Ketamine Academy Policy & Procedure Manual 
Get Over 180 Policy & Procedures You Need To Run An Effective, Efficient, and Compliant Practice Plus Important Additional Forms And Checklists
Note: This Manual is extremely comprehensive and due to its size (over 530 pages!) and to allow you the ability to customize to best meet your needs, it will be delivered in electronic format only.
Why You Need A Policy & Procedure Manual
Two words: Gross Negligence

As a medical professional reading those two words together probably caused a bit of uneasiness or possible outright fear. That’s good.

We all know this is something we never want to hear in our time practicing medicine, whether you're a nurse or a physician, because it means a willful disregard to a person’s safety and it can have huge consequences.

Everything from an exponentially higher fines to losing your license and in the worst cases criminal accusations.

When you're a medical professional directly overseeing the care of a patient it could be giving a person a medication their chart says they’re allergic to or leaving a medical instrument inside a body cavity.

When talking about practicing medicine from a business level things are a little different and the focus needs to shift more towards what the clinic has in place to protect itself.

For example, the likelihood of someone coding out during an infusion is very small and hopefully an incident you never have to deal with. No matter how small the possibility though, you still have to know what to do and be prepared for it to happen.

Let’s say the worst happens and someone does code during an infusion and one of your employees was working that day instead of you. Now let’s say your employee doesn’t know where to find the crash cart?

Who’s fault is that?

Of course we want to say it’s their fault and while that may be true that doesn’t always matter.

What if during an investigation the employee says they were never told where the crash cart was.

If you have a policy and procedure manual that clearly defines what to do in the event of a code and says exactly where to find everything needed then you’re covered.

However, if you don’t that could fall to you and could be considered gross negligence on your part as the owner.

In 2018 there was $28 million in fines issued for HIPAA compliance alone. One of the best ways to protect your business from fines, or worse, is to have a strong Policy & Procedure Manual in place.
You asked for it and here it is! 
Introducing our very own Ketamine Academy Policy & Procedures manual.

Over the last few months I’ve had hundreds of requests from students and clinic owners about creating a Policy & Procedure Manual. This is a really good thing, every clinic absolutely needs one of these.

An effective P&P manual lays out exactly how things should be done at your clinic. It gives employees a resource to look back at so they know what’s expected of them and how to conduct business.  

Essentially, it lays out how your business runs day to day.  They're important to reduce liability of your clinic and reflect highly upon your own professionalism in running your business.  State and Federal agencies have also been known to ask for these from time to time and not having one can put your business at serious risk.

The problem is creating a comprehensive P&P manual is a huge undertaking. It’s tedious and boring unless you’re the kind of person that absolutely loves writing out processes.

If you’re not, hiring someone to create this for you is extremely expensive. When I was looking to create one for my clinic I was getting quotes from attorneys for $5,000.

But you won’t have to do that. I’ve spent several months creating a comprehensive Policy & Procedure Manual specific to running a Ketamine Clinic.

Now I’m offering it to you for a fraction of the price you’d have to pay to have one created yourself.

Let me be clear, this is still a template. There are going to be places you have to add your specific clinic information and change a couple sections so they make sense for the clinic you’re running.

But I’ve done 95% of the work for you. It contains all of the Policies & Procedures I used in my very own clinic.

If you don’t want to spend countless hours and thousands of dollars to create your own then order your copy of the Ketamine Academy P&P Manual now.
What's Inside?
Section 1 - Introduction
1.1 Policy and Procedure Manual
1.2 Developing Policies and Procedures 
1.3 Policies and Procedures ‐ Master Book Maintenance 
1.4 Policies and Procedures ‐ Writing and Implementation 
1.5 Policies and Procedures ‐ Revision and Retirement 

Section 2 Forms - Employment and Hiring
Form 2.1 Credentialing Data Sheet 
Form 2.2 Employee Confidentiality Agreement
Form 2.3 Employee Time‐Off Request Form 
Form 2.4 Professional Development Training Request 
Form 2.5 Job Requisition Form 

Section 2 - Employment and Hiring
2.1 Americans with Disabilities Act 
2.2 Background Checks ‐ General 
2.3 Background Checks – Written Authorization 
2.4 Base Compensation 
2.5 Benefits Eligibility 
2.6 Candidate Interviews 
2.7 Code of Conduct 
2.8 Confidentiality Agreement 
2.9 Corrective Action 
2.10 CPR Certification 
2.11 Disciplinary Termination Policy 
2.13 Employment Application 
2.14 Employment Eligibility Verification 
2.15 Equal Opportunity Employment 
2.16 Establishing Salaries and Compensation 
2.17 Medicare Provider Enrollment Process 
2.18 Introductory Period for New Employees 
2.19 Leave of Absence 
2.20 Nature of Employment 
2.21 Nepotism 
2.22 No Distribution or Solicitation 
2.24 Performance and Salary Reviews 
2.25 Performance Bonuses 
2.26 Performance Improvement: Individual Provider 
2.27 Personnel Files 
2.28 Personnel Records and Administration 
2.29 Provider Credentialing 
2.30 Provider Recredentialing 
2.31 Recruitment 
2.32 References and Supplemental Investigations 
2.33 Suspension 
2.34 Time‐Keeping 
2.35 Time Off, Holidays, Religious Observances, Jury Duty, Bereavement 
2.37 Work Hours 
2.38 Workplace Searches 

Section 3 Forms - Workplace Conduct and Professionalism
Form 
3.1 Disciplinary Action Checklist 

Section 3 - Workplace Conduct and Professionalism
3.1a Attendance 
3.1b Attendance – Disciplinary Action 
3.1c Attendance – Emergencies and Inclement Weather 
3.2 Drug and Alcohol Policy 
3.3 Drug and Alcohol Testing 
3.4 Grievance Policy 
3.5 Internet Use 
3.6 Professional Appearance 
3.7 Smoking Policy 
3.8 Telephone and Cell Phone Policy 
3.9 Violence in the Workplace 

Section 4 Forms - Clinic Operations

Form 4.1 Professional and Business Insurance Worksheet Form 
4.2 Office Security Checklist 

Section 4 - Clinic Operations
4.1 Audits 
4.2 Building Security 
4.3 Business Associate Agreements 
4.4 Business Associate Inventory 
4.5 Clinic Credentialing 
4.6 Clinic Hours and Emergency Service 
4.7 Performance Improvement Plan 
4.8 Computer Workstation Protocol 
4.9 Display of License 
4.10 Electronic Communications Protocol 
4.11 Clinic Facility Design 
4.12 Firearms and Other Weapons 
4.13 Identity Theft Detection and Prevention 
4.14 Internet Use Protocol 
4.15 Mandated Reporting of Child Abuse and Neglect 
4.16 Mobile Device Protocol 

Section 5 Forms - Records and Data ManagementForm 
5.1 Electronic Security Incident Report Form 
5.2 HIPAA Security Policies and Procedures Checklist Form 
5.3 HIPAA Security Assessment Form 
5.4 Patient Acknowledgment of Receipt of Notice of Privacy Practices Form 
5.5 Release of Medical Records Log Form 
5.6 Authorization for Use and/or Disclosure of Protected Health Information Form 
5.7 Authorization Checklist for Release of Medical Record Information 

Section 5 - Records and Data Management
5.1 Access Rules 
5.2 Data Backup 
5.3 Data From Other Facilities or the Patient 
5.4 Data Integrity: Access, Audit Trail, and Security 
5.5 Documentation of Privacy and Security Policies and Procedures 
5.6 HIPAA and HITECH Privacy Compliance 
5.7 HIPAA and HITECH Security Compliance 
5.8 Legal Medical Record Standards 
5.9 Legibility and Display of Entries 
5.10 Meaningful Use Audits 
5.11 Notice Of Privacy Practices 
5.12 Patient Request for Medical Record 
5.13 Performing a Billing or Coding Audit 
5.14 Purging and Destruction of Paper Records 
5.15 Purging ePHI 
5.16 Responding to Subpoenas or Court Orders 
5.17 Retention of Medical Records 
5.18 Retirement of Medical Records 
5.19 Safeguarding PHI in Non‐Electronic Form 
5.20 Storage and Retrieval of Paper Medical Records 

Section 6 Forms- Accounting, Claims, and Billing
Form 6.1 Example Payer Plan Profiles 
Form 6.2 Payer Plan Profiles 
Form 6.3 Payer Organization Profiles 
Form 6.4 Report of Suspected Fraud and Abuse 
Form 6.5 Petty Cash Reconciliation Form 
Form 6.6 Office Patient Account Billing Policy for Treatment of Automobile Injuries 
Form 6.7 Charge Capture Checklist 
Form 6.8 Medicare Advance Beneficiary Notice (ABN) 
Form 6.9 Insurance Benefits Authorization and Assignment 
Form 6.10 Payment Options and Procedures At Check‐Out 
Form 6.11 Deposit Transactions 
Form 6.12 Treatment Financial Agreement 

Section 6 - Accounting, Claims, and Billing
6.1 Automobile Accident‐Related Injury Claims 
6.2 Fee Schedule Administration 
6.3 Structuring a Compliance Plan 
6.4 Conducting an Internal Audit 
6.5 Internal Controls 6.6 Petty Cash 
6.7 Managing Incoming Cash 
6.8 Bill Paying 
6.9 Charge Capture and Diagnosis Coding 
6.10 Charge Capture, Encounter Forms, Data Entry 
6.11 Medicare Non‐covered Services – Advance Beneficiary Notice
6.12 Payment Posting 
6.13 Financial Agreement for Patient Responsibility 
6.14 Claim Submission to Third‐Party Payers 
6.15 Charge Submission Turnaround Time 
6.16 Charge Corrections 
6.17 Open Claims 
6.18 Denied Claims 
6.19 Patient Communication on Insurance Balances 
6.20 Refunds to Patients 
6.21 Unapplied Payments 
6.22 Patient Billing Inquiries 
6.23 Waiver of Patient Responsibility 
6.24 Financial Hardship 
6.25 Returned Checks for Insufficient Funds 
6.26 Payment Plans 
6.27 Turning Accounts to Collections 
6.28 Collection Agencies and Patient Disputes 
6.29 Small Balances 
6.30 Write‐Offs 
6.31 Bankruptcy 

Section 7 Forms - Emergencies and Disaster Response
Form 7.1 Hazard Vulnerability Analysis 
Form 7.2 Pre‐Event Planning Checklist 
Form 7.3 Event Checklist 
Form 7.4 Post‐Event Checklist 
Form 7.5 Practice Continuity and Disaster Preparedness Plan 

Section 7 - Emergencies and Disaster Response
7.1 Emergency Equipment and Medication 
7.2 Emergency Evacuation Plan 
7.3 Fire Plan 
7.4 Psychiatric Emergency Plan 

Section 8 Forms - Patient Management
Form 8.1 Patient Daily Sign‐In Sheet 
Form 8.2 Authorization to Transfer Medical Records 
Form 8.3 Financial Agreement 
Form 8.4 General Medical Consent 
Form 8.5 Ketamine Infusion Therapy Patient Informed Consent 
Form 8.6 New Patient Medical History Questionnaire 
Form 8.7 Patient Dismissal Letter 
Form 8.8 New Patient Registration Form 
Form 8.9 Referral Tracking Form 
Form 8.10 Patient Financial Policy 

Section 8 - Patient Management
8.1 Communicating Test Results and In‐Office Laboratory Reports
8.2 Marketing, Fundraising, Sale of PHI Under HIPAA 
8.3 Marketing Policy 
8.4 Patient Education 
8.5 Patient Grievances 
8.6 Patient Portal 
8.7 Patient Satisfaction 
8.8 Prescription Ordering and Documentation 
8.9 Prescription Refills 
8.10 Procedure for Follow‐Up 
8.11 Procedure for Patient Scheduling 
8.12 Steps to Terminate Patient Relationship 
8.13 Tracking System for Diagnostic Reports 
8.14 Video Monitoring Policy 
8.15 Website and Social Media Marketing 

Section 9 - Ketamine Infusion Therapy
9.1 Ketamine Protocol – Administration Procedures 
9.2 Ketamine Protocol – Background and Drug Info 
9.3 Ketamine Protocol – Equipment and Adjuvant Medications 
9.4 Ketamine Protocol – Preparation Notes 
9.5 Ketamine Protocol – Required Monitoring 
9.6 Management of Allergic and Anaphylactic Reactions 
9.7 Patient Distress  
9.8 Ketamine Protocol ‐ Oral Administration
More Ketamine P&Ps to be added 

Section 10 Forms - Workplace Safety
Form 10.1 Employee/Contractor Injury Report Form 
Form 10.2 Accident Investigation Report Form for Supervisor 
Form 10.3 Ten‐Step Checklist for Exposure Control Plan Development 
Form 10.4 Declination Statement of Hepatitis B Vaccine 
Form 10.5 Sharps Injury Log 
Form 10.6 OSHA Training Record and Checklist 
Form 10.7 Acknowledgement of Receipt of OSHA Training 
Form 10.8 Employee Acknowledgment of Exposure Control Plan 

Section 10 - Workplace Safety
10.1 Sharps Disposal 
10.2 Engineering and Work Practice Controls 
10.3a OSHA Compliance Committee 
10.3b OSHA Compliance Committee ‐ Duties 
10.4 Clinic Exposure Control Plan 
10.5 Exposure Control Plan Administration 
10.6 Exposure Determination 
10.7 Universal Exposure Control Practices 
10.8 Exposure Control Plan Review & Availability 
10.9a Post‐Exposure Evaluation and Follow‐Up ‐ Administration 
10.9b Post‐Exposure Evaluation and Follow‐Up – Plan of Action When Exposure Incident Occurs 
10.9c Post‐Exposure Evaluation and Follow‐Up – Plan of Action When an Exposure Incident Occurs 
10.10a Biohazardous Waste 
10.11a Infection Control Competency Training 
10.11b Infection Control Competency Training – Bloodborne Pathogen Training 
10.12 Injection Safety 
10.13 Injury Prevention 
10.14 Housekeeping 
10.15 Recordkeeping 
10.16 Hepatitis B Virus (HBV) Vaccination 

Section 11 Forms - Drugs, Chemicals, and Controlled Substances
Form 11.1 Controlled Drug Count Log 
Form 11.2 Controlled Drug Dispensing Record 

Section 11 - Drugs, Chemicals, and Controlled Substances
11.1 Controlled Substances 
11.2 Inventory Rotation 
11.3 Recall Response Plan 
11.4 Use of Single‐Dose and Multiple‐Dose Containers 

Section 12 Forms - Equipment, Supplies, and Inventory
Form 12.1 Equipment Record Log 
Form 12.2 Equipment Repair Record 

Section 12 - Equipment, Supplies, and Inventory
12.1 Infusion Equipment Requirements 
12.2 Supply Procurement, Receipt, and Inspection 
12.3 Purchasing Policy and Procedure 
12.4 Request for Proposal 
12.5 Vendor Accounts
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