Proxi GUIDE manual
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Evidence

Source register

Primary GUIDE, privacy, authority, clinical-design, and medication infrastructure sources.

Active registerSource: 09_Source_Register.md

Status: Semantic source register

Source-record contract#

Every source used by a rule or SOP must have a stable source ID, title/version, locator, authority classification, exact relied-on sections, verification date, and any limitation. A public source can support a public requirement; it cannot substitute for a missing executed agreement or resolve a participant-specific operating choice.

Primary GUIDE sources#

Source IDTitle/versionRelied-on sectionsAuthority/statusVerifiedReview
SRC-CMS-GUIDE-RFA-V1CMS GUIDE Request for ApplicationsCare Team Requirements and Care Navigator Training at PDF pp. 25-27; Appendix B 1.1-1.3, 2.1-2.4, 3.1-4.4, 5.1-5.5, 6.1-6.4, 7.1-7.5, 8.1-8.5Primary public CMS source; supports beneficiary leadership, care-team composition, dementia-proficient clinician, human care navigator, navigator training, home visits, no-caregiver safeguards, minimum contact frequency, care-plan content/sharing, 24/7 human access, clinical consultation, coordination, medication, and caregiver-service obligations. Section 7.1 places prescribing-authority reconciliation at the initial assessment, future assessments, and periodic reviews requested by the care team, beneficiary, or caregiver as appropriate; it does not create a monthly reconciliation requirement. Appendix B 2.1-2.4 requires beneficiary-led care-plan content, revision, EHR incorporation, and sharing, but does not expressly require a generic whole-plan RN co-signature; that absence does not settle any additional executed-agreement, state-law, or Participant-policy requirement. CMS specifies frequencies and qualifications but not contact minutes. It does not establish this project's P0 taxonomy, exact US emergency-routing design, operational retry limits, staffing geography, caseload, or route-specific evidence standards2026-07-14
SRC-CMS-GUIDE-FAQCMS GUIDE Frequently Asked Questions, current pagePatients and Caregivers Q4 and Q8; Care Delivery Requirements Q12-Q13; Partner Organizations Q14Primary current CMS explanatory source; supports current RCC/memory-care eligibility and approved-partnership context beginning July 1, 2026; the required caregiver-service menu; caregiver choice; and virtual delivery. It does not prescribe training minutes, a quiz, a synchronous instructor for every topic, or AI-only completion. Subordinate to controlling law, current model documents, and the executed agreement2026-07-12
SRC-CMS-GUIDE-PMP-3.0CMS GUIDE Payment Methodology Paper v3.0, effective June 1, 20261.4.2, 2.4-2.9, 2.10-2.13.1, Exhibit 5, Exhibit 8, 3.1, Exhibit 9, Appendix KPrimary current public CMS methodology; supports care-team and Partner Organization approval/arrangement/documentation context; suspected-dementia assessment and roster-clinician attestation; current eligibility/residence and RCC tier definitions; preliminary versus final alignment; annual-assessment timing; the one-actual-non-respite-service monthly DCMP floor; tier contact overlays; non-contact service in a cadence-current off-contact month; infrastructure exclusion; the eight-consecutive-claimless-month unalignment condition; PY2026 residence-transition periods; and current billing requirements. It does not specify labor minutes, a minimum number of monthly service domains, caseload, or AI-only caregiver-training acceptance2026-07-13
SRC-CMS-GUIDE-PMMCMS GUIDE Performance Measurement Manual, current public version2.3 and Appendix C only for the current claims-based DAE measure; any other use must name the exact sectionPrimary public CMS measurement source. The DAE measure concerns patterns of specified high-risk medication fills; it is not an individual treatment, prescribing, or deprescribing protocol. No project rule may cite this source generically2026-07-11
SRC-GUIDE-PA-PY2026Acquired participant's executed PY2026 Amended and Restated GUIDE Participation Agreement and appendicesAll participant-specific termsControlling participant document; BLOCKED -- not present. See O-PA-001Not verified

Interoperability and privacy#

Source IDTitle/versionRelied-on useAuthority/statusVerifiedReview
SRC-TEFCA-TREATMENT-1.2TEFCA Exchange Purpose Implementation: Treatment v1.2Exchange-purpose and transport/channel implementation contextInteroperability guidance; does not decide who belongs on a care-plan recipient manifest or what satisfies distribution2026-07-11
SRC-TEFCA-EP-5.0TEFCA Exchange Purposes v5.0Exchange-purpose definitionsInteroperability guidance; not a substitute for privacy, consent, state-law, or executed-PA review2026-07-11
SRC-HHS-HIPAA-TPOHHS Uses and Disclosures for Treatment, Payment, and Health Care OperationsTreatment-disclosure and minimum-necessary distinctionPrimary federal guidance. The HIPAA minimum-necessary standard does not apply to provider-to-provider treatment disclosures; any narrower Care Plan payload is an internal data-minimization policy or another applicable legal/contractual requirement2026-07-11
SRC-HHS-HIPAA-MIN-NECHHS Minimum Necessary RequirementRoutine-versus-non-routine disclosure review design onlyPrimary federal guidance. Standard protocols may govern qualifying routine and recurring disclosures, while non-routine disclosures subject to the minimum-necessary requirement use individual review under established criteria. This does not itself authorize any disclosure or displace treatment exceptions, special-category rules, state law, beneficiary restrictions, contracts, the executed Participation Agreement, or participant policy2026-07-12
SRC-HHS-PART2-2024HHS 42 CFR Part 2 Final Rule fact sheetPart 2 issue identification onlyPrimary federal summary; a fact sheet does not replace case-specific Part 2/privacy analysis2026-07-11
SRC-HHS-TELEHEALTH-LICENSUREHHS Licensing Across State LinesBeneficiary-location licensure and available cross-jurisdiction authorization pathsPrimary current federal explanatory guidance. U.S.-based location does not itself establish authority to practice a licensed profession where the beneficiary is located2026-07-12
SRC-HHS-OVERSEAS-EPHIHHS Overseas ePHI FAQOffshore ePHI geography and risk-analysis boundaryPrimary federal guidance. HIPAA has no separate geographic prohibition, but overseas processing/storage may increase risk and requires appropriate BAA, risk analysis, risk management, and safeguards. This does not approve offshore GUIDE service delivery2026-07-12
SRC-HHS-AUDIO-TELEHEALTH-2026HHS OCR Guidance on Audio-Only Telehealth, content reviewed June 23, 2026Telephone/VoIP privacy and security analysis; conduit versus business-associate boundary; recordings, transcripts, and translationPrimary federal guidance. A transmission-only provider with only transient PHI access may be a conduit, but an app/vendor that creates, receives, maintains, records, transcribes, or translates PHI is more than a conduit and requires a BAA when used on behalf of a covered entity. It supports vendor/retention/security controls; it does not itself authorize a call, recording, AI participation, offshore processing, GUIDE service, or clinical act2026-07-14
SRC-FCC-AI-VOICE-24-17FCC Declaratory Ruling FCC 24-17, released February 8, 2024TCPA treatment of outbound AI-generated/artificial voicePrimary federal ruling. AI-generated human voice falls within the TCPA's artificial/prerecorded-voice restrictions; prior express consent is required absent an emergency purpose or exemption. The ruling also identifies initiating-entity disclosure requirements and applicable telemarketing opt-out requirements. It does not establish that a proposed Proxi call fits an exemption, settle all federal/state calling rules, or authorize PHI disclosure2026-07-14
SRC-CA-PEN-632California Penal Code section 632Example state all-party rule for covered confidential communications and electronic eavesdropping/recordingPrimary state statute. Use only as a legal-review trigger; application depends on facts, location, communication type, expectations, exceptions, and current law. It supports the conservative national all-participant-disclosure/permission design but does not itself create a universal national rule2026-07-14
SRC-FL-934-03Florida Statutes section 934.03Example state all-party prior-consent rule for covered interceptionPrimary state statute. Use only as a legal-review trigger subject to facts and exceptions. It supports a conservative national operating path; it is not a universal legal conclusion2026-07-14
SRC-WA-RCW-9-73-030Washington RCW 9.73.030Example state all-participant rule for covered private communications/conversations and announced recording/transmissionPrimary state statute. Use only as a legal-review trigger subject to facts and exceptions. It supports disclosed permission before AI transmits/listens/records; it does not settle every call configuration2026-07-14
SRC-ONC-TEFCA-2026ONC TEFCA overview and ONC connection overview, updated June 5, 2026Nationwide-exchange capability, exchange-purpose assertion, and Participant/Subparticipant connection pathPrimary federal program guidance. TEFCA can support treatment, payment, health-care-operations, public-health, government-benefits, and individual-access requests; each request asserts a purpose, and organizations connect through a QHIN or connected network/technology provider after agreement, directory, technical, and compliance onboarding. It is not an unrestricted or automatically complete GUIDE data feed2026-07-14
SRC-CMS-ADT-COPCMS ADT Patient Event Notification FAQEvent-time ED/inpatient admission, discharge, and transfer triggers; established or patient-identified responsible recipient routesPrimary CMS implementation guidance. Applicable hospitals may send event notifications directly or through an intermediary to an established PCP/practice, patient-identified responsible practitioner/entity, and other qualifying recipients for treatment, care coordination, or quality improvement, subject to identity and privacy conditions. An ADT event is a trigger and minimal notification, not a discharge record, diagnosis, medication reconciliation, or completed transition2026-07-14

Beneficiary-authorized payer, claims, and provider-discovery data#

Source IDTitle/versionRelied-on useAuthority/statusVerifiedReview
SRC-NC-MEDICAID-PCP-ASSIGNMENTNC Medicaid: Enrollee Report Updates for Primary Care Practices, current pageOfficial state example of Medicaid PCP assignment data containing provider name, NPI or atypical ID, assigned practice location, enrollment dates, assignment effective date, and active statusPrimary state Medicaid operational source. It directly supports the administrative assignment recorded by NC Medicaid at the practice-location level; it does not establish the beneficiary-identified PCP, an actual current treatment relationship, GUIDE-team membership, or national Medicaid availability. Other states and MCOs require source-specific verification2026-07-12
SRC-CMS-PATIENT-ACCESS-APICMS Patient Access API FAQ, current pageBeneficiary-authorized access through a chosen application to claims, encounters, and clinical data maintained by impacted MA, Medicaid, CHIP, and FFE payersPrimary federal implementation guidance. It supports payer-specific candidate discovery and dated utilization, not a central Medicaid lookup or a universally required beneficiary-to-individual-PCP field. Payer data can corroborate a treating relationship but does not by itself establish the current PCP, GUIDE-team membership, or a clinical endpoint2026-07-12
SRC-CMS-PROVIDER-DIRECTORY-APICMS Provider Directory API FAQ, current pagePublic payer network data including contracted provider name, address, phone, and specialtyPrimary federal implementation guidance. Directory data supports provider discovery and routing candidates; it does not establish member assignment, a treatment relationship, GUIDE-team membership, disclosure authority, or that a listed endpoint accepts a GUIDE notice or care plan2026-07-12
SRC-CMS-NPI-FACT-SHEETCMS NPI Fact Sheet, December 2024NPI/NPPES identity normalization for individual and organization healthcare providersPrimary CMS identity source. An NPI is an identifier; CMS states that having one does not ensure licensure or credentialing, guarantee payment, or enroll the provider in a health plan. It also does not establish a beneficiary relationship, PCP assignment, current practice location, GUIDE-team membership, or a usable clinical endpoint2026-07-12
SRC-CMS-BLUE-BUTTONCMS Blue Button 2.0 API, current pageBeneficiary-authorized Medicare Parts A, B, and D claims data, including dated primary-care treatment and prescription activityPrimary CMS API source. It supports Medicare utilization and provider-candidate discovery; it is not Medicaid data and does not provide an authoritative current-PCP designation, beneficiary preference, GUIDE-team membership, current medication use, or a clinical routing endpoint2026-07-12
SRC-CMS-HETS-13-0CMS HETS 270/271 Companion Guide v13.0, July 2025Real-time Medicare eligibility inquiry and returned A/B, MA, Part D, MSP, QMB, hospice, hospital/SNF, and selected benefit informationPrimary CMS transaction guide. Access requires an authorized trading partner, Medicare-provider relationship/NPI predicates, registration/testing, production approval, and Medicare-business use. Data is refreshed once daily early each Eastern morning and is true/accurate only at transaction time; it is not GUIDE alignment, a current-PCP lookup, a guarantee of payment, or a current clinical record2026-07-14
SRC-CMS-PROVIDER-ACCESS-2027CMS Interoperability and Prior Authorization Final Rule fact sheet2027 payer Provider Access API and expanded Patient Access API design horizonPrimary CMS final-rule summary. Beginning with applicable 2027 compliance dates, impacted payers must support specified APIs; Provider Access is for in-network/enrolled providers with a treatment relationship and patient opt-out, and includes claims/encounters, USCDI data, and certain non-drug prior-authorization information. It does not establish current Proxi entitlement, universal payer participation, or drug-PA access2026-07-14

Workforce geography and professional authority#

Source IDTitle/versionRelied-on useAuthority/statusVerifiedReview
SRC-NLC-CURRENT-MAPNurse Licensure Compact Current MapCurrent participating-jurisdiction checkOfficial NLC source. Puerto Rico is not listed as an NLC jurisdiction; absence does not replace a current board verification for a specific nurse2026-07-12
SRC-PR-NURSING-BOARDPuerto Rico Board of Nurse ExaminersPuerto Rico nursing regulation and licensing authorityPrimary Puerto Rico government source2026-07-12
SRC-PR-TELEHEALTHPuerto Rico Telemedicine and Telesalud Practice and CertificationPuerto Rico health-professional telehealth authority and certificationPrimary Puerto Rico government source. It governs practice in Puerto Rico and does not create nationwide professional authority2026-07-12
SRC-USA-TERRITORIESUSAGov: Visiting U.S. territoriesPuerto Rico's status as a U.S. territoryOfficial U.S. government explanatory source; territory status does not itself establish professional authority outside Puerto Rico2026-07-12
SRC-HIPAA-STATE-DEFINITION45 CFR 160.103 definition of StateHIPAA definition that includes the Commonwealth of Puerto RicoPrimary regulatory text for HIPAA terminology only; it does not collapse distinct professional-licensing jurisdictions2026-07-12
SRC-ALZ-DCN-TRAININGAlzheimer’s Association Dementia Care Navigation TrainingOfficial program title, audience, curriculum, GUIDE-training claim, price, credential wording, and two-year certification termPrimary issuer source. The official credential is essentiALZ® certification for dementia care navigation. It recognizes dementia-navigation knowledge but does not create professional licensure, clinical authority, or Medicare billing eligibility2026-07-12
SRC-ALZ-DCN-OBJECTIVESAlzheimer’s Association Dementia Care Navigation Training Learning ObjectivesPerson-centered care, navigation, ADLs, behavior/communication, safety, abuse/neglect, planning, caregiver well-being, assessment/care planning, transitions/coordination, and cultural-competency curriculumPrimary issuer curriculum source. Training scope supports broad nonclinical navigation but does not establish authorization for diagnosis, treatment, prescribing, nursing, social work, medication reconciliation, or other licensed acts2026-07-12

Clinical operating design guidance#

Source IDSourceIntended use and limitationVerifiedReview
SRC-AHRQ-RED-2025AHRQ Re-Engineered Discharge overview, delivery guidance, and postdischarge follow-up Tool 5, Tool 5 last reviewed March 2025Patient-safety design support for transition packets, medication and appointment review, pending results, equipment/home services, problem-contact plans, accessible instruction, teach-back, and proposed 48-to-72-hour recovery contact. Hospital discharge guidance, not a GUIDE mandate, universal clinical protocol, or substitute for the discharging/treating clinician2026-07-12
SRC-AHRQ-IDEALAHRQ IDEAL Discharge Planning, content last reviewed December 2017Patient/family-engagement design support for discussing home life, medications, warning signs, test results, follow-up appointments, plain-language education, teach-back, and beneficiary/family goals. Not a GUIDE requirement or current prescribing standard2026-07-12
SRC-AHRQ-TEACH-BACK-3EAHRQ Health Literacy Universal Precautions Toolkit, 3rd Edition, Tool 5, current public versionDesign support for non-shaming teach-back/plan-back and show-me checks, correction, and repeat explanationPrimary federal patient-safety/health-literacy guidance. Teach-back checks whether the educator explained clearly; it is not a quiz or memory test. It supports Proxi's focused caregiver application touchpoint but is not a CMS GUIDE completion mandate and does not establish clinical authority

Ambulatory clinic procedure-design references#

These sources shape procedure language and closed-loop operating design. They do not create GUIDE requirements, settle Proxi workforce authority, or replace the controlling source order in README.md.

Source IDSourceAdopted drafting or operating patternLimitationVerifiedReview
SRC-AHRQ-AMB-LABAHRQ Improving Your Laboratory Testing Process, step-by-step ambulatory toolkit; last reviewed January 2018Map the office process from order through result notification and follow-up; pair each real performer with an observable action; assess, improve, implement, and reassess. The revised toolkit was pilot-tested in a small internal-medicine practice and a family-medicine residency practiceAmbulatory quality-improvement design, not a current clinical protocol, GUIDE rule, or delegation authority2026-07-14
SRC-AHRQ-HL-UPT6AHRQ Follow Up with Patients: Tool 6, last reviewed February 2024State the reason for follow-up, assign the responsible staff by purpose, honor contact preference, schedule and track the work, and record what the contact achievedPrimary-care health-literacy guidance; its example staff assignments and clinical thresholds are not automatically Proxi policy2026-07-14
SRC-AHRQ-HL-UPT21AHRQ Make Referrals Easy: Tool 21, last reviewed April 2024Explain why the referral matters; ask whether scheduling help is wanted; address barriers; provide written instructions; confirm understanding; track completion; obtain the returned result; follow up when incompletePrimary-care referral guidance, not a GUIDE completion rule or blanket authorization to disclose information2026-07-14
SRC-CDC-OUTPATIENT-CHECKLISTCDC Infection Prevention Checklist for Outpatient Settings, version 2.3Tailor procedures to services actually performed; identify not-applicable work; use observable assessment items; require job-specific competency; record gaps and corrective actionInfection-prevention checklist, not a GUIDE clinical protocol. The document version is older, so current underlying clinical guidance must be verified before clinical use2026-07-14
SRC-ONC-SAFER-2025ASTP/ONC 2025 SAFER GuidesPrioritize common high-risk failures; name individual and organizational responsibilities; separate clinical communication, test-result follow-up, patient identification, contingency, and system-management controls; use self-assessment for improvementRecommended health-IT safety practices, not law or automatic conformance evidence2026-07-14
SRC-HRSA-QIQA-CH10HRSA Health Center Program Compliance Manual, Chapter 10: Quality Improvement/AssuranceSeparate authority, requirements, demonstrating compliance, and related considerations; designate responsibility; implement operating procedures; monitor outcomes; update procedures when change is requiredApplies to HRSA Health Center Program compliance, not GUIDE. Proxi adopts the document-structure pattern only unless another source independently controls the substance2026-07-14

Medication and claims infrastructure#

Source IDSourceIntended use and limitationReview
SRC-SURESCRIPTS-MHASurescripts Medication History for AmbulatoryProduct capability/procurement evidence, not clinical ground truth or authority
SRC-SURESCRIPTS-MHPSurescripts Medication History for PopulationsProduct capability/procurement evidence, subject to O-007
SRC-CMS-EPCSCMS Electronic Prescribing for Controlled Substances ProgramEPCS program context only; cite exact rule when relied on
SRC-CMS-EPRESCRIBING-STANDARDSCMS E-Prescribing Standards and Requirements, current pageRelied-on use: NCPDP SCRIPT, formulary/benefit, real-time prescription benefit, medication-history, and ePA transaction context. Primary CMS standards summary; it does not prove network or product access, dispensing, possession, actual use, reconciliation, prescribing-clinician agreement, or clinical appropriateness. Verified 2026-07-14.
SRC-AHRQ-MATCH-2022AHRQ MATCH Toolkit, Chapter 3 process design, and Chapter 7 high-risk situations, chapters last reviewed July 2022Patient-safety design support for a shared intended medication list, defined multidisciplinary roles, source verification, medication-by-medication comparison, prescriber discrepancy resolution, patient/caregiver participation, transition reconciliation, clear communication, and teach-back for cognitive or health-literacy risk. Not a GUIDE mandate, current drug-specific clinical rule set, participant-specific policy, or substitute for prescribing authority
SRC-HL7-FHIR-MED-R5HL7 FHIR MedicationRequest boundaries and related medication resources, FHIR R5Interoperability-semantic distinction among medication request/order, dispense/supply, administration, and reported medication statement. Does not prove clinical truth, authority, ingestion, or select the eventual US implementation profile/version
SRC-NLM-RXNORMNLM RxNorm OverviewNormalized drug names and identifiers across terminologies. Does not establish therapeutic equivalence, interaction, appropriateness, regimen status, or complete coverage of supplements/natural products; ambiguous/out-of-scope content remains unresolved
SRC-FDA-AEMS-2026FDA Adverse Event Monitoring System data limitations, current as of March 11, 2026Supports the boundary that a report or temporal association does not establish product causation and may be duplicate, incomplete, or unverified. Does not define ProxI urgency, diagnosis, treatment, or reporting policy

Controlling-document warning#

The source-of-truth order in README.md applies. The acquired participant's executed Participation Agreement and appendices control where they differ from generalized public material. Any rule dependent on nonpublic or participant-specific terms remains PROVISIONAL or BLOCKED until SRC-GUIDE-PA-PY2026 is obtained, verified, and linked to a recorded decision.