UCSF ADVANCED PRACTICE NEWSLETTER
February 2019
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CELEBRATING PROFESSIONAL
NURSE PRACTITIONERS
NURSE ANESTHETISTS
PHYSICIAN ASSISTANTS
NURSE MIDWIVES
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IN THIS ISSUE
Highlighting AHP Practice at UCSF Health
An AHP driven CPAP Clinic to Improve Treatment Adherence and Outcomes
AHP UPDATES
NEW Ambulatory AHP TIME STUDY for Medi-Cal
AHP Academic Stipend
Exceptional AHP and Nursing Week Award Nominations
NP3 Promotion and Recent Recipients
Reimbursement for Prolonged Records Review
Compliance with SB 1152
FAQ regarding Billing and Coding
New Educational Video for Bariatric Surgery by Ryan Wilson, PA
APEX Upgrade February 10th
GME Grand Rounds
New AHPs to UCSF Health for the 7th Cohort in18/19 FY
Advisory Board Minutes,December 2018
Committee Opportunities for AHP Advisory Board - please volunteer
Trends in Primary Care Visits
True North Metrics
Stethoscope Hygiene
Association of PAs in Oncology Conference
Pediatric Pain Conference
California Healthcare News
UCSF Health Events Calendar
PAs engaged in Street Medicine
Doximetry Article - AHPs meeting the needs in Primary Care
Center for the Enhancement of Communication in Healthcare
New Mandate for CA Opiate Prescribers
AHP Students at UCSF Health
CAPA and Medicare Provisions for PAs in Hospice Care
Sharing your Expertise across the State and Nation
New Hospital at Parnassus Heights
Caring for the Caregiver/Schwartz Rounds
SON Preceptor Opportunities
RECOGNITION, PUBLICATIONS, PRESENTATIONS, AND NEWS
Jeff McKinney, NP
2 Articles Published and one presentation at AASLD
Recognition for Angela Laffan in the Great Catch Award
DGIM Crede Award 2018
Patty Paik, NP was the recipient
RESOURCES
Fun Discounts for UCSF Employees
Pager Box Update
2018/2019 AHP Advisory Board
Required Training in LMS
Face Card Process
How To Correct The Staff Directory
AHP Resource Manual Link
Adding New Privileges
Scope Of Practice Details
Licensing and Certification Responsibilities
CURES Sign Up for Scheduled Medication Prescribing
BRN Link
DEA
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HIGHLIGHTING THE ADVANCED HEALTH PRACTITIONERS
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Pictured left to right
Sonia Padilla, Julianne Blythe PA and Veronica Mallari MSN
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An AHP driven CPAP Clinic to Improve Treatment Adherence and Outcomes
UCSF Sleep Disorders
J
ulianne Blythe PA, Veronica, Mallari NP, Sonia Lopez, Chris Garvey NP, Kim Trotter MA, Tu Grimalauskas, Rochelle Zak MD, Laura Koth MD, and David Claman MD
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Obstructive sleep apnea (OSA) is a common disorder associated with cardiovascular disease and cognitive abnormalities. Effective treatment with continuous positive airway pressure (CPAP) is associated with improved outcomes in moderate to severe OSA, yet CPAP adherence in the US has remained at 34% for the past 20 years.1 Models are needed to enhance adherence, improve clinical outcomes, and support insurance coverage requirements of face to face CPAP assessment and documentation of adherence.
A UCSF AHP-led team intervention of patients diagnosed with OSA and prescribed CPAP includes individualized clinician evaluation, focused training on OSA, treatment options, role of CPAP, and adherence and follow up requirements. Patients are advised of the insurance requirements for coverage of CPAP, including patient use of CPAP > 4 hours per night for 70% of 30 consecutive days during initial 90 days of use, and need for face-to-face follow-up to evaluate adherence. Adherence and clinical effectiveness were measured with cloud enabled CPAP download.
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179 patients with mean apnea hypopnea index (AHI) of 38.6 (severe = > 30) were included in the retrospective analysis. 90.5% met adherence requirements. Mean AHI in follow up was 4.4 (normal = < 5) during the initial 90 day assessment and mean CPAP usage was 6.38 hours per night. Use of a AHP-led multidisciplinary CPAP clinic utilizing structured patient involvement including training on OSA and potential negative impact, treatment options, adherence and follow up requirements, and focused re-assessment within 90 days of treatment initiation resulted in 90 day adherence of 90.5%. A behavioral approach that includes patient engagement with training on health impact of untreated OSA, potential benefits and challenges of CPAP, treatment alternatives, insurance requirements for PAP coverage and clinician real time evaluation of adherence and AHI data appears to favorably influence adherence and potential for improved clinical outcomes. The study will be submitted in abstract form to two international scientific meetings in anticipation of manuscript development.
Reference:
Rotenberg B, Marariu D, Pang K. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016; 45: 43. Published online 2016 Aug 19. doi: 10.1186/s40463-016-0156-0
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VERY IMPORTANT
Applies to Ambulatory AHP Providers ONLY
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As we move to make inpatient AHPs billing providers, we need to offset this change with adding a workflow to ONLY outpatient providers to begin. This involves AHPs completing a Medi-Cal SPA Time Sheet which physicians already complete. This event only happens 3 times per year and date selection is random and decided by Medi-Cal. It could add significant revenue for work that you do that is NOT reimbursed currently. The following content provides information that ALL ambulatory AHPs must review. Identified AHP providers will receive a link to the Learning Module in the LMS system separately that will act as the audit for Medi-Cal.
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The UCSF Office of Advanced Practice has 15 supported stipends to offset the cost of AHPs presenting at an academic conference in their specialty. Podium/poster/panel presentations will be eligible. Other requirements listed in link.
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SUPPORT FOR Academic Excellence for AHPs PRESENTING AT A CONFERENCE RELEVANT TO THEIR SPECIALTY
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Gabe Schwartz, NP (bottom)
Adult GI medical oncology
talk: Updates in Cancer Screening
42nd Annual Educational Conference California Association for Nurse Practitioners in San Diego, CA
Mary Lesh, NP (middle)
Pediatric hematology-oncology
Talk: MSKUS-Professional Approach to New Therapies
Nurses Forum of International Society Hemostasis Thrombosis in Melbourne, Australia
Sarah Kabatt, NP (not pictured)
Pediatric Cardiac Intensive Care
Talk: Impact of Iron Supplementation in Infants with Shunted Single Ventricle Physiology
22nd Annual Update on Pediatric and Congenital Cardiovascular Disease in Huntington Beach, CA
Alisa Yee, NP (top)
Adult GI surgery Oncology
Poster: Onboarding for Advanced Practice Providers
Americas Hepato-Pancreatio-Biliary Association Annual Conference in Miami Beach, CA
We are proud to highlight the first four recipients and their work.
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Exceptional AHP Award and Nursing Week Advanced Practice Awards will be here soon. Please consider nominating a colleague Now.
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NP3 PROMOTION MATERIALS and DEADLINE:
March 29, 2019 for new applications
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Latest Appointment of Successful Nurse Practitioner 3 Providers
Claire Parker. PNP Pediatric Pulmonary HTN
Fabienne Hollinger, PNP Pediatric Oncology
Maura O'Day, PNP Pediatric Surgery
Please join me congratulating them.
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Reimbursement for Prolonged Records Review in the Ambulatory Setting
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One challenge of caring for patients in the outpatient setting comes with the extensive non-face-to-face time associated with care in some cases. In 2017, CMS recognized the need to value provider time for reviewing clinical records in "prolonged service without direct patient contact" when more than 30 minutes are spent for a given patient. Through the work of many, a workflow has now been established in APeX enabling providers to bill for and receive wRVUs for records review exceeding 30 minutes, even if that review happens in the days prior to or following the face-to-face visit. (Up to a half hour of review is considered within reason and is captured with standard charges.) These codes 99358/9 for prolonged non-face-to-face time can also include communication with other professionals about the case or communication with the patient and family separate from the direct care.
Reimbursement for these charges works most reliably for Medicare patients as other payers may or may not recognize these codes. These codes only apply to time spent by the billing Attending Physician or Advanced Practice Provider (not staff, students, residents or fellows).
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Compliance with SB 1152
Effective 1/1/2019
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Billing and Coding Information Presentation
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New Bariatric Surgery Orientation Video for Patients and Providers.
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Ryan Patrick Wilson, PA-C, MSPAS, MPH
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New patient bariatric surgery orientation video created by Ryan Wilson, PA and Stan Rogers, MD. This will help educate other AHPs and physicians about the diseases of obesity and the benefits of bariatric surgery as it improves or eliminates obesity related diseases. It is the same content Ryan presents to patients through in person orientations.
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APEX UPGRADE COMING SUNDAY FEBRUARY 10th
You have to select site and log-in to view earning. Must be logged into UCSF VPN.
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Simplifying Medication Reconciliation in Ambulatory with Upgrade
Going forward, MA/LVNs will review and remove medications from the list, while physicians/providers will click once to agree to all changes.
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GME Grand Rounds - inter-professional opportunity to share experiences.
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AHP NEW HIRES FOR 7TH COHORT 2018/2019 FY
Please welcome these new AHP professionals
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AHP ADVISORY BOARD MINUTES
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Seeking AHP Committee Participants that will report to the AHP Advisory Board.
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Trends In Primary Care Visits
HCCI - healthcostinstitute.org
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UCSF HEALTH UPDATES REGARDING TRUE NORTH METRICS
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2nd Surgical Oncology Advanced Practitioner Conference (aka SOAP Conference), April 26-28, 2019 at MD Anderson
has been approved for 17.75
AMA PRA Category 1 Credits
TM
, of which 1.50 have been designated in the area of medical ethics and/or professional responsibility.
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Pediatric Pain Conference
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CALIFORNIA HEALTHCARE NEWS
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A COUPLE ARTICLES RELEVANT TO ADVANCED PRATICE. YOU CAN SUBSCRIBE IF YOU WISH.
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Street Medicine: PAs Deliver Healthcare to the Homeless
PAs Coordinating Medicine for Homeless Patients
December 10, 2018
By Dave Andrews
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Article from Doximetry discusses the benefits of NPs and PAs providing care to the needs of Americans across the United States.
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Enhancing Relationship Centered Communication Skills Professional Development for Clinicians
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NEW STATE MANDATE FOR OPIATE PRESCRIBERS JANUARY 1ST, 2019
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As of Jan 1 we will be mandated to offer naloxone to higher risk patients when prescribing opiates (high total daily doses of opiates (90mg daily or more), you are co-prescribing benzodiazepines, they are high risk due to prior OD or substance use, or at risk of return to high dose when no longer tolerant.
The med center APEX team has responded by designing a BPA (pop up) when you prescribe opiates with an option to prescribe nasal narcan and description of who it is suggested for. This will be across the board for all UCSF apex users. For now it will fire for all opiate Rx but later only for patients meeting certain higher risk criteria. You don’t have to do anything but click and decide if you want to add the pre populated nasal narcan Rx for your patient if they meet the criteria in your opinion.
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For more information, contact Mitchel Erickson, NP Director of Advanced Practice
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ALL AHP STUDENTS AT UCSF HEALTH FACILITIES
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All preceptors are required to ensure all students from ALL educational institutions have been vetted by UCSF prior to any educational activities, including employees. UCSF has many parts of the organization involved in this process. Their school needs an affiliation agreement with UCSF, they need health screening to be completed, they require online training for Health and Safety and APEX, and sign a HIPPA form.
New Information to come soon to centralize student engagement at UCSF Health.
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Medicare to Allow PAs to Manage Hospice Care
By Bob Miller, PA Chair, CAPA Professional Practice Committee
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Congress recently passed two new laws that will improve the ability for PAs to manage and provide hospice care for Medicare patients and also to supervise cardiac and pulmonary rehabilitation for Medicare beneficiaries.
The Medicare Patient Access to Hospice Act has been passed by Congress and goes into effect on January 1, 2019. This long-awaited legislation was largely due to repeated efforts by the AAPA to reduce unwarranted Medicare restrictions to effective and efficient PA practice. Prior to this law, a patient requiring hospice care could not be managed or cared for by a PA even if the PA had been their primary provider. That would force the terminally ill patient to have to choose a different provider at a time when the patient would be at their most vulnerable. “Too many PAs have patients that have been under their care for years who have been forced to choose between continued care and hospice,” said Gail Curtis, PA-C, MPAS, DFAAPA, Immediate Past President, AAPA’s Board of Directors.
Other new legislation, the Improving Access to Cardiac and Pulmonary Rehabilitation Act, will go into effect on January 1, 2024. This law now provides language which will allow PAs to supervise cardiac and pulmonary rehabilitation programs for Medicare patients.
Both of these new laws will reduce barriers for Medicare patients and greatly improve access to quality team healthcare, especially in rural practices.
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WANT TO SHARE YOUR EXPERTISE WITH AHP COLLEAGUES ACROSS THE STATE, THE NATION, OR THE WORLD?
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THE NEW UCSF HEALTH HOSPITAL AT PARNASSUS HEIGHTS
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MORE INFORMATION AND TO BE A PEER SUPPORTER, EMAIL THE FOLLOWING LINK.
Other Resources
:
1.
Mindfulness Mediation
2.
Gratitude Mediation
3.
Loving Kindness Meditation
4.
1-Minute Meditation (for the super-busy)
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Are you a Clinical Preceptor?
Are you interested in precepting or becoming volunteer clinical faculty?
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Presentations, Publications, Recognitions, and News
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Poster presentation in San Francisco at American Association for the Study of Liver Diseases in November 2018.
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Jeff was appointment as a HS Clinical Assistant Professor (WOS) in UCSF School of Nursing, and also had an abstract presented in the annual AALSD Liver Meeting here in SF. He would like to acknowledge the support and encouragement of Norah Terrault, MD and Jennifer Price, MD.
He had two articles accepted in peer reviewed journals.
Sexually Acquired Hepatitis C Infection in HIV-uninfected Men Who Have Sex with Men Using Pre-exposure Prophylaxis Against HIV
Jennifer C. Price1, Jeffrey E. McKinney1, Pierre-Cedric Crouch2, Stephen M. Dillon3, Asa Radix4, Alicia Stivala4, Jesse R. Carollo5, Daniel S. Fierer5
Post-sustained virologic response liver stiffness may underestimate fibrosis after direct acting antiviral-containing therapy.
Ani Kardashian1, Jeff McKinney2, Nina Huynh3, Robin Yu4, Marion Peters5, Lisa Catalli2, Jennifer C. Price5
Published by Oxford University Press for the Infectious Diseases Society of America 2018.
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The “Great Catch for Patient Safety” program seeks to formally recognize staff, faculty and trainees who report safety issues and take action to prevent or mitigate harm. The following employee went above and beyond to “stop-the-line” for patient safety:
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Angela Laffan, NP, Cancer Center
Took time to review information and ask questions regarding abnormal imaging scans which noted a slow-growing pulmonary nodule resulting in biopsy and surgical removal.
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Robert H. Crede Awards in Department of Internal Medicine at UCSF Health MZ
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Recipient Patty Paik, NP was honored for this award in 2018 for the NP providers.
The annual DGIM Robert H. Crede Awards provide the faculty and staff of Mt. Zion DGIM an opportunity to recognize their co-workers for their dedication and service to the Division, our students, our patients and the community.
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RESOURSE INFORMATION AND LINKS
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UCSF EMPLOYEE DISCOUNTS AND BENEFITS FOR WORK, LIFE, AND FAMILY
Six Flags - when buying tickets enter promo code UCSF
California Academy of Sciences - when buying tickets for 20% off use promo code UCSF
SF Zoo - use discount code 75001 for $3 off adults, $2 off children with one free train or carousel ride for each ticket
Monterey Bay Aquarium - discount using Store Name UCSF1002
Travel discounts - hotels, packages, cruises. Register for UCSF Passport Discounts, search UCSF Get Away Today
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UPDATING YOUR PAGERBOX CONTACT INFORMATION IS IMPORTANT
In order for other providers to reach you or contact you outside the messaging feature in apex, pagerbox is another mechanism to utilize. This is an internal system and not available to patients. If you do not have a pager, please consider adding your contact information to the pagerbox system. You are only required to respond to pagerbox messages during your normal working hours. All Pagerbox services are now managed by UCSF IT Services.
Feel free to let me know of any problems.
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2018/2019 AHP ADVISORY BOARD
Feel free to reach out to them through global Outlook
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Alisa Yee, NP
Willie Ching, CRNA
Shelley Gierat, CRNA
Jeremy Graham, NP
Jennifer Kerney, NP
Laura Kirk, PA - Chair
Maura O’Day, NP
Brandon Sessler, PA
Stacy Wong, NP
Eliana Agudelo, PA
Dana Morgan, PA
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Laura Weil, CNM
Annette Carley, NP
Gerri Collins Bride, NP
Tracy Curtis, PA
Mitch Erickson, NP
Lissa Gray, NP- Co-chair
Rebekah Kaplan, CNM
Danielle Krieger, NP
Tara Valcarcel, NP
Stacie Rohovit, NP
Michelle Klosterman, NP
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Check for any Required Training
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THE APEX SMART PHRASE FOR AMBULATORY AND EMERGENCY DEPARTMENT ENCOUNTERS
This phrase MUST be present in ALL encounter notes. ONLY this phrase will work to capture your wRVU attribution. The billing logic was designed for ONLY THIS DOT PHRASE (.ahpvisittype)
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FACE CARDS FOR AHP PROVIDERS
Use the following web-link to complete the ordering process. The instructions are self explanatory. You do not pay but do need to create an account. You may upload a professional photo of your choice or use the RCL or use the RCL photo stock. If you want to use the RCL photo stock. To retrieve a photo taken by RCL, please contact the email below with your name and purpose of use. State for UCSF provider Face Cards.
webservices@ucsfmedctr.org
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Making yourself more visible at UCSF Health
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In an attempt to ensure all Advanced Health Providers are visible to the public, your patients, and your colleagues at UCSF, please check and to ensure your working title and contact information are correct. Click the link below and complete the log in process and correct what you can. If your title is incorrect then an additional step will be required as this function is controlled by HR. If you find your title needs to be corrected, email me at
mitchel.erickson@ucsf.edu
with your hire title and I will collect information in batches and forward to the correct person. The "Find a Doctor or staff member" portal update is delayed. UCSF Health is building a new web portal and is challenged with migrating data from the old platform to the new platform. Once ready, we will have capacity to add all the AHPs with photos and CV related data. We have been authorized to develop a dedicated AHP Web portal at UCSF Health. More to come.
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This link will bring you to the UC ME login page. Use the button on the far left at the bottom to access the AHP Resource Manual.
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ADDING NEW PRIVILEGES
This can be completed at the UC Me page by clicking on REQUEST NEW PRIVILEGE.
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Look up your credentialed standardized procedures: Must be through VPN or UCSF computer.
Look up all the standardized procedures:
OMAG POLICIES
CIDP
FPPE/OPPE
This link will work from a any computer with/without VPN enabled using IE or Chrome.
Click on Professional Organization Links:
All prescribers of Scheduled Medications will need to register and review upon writing Scheduled Prescriptions
IMPORTANT - RELATED TO YOUR DEA LICENSE
If your DEA license was issued in another state, you need to go online to the DOJ website and change the location to California. Your DEA needs to be in the state where you practice as all state laws are different. YOU
DO NOT
HAVE TO PAY FOR DEA LICENSE OR RENEWAL AS YOU WORK FOR A PUBLIC INSTITUTION.
Very IMPORTANT message from BRN: As of Jan 1st, 2016 if you were licensed in California
prior
to March 1st, 2009 you are required to resubmit fingerprints via the new Live Scan Service. If your renewal seems to be in limbo for unclear reasons, this may be why. After Jan 2018, you will no longer receive a card license. Verification if online only.
This information was extracted directly from State organizations and agencies but does not infer any authority as to its content and you are reminded to check with your state authorities regarding statutes of practice in California.
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If you have any suggestions regarding content or additions to the monthly newsletter, please send them to: (submission deadline is 1st of each month)
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