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Project Access Dallas Patient Enrollment Process
Once eligibility for Project Access Dallas (PAD) is established, complete
the following steps to enroll a patient.
- Log on to https://www.projectaccess.info/projectaccess/enter.cfm
Enter Username and Password and click Submit.
- Click Patient
Search link located on the left side bar. Enter the patient’s
last name and date of birth (this eliminates duplicate enrollments).
Once you determine the patient is not in the system, click Enroll
A New Patient. It will take you to the Patient Profile Form. Complete
the Patient Profile and click Submit, verify the information,
and click Submit again. The system then produces a patient ID
number.
Complete the
following on-line with the patient
- Enrollment
Application (link to this survey is located on the left side toolbar
under Patient Forms)
- Patient Needs
Assessment (also located on the left side toolbar under Patient
Forms) These questions are used to evaluate the patient’s health
care and social service needs.
- Contact Log
(link is located on the top toolbar on the patient profile page) The
Contact Log records every interaction with the patient by all PAD team
members. It’s helpful to document why the patient is being referred
to PAD, where they were referred from, and what their medical issues
are.
- Select Medical
Home
(located on the patient profile page under Associated Providers). Click
Select Medical Home, then Find a Medical Home, then Select
next to your clinic name from the list that appears. If you are unsure
of the patient’s medical home assignment, contact PAD staff for
assistance.
Have the Patient
sign the PAD consent forms.
The section labeled
Authorization to Use and Disclose Confidential
Health Information is a release of the patient’s
medical record to be shared when necessary between PAD providers and/or
PAD staff. The section labeled Program Information
& Patient Consent for Services explains that PAD providers
are volunteers. The Patient Responsibilities
section describes how the PAD program works and what the patient can expect.
The Question and Answers
section is to be discussed and given to the patient.
Give the patient
the following items:
- Project Access
Dallas ID card:

- Print
the patient’s name on the card
- Print
the Patient ID on the card. This number is generated by the website.
- The
expiration date is always the last day of the month, one year after
the patient enrolls. Example: Patient is activated on 6/1/2010, expiration
date is 6/30/2011.
- Advise
the patient to contact the Patient Help Line number for any concerns
regarding their enrollment or services.
-
PAD Brochure
- Copy of signed
consent forms
Upload the following
forms to the Project Access Dallas website:
- Signed Patient
Consent Forms
- Patient’s
Financial Information One of the following must be provided for any
household member with income:
- Paycheck within
last 30 days
- IRS Form W-2
- Complete previous
year’s tax return
- Letter from employer
stating number of hours worked, pay rate, pay frequency, employer name
and phone number, and employer signature
- Social Security
Income
- Unemployment Compensation
- Proof of benefits
received from Food Stamps, Public Housing, AFDC, TANF
- Complete bank
statements
- Child Support
documentation from the Texas Attorney General’s office, or a court
order showing amount to be paid
- Letter from patient/spouse
stating their own income is accepted ONLY if there is no steady employer
to provide employment documentation. MUST BE NOTARIZED.
If no household member has income:
- A letter of support
is required from individual(s) financially assisting the patient, providing
food and housing, and/or providing resources to meet basic needs. Letter
must include:
- Patient’s
name
- Current date
- Description
of assistance being provided
- Name, signature,
and phone number of the individual assisting the patient.
*If
you aren’t sure whether the financial documentation is adequate,
please contact PAD staff.
*If you use a Baylor facility for hospital services, complete the
Baylor Application for Financial Assistance and
upload with Financial Information.
*Households are counted by physical members living in the home. If
the patient pays rent to another household member, the patient and/or
their dependents may be counted as a separate household. |
- Copy of the patient’s
picture ID, which could verify their Dallas County residency
- Proof of Dallas
County residency showing patient name and address. In order of preference,
please submit one of the following:
- Rental agreement
or mortgage statement
- Utility bill
- A statement of
assistance from a homeless shelter or other housing service.
- Picture ID with
current address
- Any other official
piece of mail, EXCEPT for cell phone bills.
- If none of the
above can be provided, a letter from individual(s) assisting the patient
with housing may be accepted. It must state the address where the patient
is residing, and be signed, dated by the person assisting the patient
and provide a phone number to reach this individual.
E-mail
Email Janie Ortega, Patient Enrollment Coordinator, at janie@dallas-cms.org
and cc: Eber Bueno, Manager of Patient Enrollment, at eber@dallas-cms.org
to change the patient’s status to Active, once the administrative
enrollment process is complete. Include the Patient Name, PAD ID number,
and Date of Birth in the email. If you need the patient to be activated
immediately, you can call Janie at 214-413-1442 or Eber at 214-413-1440.
If neither is available, contact Billy Lane, Director of Patient Enrollment,
at billy@dallas-cms.org or 214-413-1433.
Once
the patient’s enrollment has been activated, enter them in the Caremark
on-line website:
Please refer to Caremark
Pharmacy Benefit Management Instructions for detailed
instructions on the process of entering a patient into Caremark. If you
do not have access clearance in the Caremark website, contact Billy Lane
at billy@dallas-cms.org, or
214-413-1433.
Last revised 04/06/2011
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Downloadable
documents:
Qualifications
[44K]
Consent
Forms (English)
[86K]
Consent Forms (Spanish)
[66K]
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