Section 182-532-760. TAKE CHARGE program—Documentation requirements.

In addition to the documentation requirements in WAC 182-502-0020, TAKE CHARGE providers must keep the following records:

(1) The signed supplemental TAKE CHARGE agreement to participate in the TAKE CHARGE program;

(2) Documentation of the medicaid agency's specialized TAKE CHARGE training and/or in-house TAKE CHARGE training for each individual responsible for providing TAKE CHARGE;

(3) TAKE CHARGE application form(s), along with supporting documentation if provided;

(4) Chart notes reflecting that the primary focus and diagnosis of the visit was family planning;

(5) Contraceptive methods discussed with the client;

(6) Notes on any discussions of emergency contraception and needed prescription(s);

(7) The client's plan for the contraceptive method to be used, or the reason for no contraceptive method and plan;

(8) Documentation of the education, counseling and risk reduction (ECRR) service, if provided, with sufficient detail that allows for followup;

(9) Documentation of referrals to or from other providers;

(10) A form signed by the client authorizing the release of information for referral purposes, as necessary;

(11) The client's written and signed consent requesting that his or her services card be sent to the TAKE CHARGE provider's office to protect confidentiality; and

(12) If applicable, a copy of the completed medicaid agency-approved sterilization consent form. (See WAC 182-531-1550 for more details about sterilization and the consent form.)

[Statutory Authority: RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-532-760, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-760, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-532-760, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 08-11-031, § 388-532-760, filed 5/13/08, effective 6/13/08. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. WSR 05-24-032, § 388-532-760, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). WSR 02-21-021, § 388-532-760, filed 10/8/02, effective 11/8/02.]

RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-532-760, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-760, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-532-760, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 08-11-031, § 388-532-760, filed 5/13/08, effective 6/13/08. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. WSR 05-24-032, § 388-532-760, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). WSR 02-21-021, § 388-532-760, filed 10/8/02, effective 11/8/02.

Rules

182-502-0020,182-531-1550,