5000, Clinical Guidelines

Revision 23-2; Effective Sept. 15, 2023

This section describes the requirements and recommendations for grantees pertaining to the delivery of direct HHSC PHC clinical services to clients. In addition to the requirements and recommendations found within this section, grantees must develop protocols consistent with national evidence-based guidelines appropriate to the target population.

All providers must offer the following six priority primary health care services on-site or by referral:

  • Diagnosis and treatment of common acute and chronic diseases affecting the general health of the client, including:
    • initial contact with a client for an undiagnosed health concern; and
    • continuing care of varied medical conditions not limited by cause or organ system.
  • Emergency Medical Services must be for the urgent care of an unexpected health condition requiring immediate attention as determined by the appropriate medical staff. Services must be those that can be treated in a primary care clinic or setting.
  • Family Planning Services - preventive health and medical services that assist a person in controlling fertility and achieving optimal reproductive and general health, including:
    • health check-up and physical exam;
    • birth control methods including pills, IUD, condoms, shot, and ring;
    • natural family planning;
    • lab tests for:
      • sexually transmitted infections (STIs);
      • pregnancy testing;
    • counseling regarding:
      • abstinence;
      • preconception; 
      • nutrition; and
      • infertility.
  • Preventive Health Services may include:
    • immunizations;
    • cancer screenings;
    • screenings for chronic conditions; and
    • health screenings to determine the need for intervention and possibly more comprehensive evaluation.
  • Health Education includes planned learning experiences based on sound theories that provide individuals, groups and communities the opportunity to increase knowledge, and skills needed to make healthy decisions
  • Diagnostic Laboratory and Radiological Services
    • These services must be medically necessary. They are technical laboratory and radiological services ordered and provided by, or under the direction of, a physician in an office or a facility other than a hospital inpatient setting.

Grantees are strongly encouraged to visit the U.S. Preventive Services Task Force website for additional guidance on preventive services.