ASU Teams

1. ASU Teams Roles & Responsibilities Sept. 8, 2011

2. Roles & Responsibilities     Descriptions: • Behaviorist • DM Team Member • Healthy Heart Team Member • Licensed Practical Nurse • Medical Support Assistant • Mental Health Specialist • Nursing Assistant • Nurse Case Manager • Registered Nurse (No Input Received) • Pharmacist • Physician • Psychiatrist • Team Leader

3. Behaviorist - Description One Duties: Behavior Health Program Coordinator, Administrative Supervisor & TherapistRed Team Role: Coordinate and collaborate with multidisciplinary teams regarding behavior health services/care, serve as a clinical consultant re: patient treatment and progress and address issues related to behavior health services & staff performanceResponsibilities: • Provide therapy (80%) • Program manager • Administrative supervisor for psychiatrist, MH Specialist & medical support staff • Problem solve re: issues affecting behavior health patients and care coordination • Advocate for program & staff to improve performance & provide quality of care • Provide clinical consultation • Plan for Behavior Health Staff and Intake meetings • Coordinate care, collaborate and consult with other Team staff & providers • Participate and contribute in Teams meetings • Develop short term task groups to improve care • Participate in clarifying responsibilities and role of behaviorists to coordinate continuity of patient care • Goal: Develop & implement a multidisciplinary clinical care meetings re: BH patient treatment planning and therapy issues.

4. Behaviorist - Description Two • Evaluate/assess clients. • Address specific needs of client, i.e. obesity, substance abuse, mental health, etc. • Receive/make referrals as necessary. • Schedule appointments. • Assist providers with feedback pertinent to emotional/cognitive needs of clients. • Attend meetings – i.e. behavioral health, team huddles, etc. • Respond to phone calls in a timely manner. • Complete all documentation in a timely manner. • Assist with coverage in the event that the other behaviorists are not at the clinic. • Assist with de-escalation of client if/when necessary.

5. Behaviorist - Description Three 1)     Direct Psychological Services: to all patients referred by PCP’s, NP’s, Behavioral Health, other agencies, or self-referrals: a)     Brief crisis intervention or assessment. b)     Diagnosing, testing, treatment planning, disposition of patient, and referral to appropriate treatment source. c)     Individual, family, group brief therapy is requested to do so. d)     Assess patients and provide evidenced based therapeutic interventions and dispositions. 2)     Crisis intervention and Collaboration: when occurring between ABQ Indian Health Clinic and another agency (e.g., ER’s, UNM-Behavioral Health, UNM-Psychiatric Unit, Kaseman, Substance Abuse Treatment & Detox (MATS). 3)     Collaborate with medical providers (PCP’s): a)     Treatment planning b)     Referrals to community-based services c)     Medication management d)     Referrals to psychiatry for medication management. e)     Psychiatric Disorders f)     Psycho-social histories of the patient. continued next slide...

6. Behaviorist - Description Three 4)     Available for “walk-in” patients: a)     Not a scheduled patient b)     Brief assessment and rescheduling for a complete assessment. c)     PCP referral (occasionally a self-referral, UNM referral, or self-referral) d)     Crisis intervention. e)     Immediate follow-up with primary physician as to treatment plan. 5)     Scheduling and cancellation of appointments: a)     Scheduling complete assessments/intake. b)     Cancelling appointments and rescheduling. c)     Telephone contact with patients. 6)     Emailing patients that have requested community-based referral resources and do not have a working phone. 7)     Community-based referral sources: a)     Keeping an updated list of community-based referrals for patients. b)     Contacting referral sources, on occasion, as to whether they have openings for patients. c)     Minimal follow-up with patients and referral sources to make sure patient was able to receive an appointment to be seen. d)     Contact with MATS to enquire as to whether a bed is available for patients. continued next slide...

7. Behaviorist - Description Three 8)     Conducting assessments (whether brief interview) or scheduled PHQ-9 and Prime MD. 9)     Huddles: scheduled meetings with PCP, psychiatrist, behaviorist, and nurse to discuss upcoming clinics and patient care. 10)     Consultation with PCP’s and NP’s regarding treatment options for patients, medication management, patient referrals, and patient follow-ups. Consultations other than huddle consult. 11)     Education: If patient is prescribed a psychotropic medication, explain to patient the side-effects of the medications and other possible options (e.g., meditation, spiritual healer, physical exercise, eating habits) to medications. 12)     Inside referrals: Contact and referral of patient to Healthy Heart, a different psychiatrist, behavioral health, or other treatment provider within the facility.  Helping patient connect with the best possible resource to meet their needs. continued next slide...

8. Behaviorist - Description Three 13)      Collaboration: help in the referral collaboration process between physician and psychiatrist to establish correct protocol and management of patient treatment.  Conduct interview, assessment, or establish appointment time for patient. Help physician and psychiatrist maintain updated information or changes in patient’s treatment and scheduling. 14)     Researching current articles and cases so as to keep current practices and medications for diagnoses as well as broadening ones knowledge base. 15)     As several doctors have suggested, “giving curb-side”, informal advice regarding psychological perspective of different patients, treatment techniques, and DSM-IV-TR criteria for diagnoses. 16)     Licensure (credentialing): Continuing education course work to maintain licensure for the State of New Mexico and to maintain provider status for   Medicare/Medicaid. Complete paperwork in a timely manner for billable hours as required by insurers in applicant’s capacity as an LPCC. continued next slide...

9. Behaviorist - Description Three 17)     Reporting and documenting services performed in EHR (e.g., assessments, telephone calls, brief interventions, any contact with patient). Adhere to the record keeping standards set forth by the Albuquerque Indian Hospital. 18)     Attending meetings: IPC, Blue Team Meetings, Huddles, Behavioral Health Staffing’s, and all other meetings requested to attend. 19)     Identified Blue Team Group Leader and all the various jobs required of the position. 20)     Development and implementation of Integrated Model of Care. 21)     Collaboration with colleagues in regards to any primary concerns or changes in treatment or plans with the PCP, psychiatrist, or referral source. 22)     Attend staff meetings and be prepared to present cases for evaluations and review and follow-up as needed. 23)     Provide crisis intervention, de-escalation, stabilization, and consultation to all staff when a psychiatrist or other behavioral health staff is not present. 24)     Obtain prior authorization for Contract Health eligible patients for acute psychiatric inpatient referral. 25)     Abide by professional and ethical standards set forth by the American Psychological Association and HIPAA. continued next slide...

10. DM Team Member • DSME Program (Diabetes Self Management Education):   • Provide a 4 session education program for newly diagnosed DM patients • Offer monthly classes • Individual patient education visits • Prediabetes Program: • Monthly group class • Individual patient education (scheduled appointments) • Prenatals • Monitor teaching • Insulin teaching                                                                                         Continued next slide....

11. DM Team Member - continued... • Diabetes Education: • Scheduled appointments to teach all diabetes/prediabetes topics:  meters and monitoring; insulin administration; byetta teaching; medication regimen; nutrition; basics of carb counting; lipid teaching; explain abnormal labs; standards of care; POC CBG’s and A1C’s • Walk-in Appointments - provided upon request and as time allows.  • Children and Adolescents - Health education during individual appts. • Support for Tribal Programs (Zia, Sandia, Alamo, Jemez) work with DM Program coordinators to help with program development and implementation • Provide education at field clinics (Zia and Sandia) - once a month • Participate in huddles

12. Health Heart Team Member • Daily individual case management visits with participants.  (Obtain A1C, BP, wt, ht and waist measures) • Weekly classes offered for participants of HHP • Monthly classes offered for community patients • Monthly recruitment activities • Preparation of material for bulletin boards at AIHC (Pharmacy, 3rd floor, 4th floor, Santa Ana and Sandia • Attending national meetings pertaining to THE GRANT. • Order labs needed for annual assessments or follow-ups. • Case management meetings to discuss clinical and other issues pertaining to patients. • HHP Team meetings to plan activities and to evaluate the direction of the project. • Referrals to other staff involved in the care of the patients. • Coordination with providers. • Meetings with the Health Board and Tribal representatives. • Attend team meetings.

13. LPN - Before Clinic - Description One 1.  Make sure all computers are working.2.  QC Glucose Meters3.  Check AED/EKG/NST4.  Place assignments up for providers for the day. continued next slide...

14. LPN - During Clinic HoursDescription One continued... • Screen patients (Vitals, bundle screens, exams due, immunizations, injuries) • Report abnormal vitals/screens to provider • Fill out forms for physicians (consents, referrals, ROIs, PE, handicap placards, BCC forms) • Set up for WHE - chaperone for PAPs, fill out BCC forms • Set up for other procedures - IUD’s, implanons, etc • Perform ear irrigations • Perform EKG’s • Wound care before and after/ splinting/adjusting crutches • Provide patient education • Enter historical information in EHR  • For PEDS - vision screens for kids; plot growth charts • For DM pts - track exams due; CBG’s and A1C’s; EKGs; meter setup and teaching; insulin starts • Phlebotomy • POC testing - A1C’s; CBG’s; U/A’s; FOBT’s; HCG’s • Assist with phone calls and scheduling apts • Accept/return patient calls from cell phone • Assist in emergency situation - obtain V/S for RN • Assist RN (Johanna) with clipboard • Respond to red flags for all blue team providers as needed • Work with providers with panel maintenance, chart reviews and scheduling                                                                                              continued next slide...

15. LPN - After Clinic and Nurse VisitsDescription One continued... After Clinic: 1.  Shut down computers 2.  Download glucose meters 3.  Put away supplies 4.  Lock cabinets 5.  Clean rooms Nurse Visits: 1.  Depo 2.  Throat cultures 3.  B12 4.  HCG’s 5.  immunizations 6.  organize prenatal care for + HcG pts 7.  STD screens

16. LPN - Description Two • Injections. • Dressing changes. • Screening. • Chaperone. • Blood draws. • Nurse procedures. • Phone calls. • Teaching. • Evaluate/assess patient care.

17. Medical Support Assistant • Assures patient charts are at 3rd floor. Clerk arrives at 3rd floor – get cart to get charts from 2nd floor. Sometimes look for charts if no in the stack. Usually it takes time to retrieve charts from medical records. It is either at BJ's desk, pharmacy,  or at the coders' desk. If staff is available they help to look for charts. Retrieve charts for 11 clinics. The following are: Desaulniers, Robinson, Rowan, Diabetes Diet, COLPO, GYN, midwives, special OB, prenatal-Rowan, Prenatal-Robinson, Foot care, and Rheumatology on designated days • Charts are arranged according to patient schedules for each doctors. Insert daily patient instruction sheets for Dr. Desaulniers, Labs for Rheumatology and Ultra-sound/labs for GYN clinics. • Print daily scheduled patients' appointment. Pin up the schedule on the board also place doctors' name on the counter. • Patients arrive before 8am. Check in/interview patients for their correct demographic/insurance/phone numbers/sign AOB for the current year • Print Health Summary for Diabetes Diet and Nursing-Red plus all add-on continued...

18. Medical Support Assistant continued... • For specialty clinic pCC are required. PCC are printed for the UNMH doctors. They are Rheumatology, GYN, Special OB, Midwives. Call BJ to schedule next appointment for pts. Any cancelation or missed appointment the PCC Ambulatory Encounter Records (missed appointment) is used for all specialty clinics. This document goes into the chart. (see attachment). No shows and cancellations are very important to the specialty clinics. BJ keeps track of all no shows. Patient call in to cancel that is not a no show it is considered cancellation and no show for pts that so not show up. • Using NM Portal (MCD) and Emdeon – check patient's insurance prior or while at the station daily. Obtain insurance care and make a copy • Interpret for the non English speaking Navajo in the Navajo language either on the 2nd floor or the 3rd floor when needed. • Reminder calls for the specialty clinics the day before appointments: Rheumatology/Special OB/GYN/Midwives/Foot Care/COLPO and Diabetes diet. • Answer phone calls /take messages for the doctors and staff. Make appointments over the phone. Patients call in to find out when their appointment are or with what doctors. Direct all calls to the RN for urgent situation. continued next slide

19. Medical Support Assistant continued... • Walk in patients. Notify RN so she can handle the situation • Request charts for doctors/RN/LNP – leave 3rd floor to 2nd floor to retrieve chart(s) • Take down charts to 2nd floor • Dual appointment for some patients – leave chart at their first appointment. Charts are retrieve from their first appointment. (2nd floor) • Notify Lorraine to man the OPD desk for lunch and at 4pm • ITAS day – every other Thursday ITAS is done for employees.

20. Mental Health Specialist Triage for BH Services: • Cross coverage for Lorraine re: BH phone calls and walk in pts, schedule appointments, assists with program resource information.  Triage outside agency calls/referrals for services. • Cross cover for Team Blue and Green Behaviorists when both are unavailable. Brief Interventions & Support Services: • Provide appropriate resource information and/or referral to other community programs • Locate resources to meet patients needs and assist with referrals and follow-up. Support Services/Care Coordination: • Address continuity of care needs, keep in touch with Pts making sure they receive services so as not to fall through the cracks. • Keep in contact with Pts for appointment, making sure they are still interested in BH services. • Consult with HCP, BH providers, medical social worker and other Tm members and community services. • Refer acute psychiatric crisis Pts to psychiatrist, on needed basis. This also includes providing escort of pts to psychiatric emergency facility.                                                                                               continued next slide....

21. Mental Health Specialist continued... Intake Assessments & Appointments • Schedule and conduct intake assessments and present to weekly Intake meeting. • Contact Pts regarding preliminary treatment recommendations and/or appointments with provider  or arrange referrals, as appropriately recommended.  Intake appointments are scheduled, at times, to accommodate work schedules for pts. Brief Support Counseling • Focus on problem solving, situational crisis management and skills building. • Consult with BH providers and obtain clinical supervision, as needed. Recently assigned by program director with move of offices. Process old MH/SS files and secure confidential, as BH rooms are being reassigned. Files will need to be scanned. Doing phone and face to face re-contact  with pts on therapy wait list. Now  wait list is at 1 yr. Contact is being done to reassess Pt’s life situation and to refer to other agencies, if they have acquired  outside third party resources.

22. Nursing Assistant - Patient Care • Screen patients for Medical visits – vitals, chief complaint, etc. • Screen patients for Nurse Visits • Collect U/A’s when appropriate • EKG’s (for regular clinic and for other clinics such as Behavioral Health and Healthy Heart) • Set up PAPs, CBE’s,  IUD’s, etc • Screening bundles • Vision screens for peds (school and sports PE’s) • Interpret for patients • Consent forms • Graph growth chart for pediatric patients • Report any abnormal findings to RN • Fit crutches • Provide wound care supplies • DM education; provide monitors • Chaperone WHE • Watch for “Red Flags” (orders pending) • Check in patient (when front desk forgets) - no data can be entered until pt is “checked in” in the computer continued next slide...

23. Nursing Assistant - Paperwork 1.  Make follow up apts for patients in room; ( running to front when apt line not answering.  NA’s cannot overbook or schedule with providers from other teams so need to go to apt line for these apts). 2. Secure and fill out ROI’s (release of information) 3. Fill out BCC forms 4. Fill in info on sports PE forms 5. PAP forms 6. Fax paperwork to other facilities 7. Update PCP’s 8. Enter immunizations in NMSIIS 9. Data entry of immunizations continued next slide...

24. Nursing Assistant - Lab & Rx Duties Lab- related Duties: 1. Draw blood in the room 2. Run specimens to lab; get specimen vials from lab 3. Clean instruments 4. Enter POC testing results – HcG’s, A1C’s, EKGs,  Pharmacy-related duties: 1.  Run to pharmacy to get IUD’s, Implanons, any meds given to pts in OPD 2. Run pain contracts and narcotic scripts to pharmacy. 3. Answer telephone calls related to pharmacy issues - redirect calls as appropriate continued next slide...

25. NA - Chart Reviews & Transport Chart Reviews: 1.  Empaneling patients 2. Chart reviews prior to Huddles 3. Telephone calls/reminder calls 4. Lab reviews 5. Med reviews 6. Take telephone messages for providers, nurses 7. Calls to other facilities 8. Update EHR record with historicals Transport Duties: 1.  Transport patients to UNM continued next slide...

26. NA - Facility Equipment & Specialty Facility/Equipment Upkeep: 1. Stock rooms - run to Central Supply for needed supplies 2. Retrieve books and dental supplies 3. Clean rooms after clinic 4. Calibrate scales 5. Check NST machine; O2; EKG machine 6. Report defective equiptment to BioMed (form must be filled out) Specialty Jobs: 1.  JVN screening 2. Order supplies  3. Stock supplies in appropriate places

27. Nurse Case Manager    • Early nurse-open up clinic/late nurse close clinic. • Put up daily schedule/adjust schedule as needed. • Phone calls for medication refills-transfer to Blue Team pharmacist with message/phone #/chart #. • Take messages for provider –relay to proper channels. • Make Same Day appts. Also if pcp schedule  is full  and unable to see their pts. Same Day appt. is made. • Fax information in timely manner. • Make regular appts. • Help with injections/nurse visits. • Help with the clipboard when individual is back logged. • Coordinate nurse visit pos/neg hcg with Green Team. • Back up person for ordering vaccines/medications for Blue Team. • Frequently check on flow of the clinic. • Assists with NMSIS/HI when staff is backed up with patient care. • If short staff-assist with chaperone/appts/blood work. • Do empaneling. • Resource person for nursing personnel and Immunizations. • Keep any information up dated that is necessary for Blue Team. • Acts as leader for prn meetings when problems arise among co-workers.

28. Registered Nurse Description still needed

29. Pharmacist - Description One • Refill Line – maintain, update and run refills.   Troubleshoot. • Scriptpro  -- maintain and update • Data entry • Order verification and patient counseling • Drug Research – appropriate therapy, new therapies • Anticoagulation Clinic • Huddle with providers on the blue team • Answer pharmacy cell phone for blue team Special Responsibilities: • Coordinate anticoagulation clinic • Tobacco Cessation Clinic • Immunizations • Co-CAC – Maintain drug data; quick orders; templates. Release/reset frozen computers.  Update patient PCP’s. What I do but don’t know if I should do: • IM injections when the nurses have left for the day.

30. Pharmacist - Description Two     • Assist in team approach with medication therapy management. Performed within different disease state managements as requested by provider. • Provide pharmacy based clinical services anticoagulation and smoking cessation presently, pending approval for emergency contraception • Counseling patients on medications going over drug interactions, adverse reactions, dosing instructions and what to expect from taking the medication. This is for medications received here as well as OTC and herbals. • Working with nursing for dispensed prescriptions as well as injectiables. • Provide the patients with a pharmacist that they can go to by name. • Work with providers on completing pain agreements for patients on 3+ months of opiate therapy, run NM BOP outside prescription reports, order UA's as necessary and improve pain management for patients • Medication issues that can be resolved by pharmacy. Determining if medication can be renewed if they have appt, contacting provider in other scenarios. Assisting patients with questions regarding pharmacy procedures. Other issues include medications on hold, expired meds. • Providing services through cell phone to assist with any questions related to Pharmacy.

31. Pharmacist - Description Three     • Review charts of provider patients being seen. • Execute pharmacy related tasks determined by clinical director. • Execute pharmacy related tasks determined by director of pharmacy. • Handle medication related patient concerns as determined by Fann’s phone calls. • Medication reconciliation at time of patient appointment. • Device education upon request.

32. Physician - Description One Patient Care - During Clinic Hours • See patients for chronic disease care and urgent concerns.  This includes history and physical exam as appropriate • Well -child visit: growth charts, developmental assessments, anticipatory guidance • Order tests (lab, x-ray, EKG) • Review previous tests • Review outside documents (consultant care, ER visits) – requires reviewing medical record and/or Powerchart and/or trying to contact consultant to obtain note • Follow-up on previously made referrals that the patient does not know what is happening • Review medications with patient (within EHR and outside medications) • Update medications – new orders, renews, discontinues (includes printing and signing controlled substance paper orders) • Complete paperwork, including PE forms, DMV forms, etc) • Patient education, including disease process, diet, exercise, medications, CHS process, UNM Cares, follow-up appointments, precautions for return, etc • Complete encounter note within EHR • Make referrals • Home visits continued next slide...

33. Physician - Description One continued... Non-Clinic/After Hours: • Complete unfinished EHR charting • Return patients phone calls (usually requires EHR note) • Renew expired medications • New complaint/concern • Need referral • Need paperwork • Need appointment • Huddles • Schedule urgent appointments for consultants (at times) • Completing paperwork/forms • Answer nurse and NA questions (help with pt triage) • Interact with outside agencies - NAPPR; schools; hospice • Coordinate care with specialists; discharge planners; CHS; etc. • Empanelling patients • Entering historical and procedure data (colonoscopies, etc)                                                                                             continued next slide...

34. Physician - Description One continued... Administrative Responsibilities: • Peer review activities • Meetings • Medical Staff • CME • Team • Committees - Medical Exec; Health IT; Facility Improvement; etc. • Field Clinics meetings • Precepting UNM family medicine residents • Reviewing and answering emails • Required trainings • Commissioned Corps/ HQ paperwork

35. Physician - Description Two Previsit Planning: Print appointment list 1-3 days prior to scheduleElectronic Health Record Chart Review • Review reminders • Review and update problem list • Review Chronic medication list • Review last office visit notes, consultant & education notes • Review Health Summary – DM standards, Cancer Screening & Immunizations • Annual  and Last Lab Tests Generate work-list for the day • Two (2) copies to screening nurse • +/- one to lab Morning Review of schedule with  nurse+/- receptionist continued next slide....

36. Physician - Description Two continued... Patient care:  clinics, visits planning, follow up, labs to pts, care coordination, phone calls, correspondences… • Medical Advisor to ASU Diabetes Education Program and Healthy Heart Program: monthly DM team meetings, monthly HHP case management meetings, medical consultant for diabetes management for educators, (limited involvement in grant writing and reports) • Consultation to providers and residents • Review and revise policies regarding diabetes care, screening, treatment, GDM, education • Assists with DM audit, generate provider specific audits • CME/PI presentations 1-2/years • Diabetes and Pregnancy Liaison for DDTP – currently chairing revision of Best Practice for Diabetes in Pregnancy • UNM FP resident rotation, optometry student observation ½ day / rotation, ongoing precepting for Gordon Quam, RN – Advanced Practice Nursing • IPC committee / Community Advisory workgroup • P&T Committee

37. Psychiatrist - Description One • Adult psychiatric evaluation. • Teen psychiatric evaluation. • Child psychiatric evaluation. • Psychotropic medication initiation and management. • Ordering and analyzing lab tests. • “Curbside Consultations” with medical providers. • Management of refill requests. • Charting in the EHR. • Data collection, analysis, and management. • Peer review. • Letter writing for patient issues/concerns. • Filling out patient forms. • Attending meetings. • Psychiatric crisis evaluation and management. • Referrals for outside services. • Obtaining patient consent for the use of psychotropic medications.

38. Psychiatrist - Description Two • Clinical care of AIHC psychiatric patients, 6-7 half day clinics per week.  • Alternating. • Clinical care of ACL psychiatric patients, 0-2 half-day clinics per week.  (Four half-day clinics per month). • Clinical care of Sandia psychiatric patients, 0-1 half day clinic per week. (Two half-day clinics per month). • Psychiatry Director • Peer Reviews • Policy as pertains to psychiatric care • Pain Initiative with following goals: • Re-initiate team huddles for review of chronic pain patient • Re-evaluate use of UDS/NM Prescription Monitoring as crucial elements of pain. • Formulate pain committee for review of problematic cases • Continue lecture series   • Facility Improvement Committee Chair • Monthly meetings • Assigned tasks as a member of the committee, to include various goals • Steering Committee Member

39. Team Leader   Early Nurse-1. Check glucose meters-do qc’s                       2. Record refrigerator/freezer temp. Also check in the p.m..                        3. Unlock medicine cabinets.                        4. Open up examine rooms                         5. once computers are on make sure they are workable.                          6. Check  oxygen tanks, NST and EKG machines/AED                           7. Make sure there is a wheelchair available.                           8. Hang up providers appt. schedule for the day./make sure enough rooms available.                            9. Hang up daily assignments for nursing staff/make changes PRN. Copies to MR.                        clerks at front desk. Phone calls.  1. Take messages for providers.                       2. Route calls to pharmacy, contract care office, eye clinic and dm educators, Red Team /Green Team.                        3. Make appts and cancel appts.                         4. Triage phone calls referral to er/note in EHR  for provider.                         5. Screen calls for SDC./add ons Continued...

40. Team Leader   Late nurse-      1. Make sure mini lab is cleaned/all specimens to lab/instruments cleaned                          2. Make sure all computers are logged off/turned off.                          3. Make sure glucose meters are down loaded/put away.                          4. Lock all medicine cabinets                          5. Stay with na when provider is not finished with clinic after 4:30pm                            6. Check outpatient daily assignment sheet for initials. Advocates for nursing staff if any concerns arises. Assist with procedures, chaperone, blood draw, also any vaccines or other injections to be given. Order vaccines and medication needed. Assist with Nurse Visits, clip board and walk-ins prn. Do immunization quarterly report, along with information on vaccines pediatric patients need.  Enter HI for nursing staff when needed. Will frequently check on the clinic flow  of patients.  I am the Liaison person for the Blue Team Leader Roxanne McNeil-keep  her informed of all that is happenings  on the team. Represent her when not available prn. Belong to SDC/Empaneling/Access committees.

41. Thank you Special thanks to Jackie Butler, Joan BigBen, Linda Shakespeare, Drs. Russo and Durham for their help with this "Roles and Responsibilities" project.