NOTE: 1. This may be used for an annual medical examination within the limitations of GR 4.6.1. 2. Complete physical examination shall include examination of each organ system of the body, except in psychiatry, dermatology and the surgical specialties. "Complete physical examination" shall encompass all those organ systems which customarily and usually are the standard complete examination prevailing within the practice of the respective specialty. What is customary and usual may be judged by peer review. 3. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.

NOTE: 1. This may be used for an annual medical examination within the limitations of GR 4.6.1. 2. Complete physical examination shall include examination of each organ system of the body, except in psychiatry, dermatology and the surgical specialties. "Complete physical examination" shall encompass all those organ systems which customarily and usually are the standard complete examination prevailing within the practice of the respective specialty. What is customary and usual may be judged by peer review. 3. Benefit includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.

NOTE: Refer to the notes following 03.04H.

NOTE: Refer to the notes following HSC 03.04HA.

NOTE: Refer to the notes following HSC 03.04H.

NOTE: Refer to the notes following HSC 03.04HA.

NOTE: 1. HSCs 03.04F, 03.04G, 03.04H may only be claimed by emergency medicine physicians, full time emergency room physicians, general practitioners or pediatricians working a rotation duty shift in an emergency department with 24 hour on-site coverage or by physicians who are providing first call coverage in an emergency department that has greater than 25,000 visits to the emergency room per year. 2. HSCs 03.04F, 03.04G, 03.04H may be claimed for those patients whose illness/injury requires prolonged observation, continuous therapy and multiple reassessments as described in GR 4.2.7 or for female patients requiring an internal examination because of obstetrical problems or gynecological bleeding.

NOTE: 1. HSCs 03.04FA, 03.04GA, 03.04HA may only be claimed by physicians working a rotation duty shift in an AACC or UCC. 2. HSCs 03.04FA, 03.04GA, 03.04HA may be claimed for those patients whose illness/injury requires prolonged observation, continuous therapy and multiple reassessments as described in GR 4.2.7 or for female patients requiring an internal examination because of obstetrical problems or gynecological bleeding.

NOTE: 1. If the assessment is less than 90 minutes, then HSC 03.04A, 03.04AZ, 03.08A or 03.08AZ should be claimed. 2. May only be claimed in an AHS regional facility or AHS/Contracted partner run geriatric program(s) or community clinic where a PCN multi-disciplinary team is contributing to the assessment. 3. May only be claimed for patients aged 65 years or older. 4. May only be claimed by general practitioners, internal medicine specialists or geriatric medicine specialists. 5. May only be claimed once per patient per year. 6. Each subsequent 15 minutes, or major portion thereof, may be claimed at the rate specified on the Price List, to a maximum of 7 calls. 7. Assessment must include the following components: a) Medical includes but is not limited to a complete physical examination, a problem list, co morbidity conditions and disease severity, a medication review and nutritional status. b) Functional includes but is not limited to a review of basic activities of daily living, instrumental activities of daily living, activity/exercise status, gait, balance and assessment of senior falls. c) Cognitive/psychological includes but is not limited to review of mental status, administration of the Mini Mental State Examination (MMSE) and mood/depression testing through Geriatric Depression Scale (GDS) or other relevant appropriate mental health examinations. d) Social includes but is not limited to a review of informal support needs and assets, care resource eligibility and a financial assessment. e) Environmental includes but is not limited to a review of current living situation, home safety and transportation. 8. Evidence that all components in note 7 were completed must be documented in the patient's records. This includes physician notes and copies of the MMSE and GDS or other relevant appropriate mental health examinations.

NOTE: 1. May only be claimed when an examination and a standard form for pre-operative assessment have been completed. 2. A copy of the form must be retained in the patient's chart. 3. May not be claimed in addition to a surgical assist (SA, SAQS, SSOS) for the same patient by the same physician. 4. HSC 03.04M may not be claimed for a pre operative physical examination when the request is for a cataract procedure (HSC 27.72A) that will not require the use of a general anesthetic.

Note: 1. Benefit includes witnessing the agents' or service providers' assessment. 2. May be claimed to determine lack of capacity or to determine that capacity has been regained.

NOTE: 1. May only be claimed 4 times per patient within the first 12 months following a renal transplant. 2. Should the required number of visits for the patient exceed four in the first year following a renal transplant, subsequent visits may be submitted using the appropriate visit HSC. 3. May only be claimed by physicians with GNSG or NEPH skill codes.

NOTE: 1. May only be claimed 4 times per patient per year for the second and subsequent years following a renal tranplant. 2. Should the required number of visits exceed four within a given post-transplant year (beginning on the date of transplantation), subsequent visits may be submitted using the appropriate visit HSC. 3. May only be claimed by physicians with GNSG or NEPH skill codes.

NOTE: 1. Intended for patients requiring scheduled comprehensive evaluations relevant to the specific type of cancer. 2. Comprehensive evaluations must adhere to protocols as defined by the facility, program or surgeon from which the patient was discharged. 3. The discharge letter that states the protocols must be forwarded to Alberta Health for claim processing for each claim submitted. The letter must indicate: a. Date of surgery b. Schedule of required comprehensive visits and other diagnostic testing c. Duration of required follow-ups (i.e. two years from date of surgery)

NOTE: 1. May only be claimed by general surgery. 2. May only be claimed for patients that have already received a consultation in the pre-operative period by the same physician who intends on performing the procedure. 3. May only be claimed in instances where more than one pre-surgical visit is necessary due to the complexities of the patients' circumstances and/or surgical needs. 4. May only be claimed in the pre-operative period for procedures with a category code of 3, 4, 6 or 14.