Clinical Guidelines


CHDP and many health plans including Blue Cross and SFHP have different periodicity for well checks for children and adolescents. The San Francisco Health Plan recommends an annual well child exam between ages 2-20, consistent with recommendations from the American Academy of Pediatrics.

SFHP’s clinical practice guidelines and patient education tools for the management of patients with diabetes have been approved by SFHP’s Physician Advisory and Quality Improvement and Pharmacy and Therapeutics Committees.

Other Useful Clinical Guidelines:

Medical Necessity Criteria

SFHP determines medical necessity using InterQual and other nationally recognized evidence-based criteria. In addition, we develop our own criteria for specific situations. The following criteria are updated and approved by the SFHP Quality Improvement Committee. If you have any questions, please call (415) 547-7818 ext 7080.

The following guidelines are used to determine authorization status for UCSF members and out-of-network referrals for the Community Health Network (CHN) medical group only. These guidelines apply to Medi-Cal, Healthy Workers, and Healthy Kids: