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Advance directive: must document whether the patient has executed an advance directive blood pressure danger zone buy digoxin 0.25 mg amex, such as a living will blood pressure medication for elderly purchase digoxin 0.25mg online, durable power of attorney or mental health advance directive 34 Behavioral Health Clinical Record Set Behavioral health agencies and practitioners must maintain current records at the primary location of service pulse pressure heart rate order digoxin with american express. Records must be maintained in accordance with practitioner or agency licensure, per state and federal guidelines. A single episode of care refers to continuous care or a series of intervals of brief separations from care to a member by a provider or facility for the same specific medical problem or condition. Documentation for all episodes of care must meet the following criteria: Legible to someone other than the writer Contains information that identifies the member on each page in the medical record Contains entries in the medical record that are dated and include author identification. Amerigroup may request that you submit additional documentation, including medical records, patient visit records or other documentation not directly related to the member, to support claims you submit. If documentation is not provided following the request or notification, or if documentation does not support the services billed for the episode of care, we may: Deny the claim. Amerigroup is not liable for interest or penalties when payment is denied or recouped because the provider fails to submit required or requested documentation. General Member Rights Members have the right to: Get understandable notices or have program materials explained or interpreted. Get information about all physical and behavioral health services covered by Apple Health. Choose their health plans and primary care providers from among available health plans and contracted networks. Get all medically necessary covered services and supplies listed in the Apple Health handbook and a schedule of benefits, subject to the limits, exclusions and cost-sharing described in the Apple Health member handbook. Refuse treatments and be told of the possible results of refusing treatments, including whether refusals may result in disenrollment from Apple Health. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. Make complaints or grievances about the health plans or providers and receive timely answers. Know about side effects of care and give consent before getting care for themselves or their children. Advance Directives We respect the right of the member to control decisions relating to his or her own medical and behavioral health care. This includes the decision to have the medical or surgical means or procedures calculated to prolong life provided, withheld or withdrawn as well as decisions about mental health treatment that members prefer when they become impaired by mental illness that affect their judgment and communication about mental health care. This right is subject to certain interests of society, such as the protection of human life and the preservation of ethical standards in the medical profession. We adhere to the Patient Self-Determination Act and maintain written policies and procedures regarding advance directives. Amerigroup recognizes and supports the following advance directives: Durable power of attorney Living will Mental health advance directive We understand a facility, physician or mental health provider may conscientiously object to an advance directive. A sample living will/durable power of attorney is located on our provider website at providers. A durable power of attorney lets a member name a patient advocate to act on his or her behalf. A living will lets a member state his or her wishes on medical and mental health treatment in writing. A mental health advance directive is a written document that describes directions and preferences for treatment and care during times when members are having difficulty communicating and making decisions about mental health care. It can inform others about what treatment is wanted or not wanted, and it can identify an agent who is trusted to make decisions and act on their behalf. Privacy Members also have the right to: Be treated with respect and with due consideration for their dignity and privacy. Expect that we will treat their records (including medical and personal information) and communications confidentially. Request and receive a copy of their medical records at no cost to the member and request that the records be amended or corrected. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation as specified in federal regulations. Grievances, Appeals and Administrative Hearings Members also have the right to: Pursue resolution of grievances and appeals about the health plan or care provided. Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated.

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Find something you do well hypertension quality improvement order discount digoxin online, like a sport blood pressure 40 year old male generic 0.25 mg digoxin fast delivery, an art or a school subject blood pressure of 80/50 order 0.25mg digoxin overnight delivery, and focus on succeeding at it. You know puberty has kicked in when you grow taller and begin to take on a more feminine shape. You also need complex carbohydrates (like whole wheat breads, pasta and cereals) and fresh fruits and vegetables. During early puberty, the first stage of breast development happens, called "budding. Once your breasts develop, wearing a bra provides support and coverage that can help you feel more comfortable. Plus, bras come in tons of fun colors and designs so you can find ones that match your personal style. Now find your bust line size by measuring around your chest over the fullest part of your breasts. Many stores that sell bras have experts who can tell your correct size by measuring you. Or, you can have a friend or trusted adult measure you using the following guide: 1. You can keep it under control, though, most of the time with a daily routine of skin care. Take a daily multivitamin, eat plenty of fruits and vegetables, and drink lots of water. Puberty may cause your hair to become oilier, thicker, coarser ­ even curlier or straighter. Body odor is triggered by your apocrine glands ­ Hair Shaft Epidermis Sebaceous Gland the kind of sweat glands Dermis Eccrine Gland that kick in at puberty. Subcutaneous Apocrine Gland Tissue Your other sweat glands ­ eccrine glands ­ start working at birth. Eccrine glands produce clear, odorless perspiration, but apocrine glands produce perspiration that can smell bad when it comes in contact with bacteria on your skin. Pores Since a lot of apocrine glands are under your arms, many people use underarm deodorants or antiperspirants. Since these are the main causes of body odor, anti-perspirants help prevent odor before it starts. So their deodorants and antikind you need or want depends perspirants are different, on you. Perspiration 13 Vaginal Discharge Vaginal discharge ­ a sign that your period is on its way. Vaginal discharge is a clear or whitish fluid that comes from your vagina (an opening between your legs). When you notice it in your underwear (a creamy white stain) for the first time, it usually means your first period is coming soon. To avoid getting discharge in your underwear between periods, you can wear a pantiliner (for more info, see pages 26, 27 and 30). If you have any discharge that is thick, yellowish or darker, smells unpleasant or causes itching or burning, it could be a sign of a vaginal infection. Your period is when you shed tissue, fluid and blood from your uterine lining (also called menstrual discharge). For most girls and women it usually happens each month and lasts between 3 and 7 days. But understanding the menstrual cycle will help take the mystery out of your period. It will also help you predict when your period will come each month, once your cycle starts. After the egg is released it travels along the fallopian tube to the thickening endometrium. The endometrium leaves the body through the vagina as a reddish fluid containing blood. Position inside body Eggs 16 Your Period Uterus Ovary Vagina the cycle repeats itself. A complete menstrual cycle runs from the first day of one period to the first day of the next. The average time this takes is 28 days, but anywhere between 21 and 35 days is normal.

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Researchers arterial bleeding buy digoxin 0.25 mg mastercard, however heart attack 18 order digoxin 0.25 mg free shipping, took to blood pressure chart newborn digoxin 0.25mg mastercard heart the recommendations of Stengel (1959) by developing more specific and explicit criterion sets (Blashfield, 1984). The most influential of these efforts was produced by a group ofneurobiologically oriented psychiatrists at Washington University in St. Their criterion sets generated so much interest that they were published separately in what has become one ofthe most widely cited papers in psychiatry. Research has since indicated that mental disorders can be diagnosed reliably and do provide valid information regarding etiology, pathology, course, and treatment (Nathan & Langenbucher, 1999). Recent major other textbooles that discuss psychopathology have either made exten largely adopted its terminology and concepts. A compromise was eventually reached in which the two late luteal phase dysphoric disorder were irtcluded irt an appendix 1995); paraphiliac rapism was deleted entirely. Largely excluded from the text is information concerning etiology, pathology, and treatment as this material was considered to be too theoretically specific and more suitable for academic texts. No substantive changes in the criterion sets were considered, nor were any new additions, subtypes, deletions, or other changes in the status of any diagnoses implemented. Future revisions will be confined to individual sections of the manual, each being revised on its own schedule. Cal syndrome or pattern that occurs in an individual and that is assoc(ated with. In addition, this syndrome or pattern must not be merely an and culturally sanctioned response to a particular event, for example, the death of one. Whatever its original cause, it must currently be considered a manifestation of a psychological, or biological dysfonction in the individual. Every adult who engaged in a sexual activity with a child for longer months would meet these diagnostic criteria. Deviant behavior alone has not traditionally considered sufficient for a diagnosis (Gorenstein, 1984). However, using the illegality of an act as a diagnostic criterion presents three problems. First, it undermines the original rationale for the inclusion ofthe impainnent criterion. Second, it provides no meaningful basis for de termining when deviant sexual acts or fantasies are or are not due to a mental disorder. Spitzer and Wakefield argued that the distinction between disordered and nondisordered abuse of children requires an assessment for the presence an underlying, internal pathology. Allowing two months to grieve before one is diagnosed with a mental disorder might be as arbitrary and meaningless as allowing a person to engage in a sexually deviant act only for six months before the behavior is diagnosed as a paraphilia. However, a limitation of this proposal is that there is currently little agreement over the specific pathology that should be required for any particular disorder. There is insufficient empirical support to give preference to one particular cognitive, interpersonal, neurochemical, psychodynamic, or other theoretical model of pathology. The precise nature of this pathology could be left unde fined or characterized simply as an "internal dysfunction" (Wakefield, Pottick, & Kirk, 2002), but an assessment of an unspecified pathology is unlikely to be reliable. Clinicians will have 71 opinions concerning the nature of the internal dysfunction and quite different for its attribution. Persons critical of the nomenclature have decried the substantial the diagnostic manual over thepast 50 years. It would have been more surprising, however, to find research and increased knowledge have failed to lead to the recognition of more. Pathology might also be in the absence of any impairment or distress (Lehman et aI. These social and political concerns, however; hinder a more dispassionate and accurate recognition of the true rate of a broad ofpsychopathology within the population (Widiger & Sankis, 2000). Wakefield (1992) has an alternative harmful dysfunction definition of mental disorder where dysfunction ofan internal mechanism to perform a naturally selected function.

Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization low pressure pulse jet bag filter buy 0.25 mg digoxin with mastercard. Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review heart attack mp3 order 0.25 mg digoxin free shipping, meta-analysis and meta-regression heart attack vol 1 pt 2 purchase digoxin visa. Bodies under siege: Self-mutilation and body modification in culture and psychiatry. Further studies reveal that approximately 50 to 75 percent of the 2 million youth encountering the juvenile justice system met criteria for a mental health disorder (Underwood & Washington, 2016). Moreover, in previous studies of juvenile offender detention facilities, two-thirds of males and three-quarters of females in these facilities were found to meet criteria for at least one mental health disorder, and an additional one-tenth also met criteria for a substance use disorder (Underwood & Washington). Such numbers are particularly troubling when compared to the general youth population, among which only about 20 percent of youth suffer from a diagnosable mental health disorder. More than 64 percent of admitted juveniles had significant symptoms of other mental health disorders, with a higher percentage of females (89. Among youth who are detained, a significant number are likely to have mental disorders that create unmanageable behaviors. Thus, it is no surprise that youth with mental disorders contribute disproportionately to detention populations. The psychiatric disorders seen most commonly in juvenile offenders are listed in Figure 1. Risk and Protective Factors Several risk factors predict violent juvenile offending. However, one must take care not to assume that a risk or protective factor will predict particular outcome. Risk factors "do not operate in isolation and typically are cumulative: the more risk factors that [youth] are exposed to, the greater likelihood that they will experience negative outcomes, including delinquency" (Kendziora and Osher, 2004). Furthermore, certain mental health disorders, such as affective disorders (depression, bipolar disorder, and anxiety disorders) and substance use disorders, increase risk (Schubert, Mulvey, & Alderfer, 2011). A more recent study found that among youth in the juvenile court delinquent population, those diagnosed with bipolar disorder were eight times more likely to be placed in detention for committing a personal crime (a violent crime against an individual) than those who did not have this disorder (Stoddard-Dare, Mallett, & Boitel, 2011). There is evidence that females in the juvenile justice system are more likely to have experienced certain types of trauma. Accordingly, these differences have also been noted as mental health risk factors for delinquency. Carr and Vandiver (2001) have identified a variety of protective factors that are associated with lower rates of recidivism among youth offenders. These protective factors are personal, familial, social, and academic (Carr & Vandiver). For example, juveniles with a lower risk for recidivism reported being happier with themselves, had more positive attitudes toward school rules and law enforcement, and had more structure and rules within their homes. Other protective factors outlined by David-Ferdon (2016) include healthy problem-solving and emotional regulation skills as well as higher rates of school readiness and academic achievement. Additional factors that contribute to healthy adolescent development and decreased aggressive behaviors include youth feeling connected to their schools, experiencing academic success, and having positive relationships with teachers, other caring adults, and prosocial and nonviolent peers (David-Ferdon et al. Although mental health disorders are common among youth involved in the juvenile justice system, these mental health problems frequently go undetected, increasing the likelihood that these juveniles will have persistent difficulties. Screening and assessment of juvenile offenders helps determine how the juvenile justice system can address their treatment needs. Screening also identifies youth who may require further attention or may have serious needs. Being "screened in" on a screening tool does not necessarily mean that a youth has a diagnosable mental health or substance use disorder or a significant risk of harming him/herself or someone else. However, it does indicate that further follow-up is necessary to determine the presence of a suspected condition. Assessment tools may help officials and mental health professionals determine if a child who has come in contact with the juvenile justice system displays signs of mental disturbance or emotional distress (Heilbrun, Cottle, & Lee, 2001).

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