þÿ<html> <head> <meta http-equiv="Content-Type" content="text/html; charset=unicodeFFFE"> <title>New Page 1</title> <meta name="Microsoft Border" content="b, default"> </head> <body background="images/ribbon.gif" style="background-attachment: fixed"><!--msnavigation--><table dir="ltr" border="0" cellpadding="0" cellspacing="0" width="100%"><tr><!--msnavigation--><td valign="top"> <div align="center"> <table border="0" width="800" cellspacing="0" cellpadding="0" id="table1"> <tr> <td> &nbsp;</td> </tr> <tr> <td> <img border="0" src="images/mammobanner.jpg" width="796" height="141"></td> </tr> <tr> <td height="50"> <p align="center">&nbsp;<p align="center"><b> <a target="_self" href="http://ncradiation.net/"> <font color="#3333FF">Section Home</font></a><font color="#3333FF">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp; </font> <a target="_self" href="progoverview.htm"> <font color="#3333FF">Program Overview</font></a><font color="#3333FF">&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp; &nbsp;&nbsp; </font> <a target="_self" href="mammcontacts.htm"><font color="#3333FF">Mammography Contacts</font></a><font color="#3333FF">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; </font> <a target="_self" href="documents/ncac.rules.pdf"> <font color="#3333FF">NC Regulations</font></a><font color="#3333FF">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; &nbsp;&nbsp; </font> <a target="_self" href="http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.htm"> <font color="#3333FF">MQSA Regulations</font></a></b></td> </tr> <tr> <td> <p class="MsoBodyTextIndent" style="margin-left:27.0pt;text-align:center; text-indent:-27.0pt">&nbsp;</p> <p class="MsoBodyTextIndent" style="margin-left:27.0pt;text-align:center; text-indent:-27.0pt"><font color="#000080"><b><span style="font-size:18.0pt"> <u>Policy for Self Requesting Mammogram</u></span></b></font></p> <p class="MsoBodyTextIndent" style="margin-left:72.0pt;text-align:justify"> &nbsp;</p> <p class="MsoBodyTextIndent" style="text-align:justify"><b>Comments:</b></p> <p class="MsoBodyTextIndent" style="text-align:justify">Facilities in North Carolina that offer screening mammography may not accept self-referred patients because a doctor is not involved.&nbsp; However under 15A NCAC 11.0603 (a)(1)(G), they may accept self-requesting patients.&nbsp; Facilities who accept self requesting patients, the inspectors will be reviewing the policy.&nbsp; This policy shall document the actions of the facility for self-requesting patients, following the patient from point of contact to the end of the mammography procedure.&nbsp; It is required that the listing of the doctor who will accept self requesting patients be available.&nbsp; A mechanism shall be in place for updating that list and this should be explained to the inspector.&nbsp; </p> <p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in" align="left"> <b>As for facilities that <u>do not</u> accept self-requesting mammograms, they MUST have a policy in place stating that fact.</b></p> <p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in"> <span style="font-size: 12.0pt">Many facilities have chosen to offer screening mammography on a self-requesting basis. &nbsp;These facilities are expected to have a policy that outlines how such patients would be &nbsp;accepted.&nbsp; The policy shall address the following situations:</span></p> <p class="MsoBodyTextIndent" style="margin-left:76.5pt;text-align:justify"> a.&nbsp; The self-requesting patient must provide the facility with the name of a referring physician who is willing to provide approprite follow-up care.&nbsp; This information shall be confirmed by the facility accepting it.</p> <p class="MsoBodyTextIndent" style="margin-left:76.5pt;text-align:justify"> b.&nbsp; A facility accepting self-requesting patients shall maintain a list of physician(s) who will accept the self-requestion patient for follow-up care.&nbsp; Either the patient or the facility may select the physician for follow-up care.&nbsp; The selected physician, by agreeing to be on the list, is responsible for the appropriate follow-up and treatment protocols.</p> <p>&nbsp;</td> </tr> <tr> <td> <p align="center"><b><font size="4" color="#3333FF"> <a target="_self" href="index.htm">Mammography Home</a></font></b></td> </tr> </table> </div> <!--msnavigation--></td></tr><!--msnavigation--></table><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td> <p>&nbsp;</p> <p>&nbsp;</p> </td></tr><!--msnavigation--></table></body> </html>