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Health Insurance Portability and Accountability Act of 1996 |
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keeping insurance between jobs, preventing health care fraud, streamlining health care transactions, protecting health care data, new pt rights, insuring the privacy of medical records. |
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pts, providers, hospitals, health plans, laboratories, billing agencies, clearinghouses, pharmacies, and indirectly all other entities that exchange data with covered entities under HIPAA through agreements and/or contracts. |
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healthcare industry asked for help to protect pts/industry. nearly 10 yrs in development. law passed in 1996. aka kennedy-kessenbaum act, started out focused on insurance portability and payment. later amended and added to. |
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ensure health insurance portability, reduce healthcare fraud and abuse, improve healthcare efficiency and effectiveness by standardizing electronic transactions, protect the security and confidentiality of pt medical records, build statistical data for analysis |
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protected health information: information that's individually identifiable (created of received), medical records and the data inside them. |
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needed to accomplish the intended purpose or task. reasonable efforts are required to limit use or disclosure to the minimum necessary. full disclosure of PHI to healthcare providers for treatment purposes is permitted if necessary. the less PHI used or disclosed, the better. |
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a health plan, clearinghouse, or provider who transmits any health info in electronic form in a healthcare transaction. comes into contact with PHI, provides healthcare services in the normal course of business, all dr.s, clinics, and hospitals in the US - and all of the ppl who work in them. |
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5 guiding principles of HIPAA (list) |
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boundaries, security, consumer control, accountability, public responsibility |
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confidential health info should be used only for healthcare purposes. |
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confidential health info should be protected against deliberate or accidental misuse of disclosure. |
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pts should be able to see what's in their records, get a copy, correct errors, and find out who else has seen their records |
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those who misuse personal health info should be punished, and those who are harmed by its misuse should have legal options |
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individual privacy must be balanced for the common good |
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communication with pts and family are okay if... |
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reasonable precautions are taken to minimize accident disclosures, and identities are verified |
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reasonable precautions are... |
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lower your voice, move to a more private area |
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accidental disclosures of PHI are permissible if... |
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reasonable precautions were taken, the minimum necessary rule has been followed consistently. it's a good idea to document accidental disclosures as it protects you and the organization. |
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HIPAA offense: single violation |
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HIPAA offense: multiple offense |
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up to $25,000, no imprisonment |
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HIPAA offense: disclosure of PHI |
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up the $50,000, up to 1 year imprisonment |
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HIPAA offense: disclosure of PHI, false pretense |
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up to $100,000, up to 5 years of imprisonment |
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HIPAA offense: disclosure of PHI, false pretenses, commercial or personal gain, malicious harm |
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up to $250,000, up to 10 years imprisonment |
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private service coverage under HIPAA |
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you are still covered as a subclass c contractor. |
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why do we do an oral mech |
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make sure everything works properly (WNL/WFL), structural deviations, functional issues (strength, ROM), appearance (symmetry, note condition) |
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what to notice at the whole face level |
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how does it all connect, nose and ears line up, eyes (1-2 inches apart), facial expressions (is there a range, do you see smile/frown/questioning) |
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lip retraction (strength, ROM, evenness), lip pursing/kiss, keep lips closed while they puff out their cheeks, alternate movement rapidly between retraction and pursing (should be rhythmic) |
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what to look at with cheeks |
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puff up cheeks and push on them |
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what to look at with mandible |
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look at rest, open and close rapidly (do you here popping?) |
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what to look for with nose |
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most people don't worry about this, but we do want to look at this for breathing patterns. can the person breathe with their mouth closed. a lot of our clients may not. |
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what to look for with teeth |
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look at how close they are, overall condition, pull out cheek with tongue depressor and look at closure. |
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what to look for with tongue |
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look at rest (fasciculations?), look during movement (anterior/posterior, elevation and depression, lateral movements) |
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what to look for with velo-pharyngeal function |
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look at rest: use flashlight, should be pink not dark/fuzzy/anything hanging. look during movement: make them say ha ha ha ha. |
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what to look for with laryngeal function |
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say ah, cough hard, clear throat, gag reflex (swallowing function, abnormal is asymmetrical, touch behind upper molars...) |
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personal identifying info, statement of the problem, background info, eval. |
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statement of problem in reports |
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usually short (1-3 sent), why is the person coming to see you that day, no background info. |
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make sure it's relevant to the pts condition, indicate where a previous eval was completed, hearing status is relevant. |
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hearing is usually first, then oral mech, receptive/expressive lang, |
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sections in reporting results |
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what test was admin, formal results, explain what was assessed in detail, informal testing, conclusion |
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your educated sense, based on the info you have on what the problem(s) might be. you normally have two or three things you think it might be. push yourself past the first idea. |
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What do I know? What do I need to know? How do I learn it? |
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developing plan for evaluation/diagnostic |
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should the family member be in the room? think about time frames, sequence of events, obligated to do at least one standardized test in the health care track, informal assessment. |
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considerations in choosing a standardized test |
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normative data matches the person you're testing. how long is it? closely relevant to the concerns you're evaluating for. if you do more than one, put the most important one first. |
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considerations in planning an informal assessment |
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needs more detailed planning than a standardized test, what are you presenting and what will they present back |
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should the family member be in the room |
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preferable to have them out for at least part of the eval. shows how they interact with unfamiliar people. family cannot interfere with testing |
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refers to statistics and how we use them for evaluation purposes |
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standardized characteristics |
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normed, validity/reliability, highly structured, detailed manual on admin. |
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informal assessment charactersitics |
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you choose/clinician designed, more naturalistic, more subjective, oriented to client (level, types of issues, interests), no norms (clinician observation and prior knowledge, research based, past performance). can still have validity if based upon research. |
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types of standardized tests |
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norm referenced test, criterion referenced test |
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based on a normative sample that was developed by the test designers. the test is given to specific demographics and the test results are the norms. make sure you match the age of the client to the sample. You make also look at SES, gender, second language abilities. (GRE) |
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criterion referenced test |
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technically could be considered a standardized test, but it really is not. this is the criteria you want them to be at before they complete/graduate/etc. someone is setting the criteria. this may be based in studies, based on data, based on experience. this is not based on other people's test results. (MEAP) |
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normal/bell curves are based on what we know about standardized tests. the line in the middle is the average where half did better and half did worse. the more similar, the smaller the SD. 0 is average. 68% of ppl are withint +/- 1SD |
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standard error of measurement |
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how much variation within an individual. want this to be very small so the test is consistent. |
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no matter who gives the test, or who does the scoring, you're going to get consistency. intra and interjudge reliability. |
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a person performs scoring and interpretation the same from week to week. |
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each person will get a score within the same confidence interval between test givers. |
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does the test meausre what it says it's going to measure |
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%ile, 90%ile did better than 90% of his age-matched peers and only 10% did better. common number used because it's easier to understand. |
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two kinds (almost never used with families because it's confusing) T scores and z scores most accurate for taking measures over time |
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developmental scores/norms |
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goes over where the normal development is and where the pt is. does not necessarily work for autistic children or cognitively impaired adults |
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not a standard score, mostly useful in the context of education. depends on the school systems as well, so it's hard to go from one to another. |
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