Foster Care Physicals

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Specializes in Family Practice/Urgent Care.

How do you handle new patients that are coming to see you strictly for a foster care physical? I feel like I am asked to sign off that they are physically and mentally fit to care for a foster child without really knowing them at all. This happens frequently at our clinic due to the high number of patients on state assistance in our area of town. I of course do a complete H&P but there are no labs drawn at the visit or prior health records to look over. Some of the patients that come in for foster care physicals are clearly in poor health but deny any health problems-mental or physical. Obviously they can lie and tell me whatever they want. There is that line on the foster care form that asks how long you have known the patient...5 minutes??! It just doesn't seem right. They may or may not have a PCP elsewhere but come to us because we are pretty good about working new patients in for things like this. The same goes for DOT physicals when you don't know the patient. How do you handle things like this where you are asked to certify the health of a patient that you barely know?

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Specializes in Peri-op/Sub-Acute ANP.

I would write something like: First visit with this patient. ___ time spent on H&P. No labs or previous records available at this time.

While this may not seem to be "nice" it would be the only thing that is true and factual, and therefore the only thing I would be willing to put my signature on.

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How do you handle new patients that are coming to see you strictly for a foster care physical? I feel like I am asked to sign off that they are physically and mentally fit to care for a foster child without really knowing them at all. This happens frequently at our clinic due to the high number of patients on state assistance in our area of town. I of course do a complete H&P but there are no labs drawn at the visit or prior health records to look over. Some of the patients that come in for foster care physicals are clearly in poor health but deny any health problems-mental or physical. Obviously they can lie and tell me whatever they want. There is that line on the foster care form that asks how long you have known the patient...5 minutes??! It just doesn't seem right. They may or may not have a PCP elsewhere but come to us because we are pretty good about working new patients in for things like this. The same goes for DOT physicals when you don't know the patient. How do you handle things like this where you are asked to certify the health of a patient that you barely know?

easy ... I DON'T certify the health of a patient I don't know. Have refused to do the foster care form more than once. As a corollary to this, our clinic has a policy that we can refuse to do paperwork of any type for a new patient.

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Specializes in Family Practice/Urgent Care.

Thanks to you both for the replies. This is definitely a grey area for me as I know it's imperative these children are placed in homes promptly, at times on an urgent basis. Moving forward I am going to have to trust my gut, and if I feel someone is not giving me the full story or a more thorough clinical workup is warranted, then I will not be signing any forms. Thanks again!

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Really? You guys can't do a physical exam on a patient and determine if they are healthy or not? Good ***

1) Full history and physical exam. Subjective is subjective. It's what the patient or family tells you. Objective is objective. It is what you see. Assessment is assessment. It is what you think. Plan is Plan. It is what you intend to do.

2) Follow up any suspicions with the proper place. Abuse and neglect - foster care agency. Medical issues - order testing as needed.

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Specializes in Nephrology, Cardiology, ER, ICU.

In my area, its frequently the ER that does the emergent foster care physicals as it would take too long to get an appt with a PCP.

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Specializes in Emergency.
In my area, its frequently the ER that does the emergent foster care physicals as it would take too long to get an appt with a PCP.

Seriously? I'm not questioning that it would take a while to get into your PCP, that can take quite a while here too. But the ED?! I would have expected retail, walk-in clinic, or even UC. I know most of my ED colleagues would be very frustrated to have to do a complete physical (I assume they are complete) and fill out significant amounts of government forms as if this is an emergent condition.

Do the ED providers also do DOT physicals in your area?

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Specializes in Nephrology, Cardiology, ER, ICU.

No DOT physicals. However, for foster care physicals, they all involved emergency placements where the parents were SUDDENLY unable to care for their kids, the kids were in IMMINENT danger or something else that was an EMERGENCY.

So....our physicals were always done outside of office hours.

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Specializes in Family Practice/Urgent Care.
Really? You guys can't do a physical exam on a patient and determine if they are healthy or not? Good ***

1) Full history and physical exam. Subjective is subjective. It's what the patient or family tells you. Objective is objective. It is what you see. Assessment is assessment. It is what you think. Plan is Plan. It is what you intend to do.

2) Follow up any suspicions with the proper place. Abuse and neglect - foster care agency. Medical issues - order testing as needed.

Really? Thank you for the quick recap of my first assessment class ever. My question was ethical in nature and pertained to what to do if faced with a patient who you felt was not giving the full story in regards to their health history. Not only that, but then being asked to sign a form verifying the patient is mentally and physically fit to serve as a foster parent. We do a lot of this type of work in our clinic and I wanted to see how other providers handled the situation if they were concerned about a new patient. I see you work in hospice-last time I checked hospice NPs don't perform foster or DOT physicals. Keep the condescension to yourself.

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Specializes in Family Practice/Urgent Care.

I'll also add that not all foster parents go into it for the right reasons, hence my concern.

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Really? Thank you for the quick recap of my first assessment class ever. My question was ethical in nature and pertained to what to do if faced with a patient who you felt was not giving the full story in regards to their health history. Not only that, but then being asked to sign a form verifying the patient is mentally and physically fit to serve as a foster parent. We do a lot of this type of work in our clinic and I wanted to see how other providers handled the situation if they were concerned about a new patient. I see you work in hospice-last time I checked hospice NPs don't perform foster or DOT physicals. Keep the condescension to yourself.

agreed. In addition to a physical exam, there are questions about mental fitness and treatment compliance on the forms in my state. I can't possibly certify those things without an established patient relationship. The last thing a foster kid needs is ANOTHER crappy parent. I try to paperwork ethically.

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Specializes in Emergency.
No DOT physicals. However, for foster care physicals, they all involved emergency placements where the parents were SUDDENLY unable to care for their kids, the kids were in IMMINENT danger or something else that was an EMERGENCY.

So....our physicals were always done outside of office hours.

Interesting, I have never seen a foster care physical in the ED here, I'm assuming it is different state requirements or something. Thanks for the explanation.

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