the sequence, liver cirrhosis portal hypertension ruptured esophageal varices hematemesis. The assumption of an intervening cause in Part I is permissible in accepting a sequence as reported, but it must not be used to modify the coding. I (a) Cerebral hemorrhage (b) Chronic nephritis Codes for Record I619 N039 Code to chronic nephritis (N03. It is necessary to assume hypertension as a condition intervening between cerebral hemorrhage and the underlying cause, chronic nephritis. Codes for Record F79 P021 I (a) Mental retardation (b) Premature separation (c) of placenta Code to premature separation of placenta affecting fetus or newborn (P02. It is necessary to assume birth trauma, anoxia or hypoxia as a condition intervening between mental retardation and the underlying cause, premature separation of placenta. As a guide to the acceptability of sequences in the application of the General Principle and the selection rules, the following relationships should be regarded as "highly improbable". The preceding list does not cover all "highly improbable" sequences, but in other cases the General Principle should be followed unless otherwise indicated. Acute or terminal circulatory diseases reported as "due to" malignant neoplasm, diabetes or asthma should be accepted as possible sequences in Part I of the certificate. The following conditions are regarded as acute or terminal circulatory diseases: I21-I22 I24. A diagnostic term that contains one of the following adjectival modifiers indicates the condition modified has undergone certain changes and is considered to be a one-term entity. I (a) Hemorrhagic cardiomyopathy Code for Record I428 Code to the category for other cardiomyopathies (I428). The Classification does provide a code, I428, for "Other cardiomyopathies" in Volume 1. Code bronchiectasis only, since there is no provision in the Classification for coding "other bronchiectasis. G309 Multiple one-term entity: A multiple one-term entity is a diagnostic entity consisting of two or more contiguous words on a line for which the Classification does not provide a single code for the entire entity but does provide a single code for each of the components of the diagnostic entity. Consider as a multiple one-term entity if each of the components can be considered as separate one-term entities. Codes for Record I (a) Hypertensive arteriosclerosis I10 I709 Code to hypertension (I10). I (a) Hypertensive myocardial ischemia Code for Record I259 Code to myocardial ischemia (I259). Adjective reported at the end of a diagnostic entity Code an adjective reported at the end of a diagnostic entity as if it preceded the entity. I (a) Arteriosclerosis, hypertensive Codes for Record I10 I709 Code to hypertension (I10). If an adjectival modifier is reported with more than one condition, modify only the first condition. I Codes for Record (a) Arteriosclerotic nephritis and cardiomyopathy I129 I429 Code to arteriosclerotic nephritis (I129). If an adjectival modifier is reported with one condition and more than one site is reported, modify all sites. Codes for Record I (a) Arteriosclerotic cardiovascular and cerebrovascular disease I250 I672 Code to arteriosclerotic cardiovascular disease (I250). The modifier is applied to both conditions, but in this case the selected cause is not modified by the other condition on the record. When an adjectival modifier precedes two different diseases that are reported with a connecting term, modify only the first disease. Codes for Record I (a) Arteriosclerotic cardiovascular disease and cerebrovascular disease I250 I679 Code to arteriosclerotic cardiovascular disease (I250). When one medical entity is reported followed by another complete medical entity enclosed in parenthesis, disregard the parenthesis and code as separate terms. Consider line (b) as two separate terms, both of which are complete medical entities. When the adjectival form of words or qualifiers are reported in parenthesis, use these adjectives to modify the term preceding it. I (a) Collapse of heart (b) Heart disease (rheumatic) Codes for Record I509 I099 Code to rheumatic heart disease (I099). If the term in parenthesis is not a complete term and is not a modifier, consider as part of the preceding term. I (a) Metastatic carcinoma (ovarian) Code for Record C56 Code to primary ovarian carcinoma (C56). Plural form of disease Do not use the plural form of a disease or the plural form of a site to indicate multiple. I (a) Cardiac arrest (b) Congenital defects Codes for Record I469 Q899 Code to congenital defect (Q899); do not code as multiple (Q897). Implied disease When an adjective or noun form of a site is entered as a separate diagnosis. Codes for Record I251 I10 I (a) Coronary (b) Hypertension (c) Code to coronary disease (I251). Line I(a) is coded as coronary disease since coronary hypertension is not indexed. Consider the site, renal, to be a part of the condition that immediately follows it on line b, since Hypertension, renal is indexed. Non-traumatic conditions Consider conditions that are usually but not always traumatic in origin to be qualified as non-traumatic when reported due to or on the same line with a disease. I (a) Fat embolism (b) Pathological fracture I749 M844 Code line I(a) as non-traumatic since reported due to a disease. Generally, it may be assumed that such a condition was of the same site as another condition if the Classification provides for coding the condition of unspecified site to the site of the other condition. These coding principles apply whether or not there are other conditions reported on other lines in Part I. Conditions of unspecified site reported on the same line (1) When conditions are reported on the same line with or without a connecting term that implies a due to relationship, assume the condition of unspecified site was of the same site as the condition of a specified site. I (a) Aspiration pneumonia (b) Cerebrovascular accident due to (c) thrombosis Codes for Record J690 I64 I633 Code to cerebral thrombosis (I633). Since thrombosis (of unspecified site) is reported on the same line with a condition of a specified site, relate to the specified site. Since infarction (of unspecified site) is reported on same line with two conditions of specified sites, relate to the specified site immediately preceding the condition. Conditions of unspecified site reported on a separate line (1) If there is only one condition of a specified site reported on the line above or below it, code to this site. I (a) Cholecystitis (b) Calculus Codes for Record K819 K802 Code to calculus of gallbladder with other cholecystitis (K801). I (a) Intestinal fistula (b) Obstruction (c) Adhesions of peritoneum Codes for Record K632 K566 K660 Code to intestinal adhesions with obstruction (K565). Since the Classification does not provide a code for obstruction of the peritoneum, relate to the site reported on the line above (intestinal). Since the thrombosis is classified to both sites (reported above and below), do not relate. It is acceptable to relate conditions not reported as the first condition on a line to the line below. I (a) Gastrointestinal hemorrhage (b) Peptic ulcer Codes for Record K922 K279 Code to peptic ulcer with hemorrhage (K274). I (a) Peritonitis (b) Ulcer Codes for Record K659 K279 Code to peptic ulcer (K279). When hernia (K40-K46) is reported with disease(s) of unspecified site(s), relate the disease of unspecified site to the intestine. I (a) Hernia with obstruction Codes for Record K469 K566 Code to hernia with obstruction (K460). I (a) Calculus with pyelonephritis Codes for Record N209 N12 Code to urinary calculus (N209). I (a) Phlebitis (b) Deformities (c) Osteoarthritis lower limbs Codes for Record I809 M219 M199 Code to osteoarthritis lower limbs (M199). Relate a condition of unspecified site to the complete term of a multiple site entity. If it is not indexed together, relate the condition to the site of the complete indexed term. I (a) Cardiorespiratory arrest with (b) insufficiency Codes for Record I469 I509 Code to heart failure (I509). Since cardiorespiratory arrest is indexed to a heart condition, relate insufficiency to heart. I (a) Renal failure (b) Vasculitis Codes for Record N19 I778 Code Vasculitis, kidney (I778). Do not relate conditions classified to R00-R99 except: Gangrene and necrosis Hemorrhage Stricture and stenosis I R02 R5800 R688 Codes for Record J189 J850 (a) Pneumonia with gangrene Code to gangrene of lung (J850). Relate gangrene to pulmonary, the site of the disease reported on the same line, since gangrene is one of the exceptions. Do not relate a disease condition that, by the name of the disease, implies a disease of a specified site unless it is obviously an erroneous code. I (a) Encephalopathy, cirrhosis Codes for Record G934 K746 Code to encephalopathy (G934). Do not relate encephalopathy to liver since the name of the disease implies a disease of a specific site, brain. Some conditions (such as injury, hematoma or laceration) of a specified organ are indexed directly to a traumatic category but may not always be traumatic in origin. Otherwise, code to the category that has been provided for "Other" diseases of the organ (usually. I (a) Laceration heart (b) Myocardial infarction (c) Codes for Record I518 I219 Code to myocardial infarction (I219) selected by General Principle. Since laceration heart is reported due to myocardial infarction, consider the laceration to be nontraumatic. Codes for Record R092 I619 I620 D320 I (a) Cardiorespiratory failure (b) Intracerebral hemorrhage (c) Subdural hematoma, cerebral meningioma Code to cerebral meningioma (D320). Subdural hematoma is considered to be nontraumatic since it is reported on the same line with cerebral meningioma. The nontraumatic subdural hematoma selected by Rule 1 is a direct sequel (Rule 3) to cerebral meningioma. Some conditions are indexed directly to a traumatic category but the Classification also provides a nontraumatic category. When these conditions are reported due to or with a disease and an external cause is reported on the record or the Manner of Death box is checked as Accident, Homicide, Suicide, Pending Investigation or Could not be determined, consider the condition as traumatic. Subdural hematoma is considered to be traumatic as indexed since "accident" is reported in the Manner of Death box. Cerebral hematoma is considered traumatic as indexed since "accident" is reported in the Manner of Death box. Some conditions are indexed directly to a traumatic category, but the Classification also provides a nontraumatic category. When these conditions are reported and the Manner of Death box is checked as Natural, consider these conditions as nontraumatic unless the condition is reported due to or on the same line with an injury or external cause. This instruction applies only to conditions with the term "nontraumatic" in the Index. The subdural hematoma is considered to be nontraumatic since "Natural" is reported in the Manner of Death box and is selected by application of General Principle. Even though Natural is reported in the Manner of Death box, the subdural hematoma is reported due to an injury.
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