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Information Flow Assessment Questionnaire 7 <br /> 4.Employee/Stan Information <br /> Story e <br /> Information Description Create Receive Send Store Type Format How Stored <br /> O C P E Use list <br /> lications/RSsum§s <br /> Disability Claims&Reports <br /> Disciplinary Action <br /> Employee Assistance Program Information <br /> Em b HeaRh Records <br /> Health Plan Enrctlment Information <br /> Ph ician Notes Absences from work <br /> Referenoe Letters <br /> Voluntary Shared Leave <br /> Worker's Compensation Claims&Reports <br /> None o to next section <br /> 5.Social Programs <br /> Storage <br /> Information Description Create Receive Send Store Type Format I How Stored <br /> plicationslFormsJ Eligibility Information O C P E Use list <br /> Case Consultation Notes <br /> Correspondence <br /> Loo Services,Cases,Other <br /> Meetin Notes/Minutes <br /> ,Summary Review Reports <br /> None jgo to next section <br /> 6.Utilization Review <br /> Story e <br /> Information Description Create Receive Send Store Type Format How Stored <br /> O C P E Use list <br /> Correspondence <br /> FL-2/MR-2 Forms <br /> Los Services,Cases,other <br /> Meetin Notes/Minutes <br /> Worksheets,Revievis,Reports <br /> None to next section <br /> 7.Clinical Information <br /> Storane <br /> Information Description Create Receive Send Store Type Format I How Stored <br /> O C P E Use list <br /> Complete Medical,Dental Record or Client File <br /> Death Medical Records <br /> Partial Clinical Information Including: <br /> Assessmentslftports <br /> Dental Records <br /> Dia gnosis/Procedure Description/Name <br /> Discharge Summary <br /> Doctors Statements for Court <br /> Exams/Evaluations/AssessmentsMistories <br /> Habilitation Plans <br /> Immunization Records <br /> Laboratory Data <br /> Jury 2001-Version 4 HIPAA 3 <br />