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09-10 AGREEMENT Between UNC School of Medicine <br />And Orange County Health Department <br />Page 3 of 10 <br />patients, prenatal patients will be managed according to OCHD established <br />protocols. These protocols will be reviewed annually and be consistent with <br />protocols used at UNC Department of OB/GYN and Family Medicine outlying <br />clinics. <br />b. Primary medical supervision of the nurse practitioners who are employees of <br />OCHD to include ongoing monitoring and evaluation of the medical acts <br />performed by the nurse practitioners; Regular individual meetings with the nurse <br />practitioners will occur according to an agreed upon schedule to review records <br />of high-risk or problematic patients; Documentation will be recorded in the <br />patient record indicating that a review occurred and noting any recommended <br />changes in the plan of care. <br />c. Co-signing charts of patients seen by new nurse practitioners of OCHD within <br />five (5) working days for at least the first six months of their nurse practitioner <br />practice, and face-to-face consultation on a weekly basis for the first month of <br />their nurse practitioner practice and at least monthly thereafter for the <br />succeeding five months; <br />d. A review of all OCHD prenatal records at 16, 28 and 36 weeks to assure that <br />appropriate medical care is being provided, with a Maternity Chart Review form <br />completed at each interval. <br />e. Weekly group meetings with clinical staff in each site according to an agreed <br />upon schedule to discuss patient care and clinical operation issues. <br />f. Overall responsibility for medical Residents and medical students working in <br />clinics including orientation, supervision of practice and assurance of <br />compliance with OCHD program and documentation requirements. <br />g. Provision of routine medical services during scheduled on-site times at OCHD <br />Outpatient Clinics, including documentation of Clinical Services provided per <br />established OCHD protocols; <br />h. Medical consultation visits to OCHD patients during on-site scheduled times at <br />Outpatient Clinics; medical consultation to OCHD nurse practitioners by <br />telephone when the Medical Director is not on-site at OCHD outpatient clinics. <br />Continuing education consultation for OCHD nurse practitioners and other <br />OCHD staff to include regular informal consultation and periodic formal <br />sessions as appropriate; <br />j. After-hours medical consultation for primary care patients of OCHD: UNC <br />Health Care's HealthLink program provides initial triage of after-hours calls as <br />per the agreement attached hereto and incorporated as exhibit A ("after-hours <br />