HLTB21H3 Lecture : lecture 3

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rosemuskrat776

2 Nov 2010

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Referred to in an egyptian papyrus document (1550 bc) Ancient greece - after alexander the great returned from india (320 bc) Rome (62 bc) - return of pompeii troops from asia minor. Hereditary illness - curse or punishment by god. Europe had to wear special clothing & bell to notify others - had to walk on the other side of the street to opposing. Patience treated in separate hospitals - live in colonies (separated) called leprosariums/ lazaretto/leper colony/ lazar house. First leper house in england 936 ad. Mid 12th century - those infected loss civic status and removed from public office. 13th century - 19 000 leper houses in use (a lot of cases) Mass of separation -- priest would hold a ceremony to let them know their responsibilities. forbade to enter areas, leave house, had to drink from own utensils, have no contact with others.

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Investigation of Possible Bioterrorism-Related Activity

Patient History:

A 38-year-old woman who resided in the Northeast was admitted to the hospital with fever, myalgia, and weakness, which progressed over 3 days to respiratory failure requiring mechanical ventilation. On day 22, after 3 weeks of intensive care, the patient was still febrile. Cultures of blood were negative.

Hospital personnel interviewed family members who reported no history of traditional risk factors for fever of unknown origin (e.g., relevant food, infected animal contact, or travel history). On day 24, the patient's family reported to hospital personnel that the patient's illness might have been caused by exposure to laboratory flasks and cultures kept in her apartment by her boyfriend. He was described as a foreign national studying biology, but recently he had returned to his country of citizenship. On day 25, the patient's family brought laboratory flasks, Petri dishes, and culture media to the hospital from the patient's apartment. Several contained an unidentified clear liquid. The patientâs unresponsiveness and the acknowledged potential for some bacterial species to be used as bioterrorist agents raised concerns among the infection control staff that this case might be associated with a bioterrorist event or unintentional exposure to contaminated materials in the patient's home. The hospital contacted local law enforcement, the Department of Public Health, and the Federal Bureau of Investigation about the unusual circumstances surrounding the case.

On day 30, under the authority of state communicable disease statutes and in cooperation with the local police department, fire department, and hazardous materials unit, NHDHHS personnel entered the patient's apartment to assess any possibility of an ongoing public health hazard. Remaining flasks were removed and cultured. After 48 hours, growth of a translucent, pinpoint, and smooth colony appeared on blood agar and chocolate agar.

Gram stain of the colonies revealed faintly staining Gram-negative rods that were catalase positive, oxidase positive, and rapidly urea positive. On day 33, the patient began to get better after extensive antibiotic therapy.

Early detection is essential to ensure a prompt response to a biological terrorist event. Local public health authorities must rely on clinicians to recognize and report suspicious or unusual presentations of disease. However, correlating suspicious cases originating from diverse locations or discerning an increase in common presentations above the normal baseline is difficult. As in this case, public health practitioners coordinating disease surveillance may be able to receive reports of rare diseases and to determine whether they are occurring at a higher than normal rate in a large surveillance area.

The CDC, in collaboration with local, state, and territorial health departments, is enhancing existing disease surveillance systems for specific diseases that are normally rare in the United States but thought to have a high potential for public health impact if used as biological terrorism agents. This is being accomplished by improving training of clinical, laboratory, and public health personnel in recognizing suspicious disease presentations and by expanding of existing, disease-specific surveillance infrastructure. In addition, surveillance is being improved for disease presentations, such as acute respiratory distress, hemorrhagic, or meningeal symptoms normally caused by common infectious agents, but that could indicate an increase in illnesses caused by a biological agent used in terrorism. Surveillance mechanisms to rapidly assess changes in rates of disease include monitoring of calls to local emergency medical systems, regularly reviewing emergency department discharge diagnoses, and linking infection control practitioner networks.

Assignment:

For this case study, write a 1-page report that describes the possible agent of bioterrorism along with pathogenesis, treatment, and prevention. Include a brief discussion of sentinel labs and their role in recognizing potential episodes of bioterrorism.

Please help

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Read the following audit engagement letter, then asnwer the questions below.

March 1, 2015

Smart and Partners, PLLC is pleased to have the opportunity to provide you with professional services. This engagement letter embodies the entire agreement regarding the services to be rendered by our firm to you.

We will prepare:

Your 2014 federal and resident state individual income tax returns;

If applicable, 2014 non-resident state individual income tax returns for the same states you filed with for 2013, unless you direct us otherwise;

2014 federal and resident state individual income tax returns for any children you specifically request;

If applicable, 2014 property tax returns for the same jurisdictions you filed with for 2013, unless you direct us otherwise;

â¢ If applicable, 2014 business or occupational license tax returns for the same jurisdictions you filed with for 2013 unless you direct us otherwise.

Please note any requested additions or deletions to the returns listed above at the bottom of this letter.

We will prepare your returns based on your filing status as reflected in your income tax returns for last year. If your marital status has changed, you want to change your filing status, or you have questions about your filing status, please contact us immediately to discuss this.

Attached to this letter is a series of important questions you should answer as a part of this engagement agreement. Any unanswered questions will be taken as a negative response and will be included in the signature and representation below.

Please forward your organized tax information at your earliest convenience, including any supporting documentation required to complete the returns. Any additional documents we request of you after we have received and reviewed your tax information must be received by us no later than April 1, 2016 to allow for the timely preparation of your tax returns.

We expect to begin the preparation of your returns upon receipt of all required tax documents. The un-extended filing due date for your tax returns is April 18, 2015.

You agree that in the event of unresolved tax issues or delays in processing, or if we do not receive all of the necessary information on a timely basis, it may become necessary to apply to extend the due date. Applying for an extension of time to file may extend the time available for a government agency to undertake an audit of your return or may extend the statute of limitations. In the event you owe taxes in excess of the amounts withheld from your income or, if you are self-employed, in excess of estimated tax payments made, penalties and interest may accrue on your unpaid taxes after the due date.

Additionally, extensions may affect your liability for other penalties and interest or compliance with government and constituent deadlines. We are available to discuss this matter with you at your request at our regular hourly fees should the need arise.

It is your responsibility to provide all the information required for the preparation of complete and accurate returns. You should retain all the documents, canceled checks or other data that form the basis of income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority. You have the final responsibility for your income tax returns and, therefore, you should review them carefully before you sign them.

Our work in connection with the preparation of your income tax returns does not include any procedures designed to discover fraud, theft, defalcations or other irregularities, should any exist. However, should we find any irregularities or unusual items we will bring them to your attention. We will render such accounting and bookkeeping assistance as determined to be necessary for preparation of the income tax returns. If we discover any errors or omissions on a prior year return we will bring that to your attention.

This engagement does not include responding to inquiries by any governmental agency or tax authority. If your tax return is selected for examination or audit, you may request that we assist you in responding to such inquiry. In that event, we would be pleased to discuss providing assistance to you under the terms of a separate engagement for that specific purpose.

The Internal Revenue Code and regulations impose preparation and disclosure standards with non-compliance penalties on both the preparer of a tax return and on the taxpayer. To avoid exposure to these penalties, it may be necessary in some cases to make certain disclosures to you and/or in the tax return concerning positions taken on the return that do not meet these standards. Accordingly, we will discuss tax positions that may increase the risk of exposure to penalties and any recommended disclosures with you before completing the preparation of the return. If we concluded that we are obligated to disclose a position and you refuse to permit the disclosure, we reserve the right to withdraw from the engagement and you agree to compensate us for our services to the date of withdrawal. Our engagement with you will terminate upon our withdrawal.

The IRS permits you to authorize us to discuss, on a limited basis, aspects of your return for one year after the return's due date. Your consent to such a discussion is evidenced by checking a box on the return. Unless you tell us otherwise, we will check that box authorizing the IRS to discuss your return with us. In accordance with federal law, in no case will we disclose your tax return information to any third party for any purpose other than to prepare your return without first receiving your consent.

The potential for conflicts of interest exist in any engagement. In the event that we in our sole discretion believe that a conflict has arisen affecting our ability to service your account in accordance with either the ethical standards of our firm or the ethical rules of our profession, we may be required to suspend or terminate our services.

In accordance with our firm's current policy on document retention, we will retain copies of the records you have provided and our work papers for your engagement for a period of seven years. After that time, our work papers and files will no longer be available. Physical deterioration or catastrophic events may shorten the availability time of our records. The working papers and files of our firm are not a substitute for your records.

In the interest of facilitating our services to you, we may communicate by facsimile transmission or by sending electronic mail over the Internet. Such communications may include information that is confidential to you. Our firm employs measures in the use of facsimile machines and computer technology designed to maintain data security. While we will use our best efforts to keep such communications secure in accordance with our obligations under applicable laws and professional standards, we have no control over the unauthorized interception of these communications once they have been sent and we specifically disclaim and waive any liability or responsibility whatsoever for interception or unintentional disclosure of emails transmitted by us in connection with the performance of this engagement.

Our professional fee for the services outlined below will be based upon the complexity or the work to be performed and our professional time to complete the work. Additionally, this fee is dependent on the availability, quality, and completeness of your records. In the event you fail to timely provide us with records that we request or if the records you provide are incomplete or unusable, we reserve the right to terminate the engagement without completing our work. If we can assist you in preparing needed records, we will contact you to discuss the problem, the additional work needed, our fees for such work, and the anticipated delay in completing our engagement before rendering further services.

All invoices are due and payable upon presentation.

You represent that the information you are supplying is accurate and complete to the best of your knowledge and that all deductible expenses, including but not limited to meals, entertainment, travel, business gifts, charitable contributions, dues and memberships, and vehicle use are supported by records as required by law. You understand Smart & Associates will not verify the information you provide, but may ask for clarification. You also represent that any unanswered questions on the attached list should be accepted as a negative response.

We look forward to serving you. Our services will conclude upon delivery to you of your 2014 tax returns for your review and filing with the appropriate taxing authorities. If the foregoing fairly sets forth your understanding, please sign this letter in the space indicated and return it to our office in the enclosed envelope. However, if there are other tax returns you expect us to prepare, such as gift and/or property, please inform us by noting so just below your signature at the end of the returned copy of this letter.

Very truly yours,
Smith and Associates, PLLC

Accepted:

James Johnson

James Johnson, Client

1-Assume that James Johnson asks the Smart and Parners, LLC to complete his taxes. Is it necessary for this agreement to be in writing? Why or why not? Explain.

2-Assume that James' Dad, Mark, accompanies him to the accounting firm. James, who is 20 and owns a housecleaning business, executes the engagement letter. Mark tells the accountant who is preparing Jamesâs taxes that if James fails to pay for the firmâs services, he will pay for them. If James fails to pay the accounting firm, will the firm be able to force Mark to pay for the services? Why or why not?

3-James explains to the accountant that she expects to receive a tax refund. Before James executes the engagement letter, he informs the accountant that he currently does not have any money to pay the firm, but he will pay the firm once she receives her tax refund. The accountant indicates that this will be acceptable. James subsequently executes the engagement letter. As soon as the accounting firm completes the tax return, it bills James and demands immediate payment. If James challenges the payment due date, is the oral agreement between James and the accountant regarding payment admissible in court? Why or why not?

For these following problems, assume that James has executed the engagement letter.

4-Assume that Jamse decides to do his own taxes with TaxAct. His friend, Bobbie, needs to have her taxes completed. James tells Bobbie that she will assign her rights to have her taxes done by the accounting firm to Bobbie, if Bobbie will pay the accounting firm for its services. Can James do this? Why or why not? What rights does the accounting firm have, if any?

5-The accounting firm completes Jamieâs taxes and asserts that Jamie owes it $500 for its services. In need of money, James agrees to clean Mister Duckâs house for $500. James asks Mister Duck to pay her debt to the accounting firm rather than pay her directly. Assuming that James performs her obligations to Mister Duck, what rights, if any, does the accounting firm have if Mister Duck fails to pay it? What rights, if any, does James have?

6-Assume that the accounting firm files James' taxes on the wrong form, resulting in substantial taxpayer payment penalties. What rights, if any, does James have?

7- On March 15, 2015, James stops by the accounting firm and tells an accountant that she cannot locate certain tax records and that she will not be able to supply them to the accounting firm. Assuming that the firm has already started Jamesâs return, what rights, if any, does the accounting firm have at that point?

Process Mapping: Hospital Response Chain (A Question for the course of Introduction to Information System)

When someone calls 9â1â1, there are a series of actions and responses that get triggered, collectively known as the preâhospital response chain. This chain is described below.

The Call for Help

When an individual experiences a medical, they typically call 9â1â1 for help. It is important that the patient stays on the phone to provide the necessary information about the emergency situation. The patient relays important information to both 9â1â1 and the health communication centre.

9â1â1 Emergency Service

The 9â1â1 dispatcher's responsibility is to take the 9â1â1 call for help and determine if the situation requires police, firefighters or ambulance services. In some emergency situations, more than one service can be dispatched2. The 9â1â1 dispatcher also needs to identify the patientâs location so that the appropriate type of ambulance can be dispatched (land, air or water)3. To make these assessments, there are a series of questions that are asked. The patient plays an important role in answering these questions. The 9â1â1 dispatcher collects all of the information needed to make these assessments and enters it into the 9â1â1 system. Once all the pertinent information has been collected, the information and call are then immediately transferred to the health communication centre. Otherwise, the dispatcher continues to work with the patient on understanding the situation.

Health Communication Centre

The health communication centreâs (HCC) responsibility is to review the information sent by the 9â1â1 dispatcher and speak to the patient to assess the nature of the situation and, most importantly, prioritize the response of the ambulance services. Additional information from the patient is typically required to do so. Prioritization is key in situations where there are multiple emergency situations. If the HCC dispatcher determines that the situation is urgent, the medical and emergency information, as captured in the HCC system, is transferred to the ambulance service, and the required number of ambulances dispatched to the scene. In situations that are not considered urgent, alternative methods of transportation are then arranged.

Ambulance Service

An ambulance service has a series of responsibilities when they are dispatched. The ambulance service is alerted to the emergency via their onâboard system. Using the location information provided, the ambulance service is then responsible for ensuring the appropriate route is taken using the navigational component of their onâboard system. Depending on the weather conditions, location, and time of day, the best route may change. Once the ambulance service arrives at the scene, they are responsible for assessing the situation and determining whether the patient needs to be stabilized at the scene first. Depending on location, assessment, and priority, the ambulance service first determines which hospital is best suited for the patient. If the patient requires stabilization, the ambulance service will work with that hospital to stabilize the patient. Specifically, they speak with the doctors at the hospital using their handsâfree mobile phones to relay the status of the patient and to receive stabilization instructions. The patient is not transported until they are in a stable condition. Once the patient is stabilized, the ambulance service continues to work with the doctors to determine whether the patientâs situation is still critical and requires hospital care. If that is no longer the case, the ambulance service will return to their dispatch station and complete a vehicle and supply report and a scene report.

On route to the hospital, the ambulance service will relay all critical information to the destination hospital using their onâboard system as well as calling them to provide an updated patient status and estimated time of arrival. This enables the hospital to complete all the necessary preparations. When the ambulance service arrives at the hospital with the patient, the patientâs status is verbally transferred to the receiving physician at that hospital. At this point, the physician and team of health professionals assess and care for the patient.

After the patient transfer is complete, there are a series of reports that need to be written and submitted by the ambulance services: 1, Patient Care and Transfer Report; 2, Scene Report (if needed) 3, Patient Invoice 4, Vehicle and Supply Report

The patient care and transfer report is used by the hospital to fill in the patient chart and can be used to determine onâgoing treatment. The ambulance service completes this report before leaving the hospital using their onâboard system and electronically submits it to the hospital. When this report is created, a scene report is not needed. A scene report is only created when the patient is not transferred to a local hospital, but assessment and care are provided at the scene. The scene report is for internal tracking purposes.

A patient invoice will be sent to the patient through the mail by the ambulance service: the typical cost for an ambulance service is $45 but if the receiving physician deemed the trip to be unnecessary, the bill will increase to $240. This information is provided by the physician in his verbal report to the ambulance service before they leave the hospital.

Finally, a vehicle and supply report will be created, for internal purposes, to track vehicle mileage, gas along with wear and tear. If there are any concerns with the vehicle or if maintenance is required the vehicle is sent to the fleet garage along with a paper report documenting the concerns. The vehicle is returned to the ambulance service when the repairs or maintenance are completed.

An inventory of the supplies on board the ambulance is taken and a list of the items needed to be replenished is electronically sent to the medical supplies warehouse via EDI for restocking. It is essential that those items are shipped quickly so that the ambulance is prepared for the next emergency. The ambulance always has reserves on board, but keeping those reserves replenished ensures they will not run out of supplies in an emergency situation.

Requirement: Draw the Process Map for the Hospital Chain Scenario

(Note: 1, Assume that the individual can call for 9â1â1 on their own. 2 In assignment we only have to focus on the land ambulance service; subâprocesses for the other services do not need to be elaborated on.)

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HLTB21H3 Lecture : lecture 3

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