FHCHC

 DPP  OGTT  Prepara.on  Checklist 24-­‐Nov-­‐10

1  Month  -­‐  1  Week  Before  Screening Yes No
Have  all  referral  forms  been  collected?
Have  all  referrals  been  entered  into  DPP  spreadsheet?
Have  all  paAents  been  scheduled  for  8:30am  or  9:00am  screening  slots  in  PCN?
Have  all  paAents  received  a  call  to  confirm  aJendence?  

1  Week  Before  Screening Yes No

Have  all  paAents  been  sent  appointment  cards  in  the  mail?
Have  the  screening,  child  educaAon,  medical  visit,  and  vitals  rooms  been  reserved?
Has  a  Clinician's  Assistant  been  requested  and  assigned  by  the  Clinicians  Assistant  Manager?
Has  screening  lunch  been  ordered?  
Has  a  phlebotomist(s)  been  scheduled?
Has  a  clinician(s)  been  scheduled  for  the  screening?  Note:  ideal  is  2  family  nurse  prac55oners
Has  Glucola  been  ordered?  
Has  the  billing  department  been  noAfied  of  the  screening  date?
Has  a  billing  department  staff  member  been  scheduled  to  manage  the  check-­‐in  desk?

2  Days  Before  Screening Yes No

Have  all  new  PECS  forms  been  printed  and  highlighted?
Have  all  previously-­‐printed  but  yet  unused  PECS  forms  been  collected?
Have  all  paAent  labels  been  printed?  
Has  a  billing  department  staff  member  been  confirmed  for  managing  the  check-­‐in  desk?
Have  all  lab  forms  been  filled  out  with  test  requisiAons,  diagnosis,  paAent  informaAon,  billing  
informaAon?
Have  all  charts  been  pulled?  
Has  FaciliAes  been  requested  to  supply  2  sharps  containers,  and  set  up  screening,  child  
educaAon,  medical  visit,  vitals  rooms  and  check-­‐in  area?
Has  the  clinician(s)  pre-­‐interviewed  all  paAents  over  the  phone?

1  Day  Before  Screening Yes No

Has  billing  department  printed  billing  forms?
Have  all  reminder  calls  been  made  to  paAents?
Have  2  copies  of  the  PaAent  Vital  Sheet  been  created?
Have  5  copies  of  the  paAent  list  been  printed  from  PCN?
Have  the  Appointment  Lists  been  distributed  to  the  Billing  Department,  clinician(s),  DPP  staff?
Has  the  Phlebotomist(s)  been  confirmed?
Has  the  Clinician's  Assistant  been  confirmed?
Has  the  Screening  Material  Box  been  assembled?
   -­‐  Pt.  Folders-­‐English  or  Spanish
   -­‐  Waist  Circumference  Tape,  Blood  Pressure  Cuff's  (2)
   -­‐  Calculator,  Name  Tags,  Insulin  Tubes  w/Numbers  &  Date