Physicians

A dedicated Physician Support Line (1-888-409-0141) is now available to physicians (including residents and fellows) and medical students to access free, confidential and anonymous advice. The support line is staffed by volunteer psychiatrists, including those from various racial/ethnic/gender identity backgrounds. This nation-wide resource is available without an appointment and can provide emotional support for difficult situations (e.g., discrimination, bigotry, intolerance) and in times of crisis. If medical attention is needed, they will help the physician/student access appropriate care. They do not report their interactions to any agencies, including employers and licensing Boards. Their website is located at: Physician Support Line and provides additional resources for dealing with common sources of stress for physicians.

Physicians and other healthcare providers who retire or stop practicing for other reasons should do their best to provide patients with continuity of care. When practices break up or separate, keep the patients’ interests first and foremost. The Rhode Island Board of Medical Licensure and Discipline frowns upon complaints that suggest physicians are fighting over patients or “using the patients” as part of the break up. Rhode Island law specifically requires that you:

• Try to resolve open patient cases;
• Publish a notice 90 days before closing a practice in a newspaper with statewide circulation, including information on how patients can get their medical records (when a physician is deceased, the heirs or the estate must give the same public notice within 90 days);
• Send a letter to patients that have been seen within the past year notifying them of the practice closure;
• Notify the Rhode Island Medical Society and the Rhode Island Board of Medical Licensure and Discipline of location of medical records;
• Create a way for patients to get their medical records for at least the next 5 years; (Though a fee can be charged for copying, the transfer of the record cannot be delayed due to lack of payment.)
• Notify your malpractice carrier and make sure you have adequate coverage after you have stopped working.

All programs complement the clinical care of providers. By the end of the program, patients will have learned how to set goals to improve their health and lifestyle, manage their symptoms and medication, work with their health care team, talk with family and doctors, relax, eat well and handle difficult emotions. By gaining these skills, patients will become activated and engaged in their care. Healthcare providers will receive feedback on the status of any patient referrals.

• Healthcare providers can set up an in-person academic detailing with Community Health Network staff to learn about resources that give your patients tools to take control of their health.
• Refer your patients to a specific Community Health Network Program

Review the training materials, resources, and videos on the Rhode Island Vital Events Registration System (RIVERS) located at: https://health.ri.gov/records

• Hold as their primary responsibility the health, safety, welfare, and dignity of all human beings.
• Uphold the tenets of patient autonomy, beneficence, and justice.
• Hold in strict confidence information obtained through employment unless legally authorized or required by responsible performance of duty to divulge such information.
• Actively seek to expand their knowledge and skills, keeping abreast of advances in medicine.
• Use their knowledge and experience to contribute to an improved community.
• Respect their professional relationship with all members of the healthcare team.
• Respect the culture, values, beliefs, and expectations of the patient and family caregiver.
• Not discriminate against classes or categories of patients in the delivery of needed healthcare.
• Disclose to his or her supervisor information about errors made in the course of caring for a patient.
• Place service to patients before personal material gain and should avoid undue influence on their judgment.
• Not misrepresent directly or indirectly, their skills, training, professional credentials, or identity.
• Not become sexually involved with patients or engage in, or condone, any form of sexual harassment.
• Seek professional help if suffering from issues of addiction or substance abuse and should not engage in patient care while symptomatic or until cleared by treating professional.

The Rhode Island State-Supplied Vaccine (SSV) program provides vaccine to healthcare providers to immunize people of all ages. A table with details about these vaccines, including their age indications, is available. A series of immunization requirements is in place to ensure that all healthcare providers are properly immunized.

An Immunization Resource Manual is located at the bottom of this page. It contains up-to-date immunization resources and information about topics such as vaccine recommendations, ordering, storage and handling, scheduling, administration, and more.

What you should do

Know about school immunization requirements

Children are required to have certain immunizations before they enter child care, pre-kindergarten, kindergarten, 7th, 8th, 9th, and 12th grade. They can be exempted from immunizations for either religious or medical reasons. A medical exemption certificate must be signed by a medical provider. A religious exemption certificate can be signed by a parent/guardian or student (18+).

Enroll in the State-Supplied Vaccine Program

Healthcare providers can enroll in the program to order vaccine for both pediatric and adult patients. Enrollment must be completed online annually.

Know about State-Supplied Vaccine Program requirements

Providers who participate in the State-Supplied Vaccine Program must agree to the program's terms and conditions and adhere to certain requirements for ordering, storing, and reporting on vaccines.

Before administering any vaccine, healthcare providers must give the current Vaccine Information Statement to patients (or their parents or guardians). This must be documented in the patient's medical record.

Know about patient eligibility

Influenza vaccine

• Children: State-supplied influenza vaccine can be provided to all children (younger than 19 years of age), regardless of residence.
• Adults: State-supplied influenza vaccine can be provided to all adult Rhode Island residents and adults who are non-Rhode Island residents but are covered by a Rhode Island employer's health plan.

Non-influenza vaccine

Non-influenza state-supplied vaccine can be provided to all children (younger than 19 years of age). Adult, insured Rhode Island residents and adults who are non-Rhode Island residents but who are covered by a Rhode Island employer’s health plan are also eligible for non-influenza state-supplied vaccine if they are:

• 19 to 26 years of age, or
• At high risk, regardless of age.

Adults who are not in one of these categories can be vaccinated as follows:

Patient type	Where/how to vaccinate
Uninsured but able to pay	Doctor's office/Privately-purchased vaccine, St. Joseph Center for Health and Human Services - Adult Walk-in, Community Health Center, or a Pharmacy
Uninsured and unable to pay	St. Joseph Center for Health and Human Services - Adult Walk-in, Community Health Center
Insured, but not through a Rhode Island employer	Doctor's Office/Privately-purchased vaccine or a Pharmacy

Medical Orders for Life Sustaining Treatment (MOLST) are instructions to follow a terminally ill patient’s wishes regarding resuscitation, feeding tubes and other life-sustaining medical treatments. The MOLST form can be used to refuse or request treatments and are completely voluntary on the part of patients. These orders can supplement Do Not Resuscitate (DNR) instructions or a COMFORT ONE bracelet. more

A physician, registered nurse practitioner, advanced practice registered nurse or physician assistant who is authorized by the patient is authorized to sign Medical Orders for Life Sustaining Treatment.

• Treat a patient in accordance with the patient's MOLST form, even if the healthcare provider who signed the MOLST order is not on staff at a facility.
• Ensure a patient's Medical Orders for Life Sustaining Treatment are transferred with the patient if he/she is transferred to another healthcare provider.
• If a new terminally ill patient comes under your care, you should ask about the existence of a MOLST form from the patient and/or the facility that is transferring the patient.
• Review the Medical Orders for Life Sustaining Treatment on admission and ensure that the orders reflect the patient’s current wishes.
• If the terminally ill patient does not have Medical Orders for Life Sustaining Treatment, you should offer them the opportunity to complete a form on admission to a nursing home, assisted living facility, home health agency, hospice program, kidney dialysis center, or hospital.
• Document if a terminally ill patient does not file Medical Orders for Life Sustaining Treatment and explain the consequences of making no decision to the patient or their recognized healthcare decision maker. If there are no limitations on care, except as otherwise provided by law, cardiopulmonary resuscitation will be attempted and other treatments will be given. If a choice regarding cardiopulmonary resuscitation (CPR) is not made, cardiopulmonary resuscitation will be attempted using all available treatment options.
• Void the Medical Orders for Life Sustaining Treatment if requested by your patient. To do this draw a diagonal line through the sheet, write “VOID” in large letters across the page, and sign and date below the line. Keep the voided MOLST form in the patient’s active or archived medical record, as appropriate.
• Follow the most recent version of the Medical Orders for Life Sustaining Treatment if more than one form is found in the medical records.

What Medical Practices Should Do

Store patient’s medical records for at least five years after the most recent patient encounter, regardless of whether the patient is alive or dead. Providers may charge a reasonable administrative fee for copying medical records; however, the transfer of medical records cannot be delayed due to non-payment of administrative fees. more

Provide copies when requested. Providers may charge a reasonable administrative fee for copying medical records; however, the transfer of medical records cannot be delayed due to non-payment of administrative fees. Records should be provided within 30 days. more

Make sure that records are still available if the practice is closed.

Use Electronic Health Records which provide better way to see long term medical issues and track trends among groups of people. Healthcare providers who accept medicaid or medicare must meet "meaningful use" standards. more

Screen all patients and caregivers.

• Check a patient’s electronic health record (EHR) and ask the patient about previous naloxone use.
• Check Rhode Island’s Prescription Drug Monitoring Program (PDMP) for clinical alerts and evidence of high-dose opioids (i.e., more than 50 oral Morphine Milligram Equivalents (MMEs) per day), long-acting opioid use, or opioid use for longer than 90 days.
• Screen all patients for a history or diagnosis of Substance Use Disorder (SUD), Alcohol Use Disorder (AUD), mental health conditions, respiratory or neurologic conditions that affect breathing, harmful use or misuse of opioids, and/or opioid overdose.
• Screen patients for use of Medication Assisted Treatment (MAT) to treat OUD.
• Screen all patients to identify use of opioids in combination with benzodiazepines, alcohol, anti-depressants, and/or sedatives.

Educate yourself, patients, and staff.

• Ask caregivers if they feel comfortable administering naloxone during an overdose in case a friend or loved one is experiencing a bad reaction to an opioid.
• Tell patients who are taking opioids about the potential for bad reactions that make breathing slow down or stop, leading to an overdose.
• Emphasize to patients that naloxone is an antidote and can save a life, just like a seatbelt or fire extinguisher.
• Tell patients and caregivers about what to expect after giving someone naloxone.
• Include a conversation about the importance of having naloxone on-hand as a standard part of opioid safety messages.
• Ensure all office staff know where to locate and how to use naloxone in case of an overdose.
• Review the signs and symptoms of opioid overdose and the legal protections under Rhode Island’s Good Samaritan Law.
• Sign and display these pledges on opioid safety.
• Print, hang, and distribute educational materials about naloxone.

Promote increased access to naloxone.

• Join the US Surgeon General and be a role model. Purchase and carry naloxone. Incorporate naloxone co-prescribing in EHRs, office protocols, and electronic prescribing systems.
• Co-prescribe naloxone to patients who are currently being prescribed syringes and needles.
• Stock naloxone in the office for emergency use and for direct dispensing to patients.
• Remind patients and staff that pharmacists can dispense naloxone and bill insurance companies without a prescription from a healthcare provider.
• If cost is a barrier for patients, help them enroll in a health insurance plan.

Register with the Prescription Drug Monitoring Program (PDMP) . Check the PDMP each time you dispense/prescribe a controlled substance to help prevent fraudulent prescriptions from being filled. This will also help identify suspected pharmacy/doctor "shopping." More

Contact us for PDMP support.

Teleconsultation lines for providers who see perinatal and/or pediatric patients to receive real-time clinical consultations with specialty psychiatrists to discuss patient diagnosis, treatment planning, medication safety, and referral support.

Learn more about the Psychiatric Resource Network (PRN) lines.

Prescribing pharmaceutical stimulant(s) for ADD/ADHD is common and, at times, very appropriate. As with any controlled substance, consideration and safeguards are necessary to prescribe responsibly and to prevent diversion. Diversion of stimulants is different and more common in the adolescent and young adult populations. These patients are more likely to share their stimulants and are not aware of the risks of doing so. Prescribers have a professional duty to prevent diversion of controlled substances. Please review this educational policy in its entirety.

more

• Ask your patient, including teens, about their use of cigarettes, and other nicotice products at every visit;
• Advise smokers/users to quit and assess their willingness to do so;
• Enroll patients in QuitWorks Form;
• Prescribe nicotine replacement therapy and/or cessaion mediation as appropriate;
• Monitor quit status through faxed QuitWorks feedback reports
  1) Within weeks telling you that QuitWorks has spoken to your patient and if the patient consents to the counselling;
  2) Within seven months telling you the patient's quit status;
• If a patient relapses, re-evalutate and re-refer to QuitWorks when appropriate.

Per the FDA Emergency Use Authorization, medical providers and patients are to be provided with factsheets for understanding this test.

Test Interpretation Factsheets

The Centers for Disease Control and Prevention (CDC) is the only place that can perform the laboratory test to diagnose Zika virus. Per the FDA Emergency Use Authorization, medical providers and patients are to be provided with factsheets for understanding this test.

Test Interpretation Factsheets

• MAC-ELISA for
  • Healthcare Providers English | Spanish
  • Patients English | Spanish
  • Pregnant Women English | Spanish
• Trioplex PCR for
  • Healthcare Providers English | Spanish
  • Patients English | Spanish
  • Pregnant Women English | Spanish

more about zika