Patient Category
- Colin.Campbell
[Revised Jan 08]
The Patient Category defaults to that of the previous script for the patient, or with an eScript the category recorded on the script.
RxOne knows that a patient is exempt when the s'net count for the family, plus the 'External safety net' count is more than the cutoff. There is no 'Exempt' switch as such, though a patient can be forced to be exempt by increasing the 'external s'net count'. The patient categories 'X1' 'X2' 'X3' used on other systems have no meaning.
An 'x' for exempt, or the patient category, can be printed on the 'HealthPAC' sticker if required, set in the advanced printer setup section.
'High use' handling is known from the 'Z1' 'Z3' category.
Permanent category change
Pull up the patient's history as usual. The 'Script' button will be highlighted. Press <tab> until the 'Patient Category' box is highlighted and change the category. All future scripts, will be done using this category. Previously dispensed scripts will not be changed, and if edited will still display the old category. Repeats of old scripts will be correctly priced using the old category.
Temporary Category change.
To make a temporary category change (just for a particular script), change it in the middle of the script while dispensing. To make a permanent change, see above.
Notes:
To have the item repriced on the new category, if changing the category part way through an item, <tab> the focus into the Instructions box and press <enter> which will force a repricing.
Safety net rollover on 1 Feb (NZ) or 1 Jan (Australia) is automatic and reversible. If the computers date is set back to before the rollover (a dangerous practice and not recommended), the count as it was at that point will be displayed.
You can choose the option to highlight the patient's category each time you go into a script. This is recommended for all pharmacies in PHO areas.
On the Main Dispensary screen, go up to Options, then RxOne Options and "Focus on Script Category"
Additional Notes
[Oct 2014]
Guidance from the Ministry website:
If the prescription is not coded the pharmacist needs to confirm that the:
patient is eligible for publicly funded pharmaceuticals
prescriber is approved for co-payments.
Is the patient eligible for funded health services?
UK citizens staying temporarily in New Zealand
A United Kingdom (UK) citizen is eligible for treatment (medical, hospital and related) on the same basis as a New Zealand citizen if they:
are ordinarily resident in the UK (including England, Scotland, Wales, Northern Ireland, the Isle of Man, the Island of Jersey and the Balliwick of Guernsey, comprising the islands of Guernsey, Alderney, Herm, Jethou and Sark) AND
are on a temporary stay in New Zealand (a temporary stay would be any stay that was not permanent, and to become permanent they would need to have a residence class visa or NZ citizenship) AND
require medical treatment which, in the opinion of a medical practitioner (or dentist for people under 19 years)
needs prompt attention
for a condition that arose after arrival into New Zealand, OR became, or without treatment would have become, acutely exacerbated after arrival.
The UK Reciprocal Health Agreement does not cover UK permanent residents.
When receiving services under the reciprocal agreement, a person may not enrol with a Primary Health Organisation (PHO). They should get the same health subsidies as a New Zealand citizen visiting a general practitioner as a casual patient, if the medical practitioner has decided the condition needs prompt attention. They may register with a GP, and should be allocated a NHI number if they do not already have one.
UK citizens may also be eligible for other publicly funded services, under other criteria. For example, if they have a work visa that, together with a stay on any other previous visa, allows them to be continuously in New Zealand for two years or more (ie. fully eligible), or if they require maternity-related services and have a partner who is eligible
Is the prescriber “approved” for co-payments
Are casuals eligible for $5 co-payments?
The patient has to be eligible for publicly funded services, but does not have to be enrolled in a PHO if the prescriber is approved. If the casual visit is to a general practice that is part of a PHO, or to any other approved prescriber then they should be charged a $5 co-payment on subsidised medicines.
See also Section “5.6.1. Patient Eligibility” of your Pharmacy Procedures Manual, which also discusses eligibility (albeit, not with respect to reciprocal health agreements)
Short answer:
UK visitors can be eligible for a A4 coding if they visited a GP who belongs to a PHO.
You do NOT have to be enrolled in a PHO to be eligible for an A4 (or J4) prescription code.