Facility Site Review (FSR)
All PCP sites participating in the Medi-Cal Managed Care Program are required by California Code of Regulations (22 CCR § 56230) and California Department of Health Care Services (DHCS) All Plan Letter 22-017 to 1) complete an initial FSR and subsequent periodic full scope reviews and 2) complete corrective action plans (CAPs) within DHCS-specified timelines for cited deficiencies.
Full scope reviews consist of completion of the DHCS Facility Site and Medical Record Review (FSR/MRR) and the Physical Accessibility Review Survey (PARS). FSRs are conducted to ensure that all contracted PCP sites have sufficient capacity to provide appropriate primary healthcare services and can maintain patient safety standards and practices. The FSR confirms the PCP site operates in compliance with all applicable local, state, and federal laws and regulations. MRRs are conducted to review medical records for format, legal protocols, and documented evidence of the provision of preventive care and coordination and continuity of care services. The medical record provides legal proof that the patient received care. PARS are conducted to assess the physical adequacy of provider sites that provide services to seniors and persons with disabilities.
Anthem Blue Cross (Anthem) has compiled a library of resources under the FSR, MRR, and PARS sections to help providers achieve a safe and effective provision of primary care services, to ensure and support the quality of care and documentation of appropriate clinical services, and to improve overall member health outcomes. Many documents were produced and developed by Anthem while others are sample or generic documents offered by external best practice sources that providers may customize to their needs. Resources also include links to public or government entity websites that offer further guidance and other valuable resources.
- California Minor Consent and Confidentiality Laws
- Child Abuse Reporting Instructions & Form
- Cleaning Log
- Cleaning Schedule
- Clinic Policies for Primary Care Provider Settings
- Comprehensive Health Assessment Forms
- Confidentiality Statement
- Controlled Substance Distribution Log
- Domestic Violence Abuse & Suspicious Injury Report Instructions & Form
- Drug Inventory List
- Elder/Dependent Adult Abuse Reporting Instructions & Form
- Emergency Earthquake Plan
- Emergency Fire Plan
- Emergency Kit Inventory Log
- Emergency Medication Dosage Chart
- Emergency Protocol and Contact List
- Employee Language Skills Self-Assessment Form
- FSR MRR Preparation Checklist
- Frequently Missed Standards Review and Attestation
- Health Education
- Informed Consent Form
- Instrument Sterilization Log
- Interim Facility Site Review
- Interpreter Services Desktop Reference
- Medical Assistant Certification
- Medical Assistant Supervision Delegation Agreement
- Medical Waste Collection Tracking Log
- Member Grievance Form (English)
- Member Grievance Form (Spanish)
- Member Grievance Form (other languages)
- Member Grievance Log (English)
- Monthly Potency Verification Log for Medications and Laboratory Supplies
- Multi-Dose Vials Guide
- Notice of Civil Rights / Nondiscrimination (for clinics with less than 15 employees) – Sample
- Notice of Civil Rights / Nondiscrimination (for clinics with 15 employees or greater) – Sample
- Notice to Consumer for Medical Doctors (English and other languages)
- Notice to Consumers for Physician Assistants
- On-site Documents Checklist
- OSHA Fact Sheet - Protecting Yourself When Handling Contaminated Sharps
- PCP Modification Request Form
- PCP Site Identification Form
- Post Site Review Satisfaction Survey
- Quality Control Log - Glucometer
- Referral Tracking Log — Blank
- Referral Tracking Log — Sample
- Safety & Member Rights Training Sign-In Sheet – for Groups
- Safety & Member Rights Training Sign-In Sheet – for Individuals
- Sharps Injury Log
- Sharps Injury Report Form
- Signature Log
- Site Evacuation Plan
- Sterilized Packages Inspection Log
- Vaccine Administration Record for Adults
- Vaccine Administration Record for Children & Teens
- Vaccine Emergency Response Worksheet
- Depression Screening Tool (PHQ-9)
- Depression Screening Tool for Adolescents (PHQ9A)
- Developmental Disorder Screening Tools (Ages and Stages Questionnaire)
- Developmental Disorder Screening Tools (SWYC)
- Domestic Violence Abuse & Suspicious Injury Report Instructions & Form
- Elder/Dependent Adult Abuse Reporting Instructions & Form
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Provider News & Announcements
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