CT Protocol for Consultant Pharmacists to Contract with Pharmacies

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14 Δεκ 2013 (πριν από 3 χρόνια και 6 μήνες)

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Consultant Pharmacists Service Agreement


This Service Agreement is entered and effective o
n __________________________2008
, by and
between ______________________ (consultant pharmacist) and _________________________
(appointed contractor for contracting p
harmacy) on behalf of ____________________________
(contracting pharmacy). The parties agree as follows:


Consultant Pharmacist Responsibilities

1.

Provide the contracting pharmacy with a schedule of availability to meet with patients.

2.

Provide a script for t
he contracting pharmacy staff to use to set up appointment
s

with
patients.

3.

Complete all Mirixa on
-
line training prior to appointments with patients
.

4.

Provide self transportation to the contracting pharmacy
.

5.

Meet with pa
tient at designated appointment

for a
face
-
to
-
face visit
.

6.

Comply with all HIPAA statues and regulations governing the confidentiality of medical
records.

7.

Complete the medication review in accordance with Mirixa guidelines
:

a.

Review and update the data inputted by the contracting pharmacy regardi
ng

allergies, c
onditions
,

and all Rx & OTC Medications prior to reviewing
medications for interventions

b.

Resolve all drug
-
drug, drug
-
food, drug
-
disease

interaction alerts

c.

Resolve all formulary
alternative
alerts

d.

Resolve unnecessary therapeutic duplications

e.

Complete all chart notes (interventions, SOAP notes, patient instructions)

f.

Quantify the number of interventions

g.

Provide the pati
ent with a Personal Medication R
ecord

(PMR)

h.

Provide the patient with a Medication Action P
lan

(MAP)
, in easy to understand
terms

i.

Document, a
uthorize and bill for the patient cases


Contracting P
harmacy

Responsibilities

1.

Contract with Mirixa
,

if the contracting pharmacy has not already done so

2.

Add
a new user account for the consultant pharmacist, allowing for access to the database

3.

A
ssign a pharmacist or pharmacy technician to call the patients to set up appointments
with the consultant pharmacist, based on
the consultant pharmacist’s

availability.

a.

A
dvise the patients on items to bring to the appointment (ie. All medications,
recent l
ab results, etc)
.

b.

Ver
ify and/or update patient personal information in the web
-
based tool (ie. Date
of birth, spelling of name, address, contact information, patient representative
information, etc)
.

c.

A
sk the
patient about their allergy, condition, and medi
cation
information and
input this into the web
-
based tool
, to give the consultant pharmacist a basic profile
of which to work from and to prepare for the appointment
.

4.

C
all patients to remind them of a scheduled appointment.

5.

Provide the consultant pharmacis
t with a private or semi
-
private area to conduct the visit

6.

Provide internet access for the consultant pharmacist if available

7.

Reimburse the consultant pharmacist for the entire amount of money

to be

issued to the
pharmacy by Mirixa
.

Reimbursement will be i
ssued within 45 days of service.

8.

Contact the consultant pharmacist with notification of new patient cases when they
become available
, if the contracting pharmacy requires further assistance
.


This Agreement promises the Consultant Pharmacist with the oppor
tunity to take on a minimum
of _________ cases.


Renewal/Termination

This Agreement shall continue until either party provides the other party with at least fifteen
days advanced written notice of termination. However, the consultant pharmacist will be
obl
igated to complete all services to any patient he/she has already had a face
-
to
-
face
appointment with.


The following parties have caused this Agreement to be executed effective the date first above
written.


Consultant Pharmacist



Contracting Pharmacy


Signed: ____________________________

Signed: _____________________________


Name: _____________________________

Name: ______________________________


Title: ______________________________

Title: _______________________________


Date: _____________________
_________

Date: _______________________________