National Health Insurance Scheme
National Health Insurance Scheme (NHIS)
RESPONSIBILITIES: The Chief Resident, consultant-in-charge, head of records, NHIS desk officer, and the matron will be responsible for ensuring these guidelines are met through vertical and collaborative communication or otherwise.
- WEEKDAYS – 8:00am 2:00pm – Morning
2:00pm 9:00pm – Afternoon
- WEEKEND/PUBLIC HOLIDAY
8:00am 2:00pm -Morning
- ANTI-NATAL CLINIC -Wednesday-Follow-up/Booking only
Information for new Patients;
Registration from 10:30am-11:00am.
- Patients to come with 2 passport photographs, HMO & parent organization information of NHIS Records
- Records open folder after taking details with 1 passport photographs fixed on the folder, 1 on hand card.
- Client presents to front door and gets listed on daily register
- Record officer sorts clients’ files; documents client’s biodata and other relevant information to open a hospital record file for new clients or retrieves files for already existing clients
- Record officer sifts clients with issues of eligibility/HMO regulations and presents to NHIS desk officer
- NHIS desk officer sorts claims with HMOs and other service providers.
- Record officer presents files to nurses for triaging, and direct patients to the waiting area and corresponding consulting r
2. NURSES’ TRIAGE
- Client in waiting area where lectures are delivered and vital signs taken by nurse.
- Clients found to have urgent/alarming/life threatening conditions are flagged, and expedited for quick attention by the clinical attendants
- Those with special conditions based on age, specific clinical or statistical parameters are channeled to the appropriate location of service (can be geriatric unit, research purposes etc) within the clinic. Example, those aged 60 years and above are fast-tracked to the geriatric unit of the clinic.
- Clients that need assistance with mobility or otherwise are sorted and assisted accordingly by clinical attendants (e.g wheel chair). This action may involve one or more of the following; urgent consultation, and transfer or referral to accident/emergency.
- Clinical attendant enters clients into daily register while calling them individually for consultation
- Doctor checks and validate client’s identification
- Doctor attends to client’s request e.g medical consultation, medical reports, follow up visits, counselling, referral etc.
- Doctor obtains history of medical complaints
- Doctor performs physical examination of relevant systems
- Doctor makes a working diagnosis
- Doctor requests investigations
- Doctor prescribes the needed treatment for clients, either drug prescriptions, physical therapy, admission, procedures, medical report or other referral/service as the case may be
- Follow up visit (if needed) is determined by the doctor in conjunction with the client
- Doctor educates client on medical condition, expected outcome, medication adverse effects (and action plan if necessary)
- Clinical attendant directs client to the next service point e.g laboratory for investigations, pharmacy for medications, other clinics for consultation
- Client’s orders are costed and directed to the NHIS cash office
- Cash Officers advice clients on co-payments where found applicable, clients make payments and return to the respective service point to be served
- NHIS desk officer collates and processes clients’ documents, viz referrals and appointments
- CLINICAL ROUNDS AND PROCEDURES
- At the decision of patient admission for inpatient care the NHIS desk officer is notified and documented appropriately
- Patients admitted in the wards are evaluated daily by a team of Family Physicians, composing of residents, senior residents and consultants
- Clinical ward rounds are scheduled as follows:
- Monday and Friday 8am to 10am: Resident ward rounds
- Wednesdays 8am to 10am: Senior residents ward rounds
- Tuesday and Thursday consultant ward rounds 8am to 10am:
- Other specialties are invited for patients requiring other secondary/tertiary care
- Patients scheduled for minor surgical procedures are operated upon on Thursdays (at the A/E theater), or Wednesdays (at the main theater in conjunction with the general surgery team
5. NHIS PHARMACY
Patient take prescription form to NHIS pharmacy along with hand card for drugs costing then proceeds to NHIS cashier to pay 10% of costed drugs. He/she then returns to the pharmacy for collection of drugs.
- LAB – patient will be given referral form by the GOPD NHIS Doctor patient goes to NHIS Desk officer for confirmation/Authorization
- REFERRAL: patient will be given referral form by the GOPD NHIS Doctor.
Patient goes to NHIS Desk Officer for confirmation/Authorization. Patient then proceeds to the referred clini
Patient may not be seen at specialty clinic until He/She is given referral to the said clinic