2015

Medical Staff Orientation

Mission Statement South Bay Hospital is committed to being the best community hospital. Our healthcare team strives to provide effective and efficient services tailored to meet the healthcare needs of our community in a skillful, caring and professional manner.

Values

• We recognize and affirm the unique and intrinsic worth of each individual

• We treat all those we serve with compassion and kindness

• We act with absolute honesty, integrity and fairness in the way we conduct our business and the way we live our lives

• We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect and dignity

Medical Staff Leadership

Evelyn Lunsford Chairman Board of Trustees Robert Betzu Chief of Medical Staff Ronald M Stengel Chief Dept. of Special Services Satya Gullapalli Chief Dept. of Medicine Mark Alkire Chief Dept. of Surgery

Administrative Team and Department Directors Title Name Phone Chief Executive Officer Sharon Roush 813-634-0101 Chief Operating Officer Dan Bender 813-634-0377 Chief Nursing Officer Terrie Jefferson 813-634-0103 Chief Financial Officer vacant 813-634-0105 Cardiopulmonary Director vacant 813-634-0116 Case Management Director Kathy Bridges 813-634-0253 Cardiac Cath Lab Director Lisa Martney-Mock 813-634-0488 Clinical Applications CPOE Director David Burton 813-634-0381 Emergency Room Director Kevin Dalrymple 813-634-0138 Environmental Services Director C.J. Cigarran 813-649-2586 Food Services Director Debbie Gilkinson 813-634-0289 Human Resources VP Doug Goodman 813-634-0402 Information Services Director Eric Young 813-634-0199 Laboratory Director Kathy Jones 813-634-0120 Marketing Director vacant 813-634-0496 Materials Management Director Dustin Batista 813-634-0162 Medical Records Director – Privacy Officer Marla Jones 813-634-0299 Medical Staff Coordinator Argelis White 813-634-0104 Nursing – ICU/PCU Marjorie Westerkamp 813-634-0340 Nursing – 3 East Telemetry Claudia Ramey 813-634-0393 Nursing – 2 nd Floor – Medical-Surgical Michelle Jutt 813-634-0347 Patient Access Director Dottie Crist-Marshall 813-634-0177 Pharmacy Director Jasmine King 813-634-0198 Plant Operations - Safety Officer Lauren Labrador 813-634-0165 Quality/Patient Safety VP Cheryl Roberts 813-634-0386 Patient Safety / Risk Management Director Cynthia Magners 813-634-0249 Radiology Director Robert Allen 813-634-0366 Rehab Services Director Paul Melancon 813-634-0221 Surgery Director Charlotte Chiddister 813-634-0280

2015 National Patient Safety Goals Identify patients correctly • Use at least two ways to identify patients. For example, use the patient’s name and date of

birth. This is done to make sure that each patient gets the correct medicine and treatment. • Make sure that the correct patient gets the correct blood when they get a blood

transfusion. • Label specimens in the presence of the patient at the bedside Improve staff communication

• Get important test results to the right staff person on time. Critical results are called within 30 minutes to the nurse and the nurse has 30 minutes to notify the MD.

Use medicines safely • Before a procedure, label medicines that are not labeled. For example, medicines in

syringes, cups and basins. Do this in the area where medicines and supplies are set up. • Take extra care with patients who take medicines to thin their blood. When patients are

started on Coumadin a baseline INR is completed. Patient education is provided regarding medication use; follow up therapy, dietary restrictions, compliance issues and potential adverse reactions

• Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.

Use alarms safely • Ensure alarms on medical equipment are heard and responded to in a timely manner.

Prevent infection • Use the hand cleaning guidelines from the Centers for Disease Control and Prevention

or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

• Use proven guidelines to prevent infections that are difficult to treat. MRSA screening, ABATE Study

• Use proven guidelines to prevent infection of the blood from central lines. Central Line Bundle –Hand hygiene, Maximal barrier precautions, Chlorhexidine skin antiseptic, Optimal site selection, Daily assessment of need

• Use proven guidelines to prevent infection after surgery – hand washing, stopping of antibiotics within 24 hours post-op,

• Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. CAUTI is the most frequent type of health care-associated infection (HAI) and represents as much as 80 percent of HAIs in hospitals

• Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI).

• Remove catheters within 24 hours of surgery.

• Prevent Ventilator Acquired Pneumonia Elevation of the head of the bed to between 30 and 45 degrees Daily “sedation vacation” and daily assessment of readiness to extubate Peptic ulcer disease (PUD) Deep venous thrombosis (DVT) Provision of oral care

Identify patient safety risks • Find out which patients are most likely to try to commit suicide

All patients are screened on admission for risk of suicidality. Clinical concerns are to be reported to the physician and suicide precautions will be implemented to include assessment by the physician or a qualified mental health professional, increased patient observation and monitoring, patient care sitter, with constant line of sight monitoring and within an arm’s reach at all times. Crisis hotline – 234-1234 or call 2-1-1 for Crisis Center Tampa

Prevent mistakes in surgery • Make sure that the correct surgery is done on the correct patient and at the correct

place on the patient’s body. A pre-procedure verification needs to occur each time there is an invasive procedure. Verification needs to occur when procedure is scheduled, at time of pre-admission testing, at time of admission for the procedure, before patient is taken to the procedure room, and anytime responsibility for care is transferred to another member of the procedure team.

• Mark the correct place on the patient’s body where the surgery is to be done. All surgeries and invasive procedures involving laterality, levels (spine), multiple structures (digits) or Laparoscopic procedures involving laterality must have the site marked by physician/proceduralists, utilizing YES and their initials to mark the site after confirmation with patient. Site marking must be visible after draping is completed.

• Pause before the surgery to make sure that a mistake is not being made Time Out Before the procedure can begin; the physician will lead the time out. The entire team must be present and needs to stop and take “time out” to verify the patient name, procedure, surgical/procedure site, consent form, position, implants/special equipment, antibiotics administered, and safety precautions. Nurse and or radiology technician will document the “time out” verification in the medical record.

Core Measures Core Measures are evidenced based guidelines proven to reduce patient mortalities and complications. They also help to reduce readmission rates. Acute Myocardial Infarction ASA on admission and discharge LDL checked within 24 hours with statin ordered for >100 Beta blocker at discharge To the cath lab in less than 90 minutes Smoking cessation counseling – all patients receive in admission folder Heart Failure LV assessment ACE or ARB if EF is less than 40% Specific discharge instructions include all of the following teaching points (daily weights, diet, activity, signs and symptoms to report to physician, follow up appointments, smoking cessation counseling) Accurate and complete medication reconciliation Pneumonia Antibiotic within 6 hours of admission Pneumonia and Influenza vaccines offered prior to discharge Smoking cessation counseling Surgical Care Improvement Project Hair is clipped not shaved Antibiotics are administered within 60 minutes of incision Appropriate antibiotics are administered Antibiotics are discontinued 24 hours post op If patient has been on a Beta Blocker it must be administered day of surgery and post op day one or two VTE prophylaxis is started 24 hours post op Global Immunizations Patients over the age of 65 must be offered the Pneumonia vaccine All patients under 65 with the following co-morbid factors, smoker, heart failure, diabetes liver disease renal failure and pulmonary disease are also required to be offered the Pneumonia Vaccine Flu vaccine – all patients must be offered the vaccine from October 1 through

March 31. Stroke Swallow screen prior to taking oral drinks or food NIH on arrival

T-pa within 3 hours of onset of symptoms if candidate ASA within 24 hours and on discharge LDL within 24 hours and statin if above 100 on discharge VTE prophylaxis within 48 hours Anticoagulation for A- Fib Rehab assessment Patient education VTE Patients receive VTE prophylaxis or have reason why not documented Patients admitted or transferred to critical care must have VTE risk assessed and VTE prophylaxis instituted unless contraindicated with reason documented VTE prophylaxis must be started within 24 hours of surgical end time unless contraindicated VTE Discharge Instructions – When a patient has a confirmed VTE and is discharged home on Coumadin, written discharge instructions must include information addressing: compliance issues, dietary advice, follow up monitoring, and information about the potential for adverse drug reactions and interactions

• When patients with VTE are started on Coumadin, overlap therapy must be administered for at least 5 day either with Heparin or Lovenox and or until the INR is greater than or equal to 2.

• Platelet count must be monitored prior to administering IV heparin in patients with confirmed VTE

Clinical Practice Guidelines for Blood Transfusion Updated Clinical Practice Guidelines for blood transfusion have been published by the American Association of Blood Banking recommending adherence to a restrictive transfusion strategy. Studies have shown that a liberal blood transfusion approach is not necessarily associated with better outcomes and may expose patients to unnecessary risks like infections, adverse blood transfusion reactions, immunosuppression phenomena, volume overload and hyperkalemia. Current practice guidelines for blood transfusion recommend the following:

• Stable, non-bleeding medical and surgical inpatients are considered candidates for RBC transfusion when the Hb level is 7.0 g/dL or less. If the patient requires a transfusion because they’re experiencing ongoing bleeding, acute coronary syndrome with ischemia, or are symptomatic the reason for transfusion must be documented.

• All RBC transfusions in non-bleeding inpatients should be ordered as single units. • If transfusion is indicated based on Hb, a post transfusion Hb must be obtained before

ordering additional units. Please help us ensure blood products are transfused based upon current evidence based best practice minimizing risks to our patients and preventing over utilization of blood products. As part of our quality improvement effort, we will be informing physicians when blood is given and

does not meet the above guidelines and or reasons for transfusion are not documented. If you have questions or concerns regarding the evidenced based guidelines, I can be reached at 813-634-0317. Sepsis Management Severe Sepsis and Septic Shock are major health care problems, killing one in four, and increasing in incidence. Like acute myocardial infarction, or stroke, the timeliness and appropriateness of therapy administered in the initial hours after severe sepsis develops are likely to influence the outcome. Please review the following definitions and evidence based care guidelines recommended for the identification and treatment of sepsis and septic shock.

Sepsis Criteria

(SIRS) is a systemic syndrome recognized by the presence of at least 3 of the following clinical criteria in the appropriate setting:

Sepsis is identified when SIRS is due to a known or suspected infection. 30-35% of patients with sepsis are culture negative. Suspicion of infection recent surgical procedure, history of Diabetes, immunocompromised, skin wound, invasive device, central line, Foley catheter, infiltrate on chest x-ray, cough with sputum production

• Temperature > 100.4 or < 96.8 • Heart Rate >90 • Respiratory Rate >20 or PaCO2 < 32 mmHg • WBC >12,000, or <4,000, or >10% bands

Biochemical markers of inflammation include C-reactive protein, which correlates with elevations in interleukin-6 as a marker of inflammation, D-dimer, which correlates with activation of coagulation in sepsis and inflammation, and procalcitonin, which is elevated primarily when the etiology is bacterial infection. Treatment Steps:

• Assess for presence of infection • Assess for signs of organ dysfunction • CBC, POC Lactate, Cultures • Broad Spectrum antibiotics –first dose STAT • Give fluid challenge

Severe Sepsis Criteria Severe sepsis is identified when sepsis is associated with one or more organ failures (respiratory, cardiovascular, renal, coagulation, hepatic, CNS). Common sites of infection in severe sepsis include pulmonary, abdominal, urinary tract, and bacteremias, although any site can lead to severe sepsis. Treatment Steps:

• Monitor and maintain respiratory/hemodynamic status • Broad Spectrum antibiotics • IV Fluids

• Appropriate consults • Transfer to ICU

Our goal is to improve patient outcomes and reduce mortality. As part of our quality improvement effort, we will be informing physicians when care provided does not meet the recommended clinical practice guidelines. Emergency Medical Treatment and Labor Act (EMTALA)

• EMTALA is a federal act that mandates that any individual, who comes to the emergency department and requests care for a medical condition, be provided an appropriate medical screening examination to determine whether or not an emergency medical condition exists.

• EMTALA requires that a hospital treat and stabilize the emergency medical condition within its capability, including inpatient admission when necessary or transfer the patient to a hospital that has the capacity and capability to stabilize and treat

• Neither hospitals nor physicians may discriminate in the provision of a medical screening examination and necessary stabilizing treatment based on race, ethnicity, economic, status, insurance status, ability to pay for medical services etc.,

• Physicians on-call for the ED, must be available to provide stabilizing treatment for individuals with emergency medical conditions, if the physician refuses to come to the hospital when requested to do so by the Emergency physician CMS may take action against the hospital and or a physician

• EMTALA violations may put the hospital in “Immediate Jeopardy” with CMS and may trigger a 23 day termination notice

• EMTALA violations may result in penalties to the hospital and or physician up to $50,000

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) HCAHPS (pronounced “H-caps”) is the first national standardized, publicly reported survey of our patient’s perspectives regarding their hospital stay while here at South Bay. It is designed to provide data on topics that are objective and important to patients. Key survey questions include the following topics – communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of environment, pain management, communication about medicines, discharge information, overall rating of hospital and recommendation of hospital. Public reporting of the survey results began in March 2008. HCAHPS results are published quarterly on the Hospital Compare website found at www.hospitalcompare.hhs.gov. Survey objectives include creating a valid comparison of hospitals and incentives to improve quality care. Again, hospitals are reimbursed based upon their performance in ensuring a positive patient experience. Core Values

Quality of care is measured by how well the health care team listens and communicates with the patient and their family

The meaning and essence of care are experienced in the moment when one human being connects with another

Feeling connected creates harmony and healing versus feeling isolated Everyone has a valuable contribution to make Establishing a relationship with the patient is the heart of care delivery A therapeutic relationship between a patient and their family is essential to quality

patient care Basic Steps in Establishing Patient Relationships

First seconds of any interaction must convey clinical confidence, approachability, understanding, compassion and kindness.

Prepare for an exchange of information, give the patient your full attention, and listen to what the patient is saying before you respond. Engage in friendly conversation.

Recognize the impact of family, remember to include and listen to them. They (family) know the patient better than we do and can provide valuable insight into their care.

Provide individualized care involve patients and their family members in clinical decisions.

Focus on building collaborative relationships. Get to know the patient as a person. Constantly look for ways to engage the patient and family in their care.

Consider cultural sensitivities. Be aware and accommodate variations. Demonstrate empathy. Expressing empathy diffuses tension and fear and helps to build

trust. As you listen imagine how you would feel in a strange place, surrounded by people you don’t know, scared and in pain. A way to demonstrate empathy is to say I’m sorry - sorry for the situation, I’m sorry you are in so much pain , I’m sorry you are experiencing this loss.

Ask for feedback, we want to encourage patients to ask questions, be receptive and respond this helps to build strong relationships.

Emergency Codes

Dial *19999 for the Operator to announce an emergency code Grey Crisis Team Red Fire Blue Arrest Blue Brose low Pediatric Arrest Pink Infant Child Abduction Green Internal Internal Disaster Green External External Disaster White Hostage Black Bomb Threat Orange Hazmat/Bioterrorism Silver Active Shooter Brown Severe Weather Walker Patient Elopement Rapid Assessment Team Change in patient condition Stroke Alert New stroke symptom Sepsis Alert Signs of sepsis are present STEMI Alert Patient with ST elevation on ECG

Fire Safety R – Rescue the patient from danger A – Activate the alarm C – Contain the fire E – Extinguish or evacuate Pass P – Pull the ring A – Aim at the base of the fire S – Squeeze the handle S – Sweep side to side at base of fire Evacuation – horizontal past the next set of fire doors Departmental Phone Directory

Pharmaceutical Wastes Black Hazardous pharmaceuticals – ignitable agents, bulk and trace

chemotherapy, chemotherapy garb – shoes, gloves, empty syringes. Examples warfarin, nicotine patches, levimir, humalog, humulin, betadine, silvadene cream, hurricaine spray, chloraseptic throat spray

White/Blue All non-hazardous pharmaceuticals, contrast waste Red Biohardous agents like albumin, live attenuated vaccines

South Bay Hospital Department Directory Hospital Departments Phone Numbers Administration (813) 634-0102

Business Office/Billing Inquiries

(813) 386-1520

Cardiopulmonary (813) 634-0116

Case Management (813) 634-0371

Community Relations (813) 634-0172

Digital Mammography (813) 642-8468

Emergency Department Information

(813) 634-0145

Food & Nutritional Services (813) 634-0290

H2U - Health, Happiness, You (813) 634-0187

Human Resources (813) 634-0349

Infection Control (813) 634-0385

Laboratory Services (813) 634-0120

Marketing/Public Relations (813) 634-0172

Materials Management (813) 634-0161

Medical Imaging (Radiology) (813) 634-0148

Medical Records (813) 634-0190

Medical Staff Office (813) 634-0104

Nursing Units 2 East 2South 3 East PCU ICU

(813) 634-0250 (813) 634-0240 (813) 634-0362 (813) 634-0350 (813) 634-0355

Outpatient Scheduling (813) 634-0422

Quality/Risk Management (813) 634-0386 Surgery Scheduling (813) 634-0279

Medical Record Documentation Requirements

Time Requirements History and Physical (H&P) Must be completed within 24 hours of the patient admission

time and or prior to surgery Brief Operative Note Must be completed before the patient transfers to the next

level of care Full Operative Report Must be completed within 24 hours of surgery end time Verbal Orders Must be signed, dated and timed within 48 hours. Medication Reconciliation Forms

Must be completed upon admission, transfer and discharge

Progress Notes

Must be completed daily at the time of assessment of patient to include, treatments to be taken, patient response to treatments provided, reasons for delays

Discharge Summary Must be completed within 30 days and include principal diagnosis, additional diagnoses or procedures, reason for admission, hospital course – significant findings, condition on discharge, specific follow up instructions

Delinquent Medical Records Incomplete medical records are considered delinquent after 30 days. A medical record is considered finalized after all orders, progress notes, dictated reports, and queries are completed in both the daily Meditech Workload and in the HPF Portal. Any orders not completed in the daily Meditech Workload will automatically flow over to the HPF portal. Physicians with incomplete orders will be notified weekly. Suspension warning letters are sent out two weeks prior to the suspension date. Confidentiality: The medical record is a legal document and is confidential. Physicians are not to review a patient’s chart unless they are directly involved in that patient’s current hospital care. Please remember the medical record is a legal document and all information contained within the record is discoverable so please refrain from unprofessional or disparaging remarks about the patient, family or other staff members. Please use caution when discussing patient care with colleagues so you’re your conversation cannot be overheard by the public.

Coding Discrepancies A joint effort between the health care provider and the coding professional is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses, procedures and complications. Medical Record documentation is used to evaluate the adequacy and appropriateness of quality care, provide clinical data for research and education, and support reimbursement, medical necessity, quality of care measures, and public reporting for services rendered by a healthcare entity. Such information is used to report mortality, complications and readmission rates as well as hospital acquired injuries and infections. As this data is publicly reported it will not only reflect on the hospital but the health care provider as well.

The quality of coding is driven directly by the documentation contained in the patient’s health record. Queries may be made in situations such as the following:

• Clinical indicators of a diagnosis but no documentation of the condition • Clinical evidence for a higher degree of specificity or severity • A cause-and-effect relationship between two conditions or organism • An underlying cause when admitted with symptoms • Only the treatment is documented (without a diagnosis documented) • Present on admission (POA) indicator status

Our 3 biggest opportunities for coding improvements are:

• Severe sepsis and sepsis with shock – we had 2 patients coded with severe sepsis who expired resulting in a higher than expected mortality rate. In reviewing the records we found that one was a patient who had a bilateral cerebellar infarct, unresponsive, respiratory failure and temp of 106. The patient was clearly a neurological problem versus sepsis. The second patient was admitted with end stage renal disease, liver cirrhosis, hepatitis B, anemia, thrombocytopenia who had sustained a fall resulting in a pelvic fracture and hematoma.

• Coding of urinary tract and catheter associated infections. Are these infections acquired while patient was in the hospital or were they present on admission (POA). In one example – documentation in the record stated urinary tract infection but the patient did not have a urinalysis or culture done and no antibiotics ordered. It is important if you’re going to document an infection, probable infection, rule out sepsis etc. that tests are ordered to confirm and treatment for the condition is provided.

• Complications like hyponatremia and an acute renal failure – again was the patient admitted hyponatremic, if the patient has an acute renal injury or bump up in creatinine – was a nephrologist consulted for treatment. Another example of a complication was pleural effusions clearly present on admission prior to procedure but got coded as a complication. Pressure ulcer clearly present on admission got coded as hospital acquired.

Clinical Documentation Reviews Clinical documentation reviews are completed monthly to ensure required documentation is complete and timely. Results are reported at the Utilization Review Committee.

Dictation Instructions Step 1 Dial extension *40408 (if inside the hospital) Dial (813) 634-0408 (if outside the hospital) Step 2 Enter your physician ID, followed by the # key Step 3 Enter the work type, followed by the # key

01 H&P 02 Consultation 03 Operative/Procedure Report 04 Final Summary 25 EEG 26 Echocardiogram 30 Pulmonary Function Test 56 Progress Note 76 Stress Test

Step 4 Enter the last 7 digits of the patient’s Account Number, followed by the # key Step 5 Begin dictating after the tone Step 6 Press “3” to begin a new report Step 7 At the end of your dictation, always press #0 for the confirmation number and document it in the medical record

Keypad Functions

1 No Function 2 Record 3 Rewind 4 No Function 5 Disconnect 6 Pause 7 Fast Forward 8 Play Back From Beginning 9 No Function *STAT 0 Fast Forward to End # No Function #0 Play Back Job # #3 New Report

Medical Staff Structure

Department Department Chair Department Vice Chair Medicine Satya Gullapalli, MD Juan Angel, MD Special Services Ronald Stengel, DO Julie Vitko, MD Surgery Mark Alkire, MD John Okun, MD Medical Staff Committees Medical Executive Committee Credentials Committee Peer Review Medical Record/Utilization Review Pharmacy& Therapeutics Infection Control Medical Staff Committees Critical Care Cancer Committee Quality Council

Ongoing Professional Practice Evaluations: Every six months a retrospective reappraisal of professional performance including; clinical and medical knowledge, patient care, interpersonal and communication skills, practiced based learning and improvement, professionalism and systems based practice will be prepared for each physician and reviewed by the department chair. Methodologies for collecting information may include periodic chart review, direct observation, monitoring of diagnostic and treatment techniques and discussion with other individuals involved in the care of each patient including consulting physicians, surgery assistants, nursing and administrative personnel. These reports will be provided to individual physicians. The timeframe for distribution will be at least annually. If the practitioner has no volume to be evaluated he/she will be ask to provide a competency assessment from another healthcare facility, hospital or outpatient surgery center. If this assessment cannot be provided within 30 days of notification, the practitioner’s medical staff category and privileges may be reclassified. Focused Professional Practice Evaluations: May be requested by the Credentials Committee for all initially requested privileges and or by the Peer Review Committee or MEC when issues affecting the provision of safe quality patient care are identified The organized medical staff has developed the following criteria to be used for evaluating the performance of practitioners when issues affecting the provision of safe, high quality patient care are identified.

• High Complication Rates ( Actual/Expected) • Adjusted Mortality ( Actual/Expected) • Medical Record Accuracy/Completion • Confirmed Quality Complaint • Core Measure Outliers – 3 or more in a Quarter • Failure to meet SIMS criteria – 3 or more in a Quarter

On Site Orientation: An onsite orientation is required and scheduled through Argelis White, Medical Staff Coordinator to secure a badge, complete computer training, take a facility tour and receive personal introductions to the senior management team members, department directors and hospital staff. Parking: Parking is available both in front of the hospital as well as in the back. Cellular Phones: Cellular phones are permitted to be used within the facility. Changes in Personal Information: Please keep the medical staff office apprised of any changes in office phone numbers, home phone, cell phone, beeper numbers and e-mail address. Changes should be reported as soon as they occur.

Dr. Doctor, Thank you for your interest in affiliation with South Bay Hospital. HCA has a comprehensive, values-based Ethics and Compliance Program. This Code of Conduct, which reflects our tradition of caring, provides guidance to ensure our work is done in an ethical and legal manner. It emphasizes the shared common values and culture which guide our actions. It also contains resources to help resolve any questions about appropriate conduct in the work place. Please review HCA’s Code of Conduct thoroughly at http://hcaethics.com/CPM/Code%20of%20Conduct%20Booklet%20Text.rtf. Welcome to be part of our Medical Staff. Respectfully, Argelis White, CPCS Medical Staff Coordinator