Sample forms to help calculate provider productivity incentives.
A sample written provider productivity incentive plan.
Files
- ProviderProductivityIncentivePlan.doc (11.71 KB)
Sample provider contract.
Files
- 58_SampleContract2.doc (31.5 KB)
Sample provider contract with a physician.
Files
- 57_SampleContract1.doc (52.82 KB)
copy deeplink Core Competency for Clinic Medical Assistant (Certified Areas are in bold)
Core Competency for Clinic Medical Assistant (Certified Areas are in bold)Staff member must be able to demonstrate the knowledge and skill necessary to provide care based on physical, psychosocial, educational, safety and related criteria appropriate to the age of the patients served in their assigned area. Validation to be completed by a co-worker with minimum of equivalent licensure, physician and/or manager/supervisor. Person validating must initial, date and indicate method of validation in appropriate column and sign form.
Files
- C.MA+or+CNA+Core+Competencies (1).doc (64.5 KB)
copy deeplink Core Competency for Clinic Licensed Practical Nurse
Core Competency for Clinic Licensed Practical NurseStaff member must be able to demonstrate the knowledge and skill necessary to provide care based on physical, psychosocial, educational, safety and related criteria appropriate to the age of the patients served in their assigned area. Validation to be completed by a co-worker with minimum of equivalent licensure, physician and/or manager/supervisor. Person validating must initial, date and indicate method of validation in appropriate column and sign form.
Files
- LPN.LVN+Core+Competencies.doc (68.5 KB)
copy deeplink Core Competency for Clinic Registered Nurse
Core Competency for Clinic Registered NurseMember must be able to demonstrate the knowledge and skill necessary to provide care based on physical, psychosocial, educational, safety and related criteria appropriate to the age of the patients served in their assigned area. Your validation needs to be completed by a co-worker with minimum of equivalent licensure and/or physician. Person validating must initial, date and indicate method of validation in appropriate column and sign form.
Files
- RN+Core+Competencies.doc (68.5 KB)
Tool that can be used to evaulate support staff (RN, LPN, MA) competencies in key areas.
Files
- SUPPORTSTAFFPROFICIENCY.doc (71 KB)
Comprehensive evaluation of staff nurse competencies.
Files
- 360_NurseComp.doc (159.5 KB)
Guidelines/Evaluation for Medical Interpreters
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copy deeplink Lab Waive Proficiency Testing Competency Checklist
Lab Waive Proficiency Testing Competency ChecklistForm to evaluate lab proficiency testing competencies during training.
Files
- 358_LabProficiencyChecklist.doc (80 KB)
Form for use in evaluating testing personnel competencies.
Files
A third example of a checklist to determine provider competencies at all age levels.
Files
- 352_AgeSpecificCareCklist.doc (73.5 KB)
Another example of a checklist to determine provider competencies at all age levels.
Files
- 39_AgeSpecificCriteriaChecklist.pdf (54.72 KB)
Checklist to determine provider competencies at all age levels.
Files
- 38_agespecific.compet.pdf (31.48 KB)