By Dr. A. Carbonell
Before seeing the patient
1. Review Labs – Labs tab
2. Review Imaging – Reports => Imaging (Local Only) for CT/MRI/X-ray *Echo/Spirometry will be in Vista*
3. Review Reports => Anatomic Pathology (Biopsy results) and Labs => Microbiology (Cultures)
4. Review Reminders (Alarm Clock upper right-hand corner)
5. Review current days vitals (All BP >140/90 need recheck)
6. Review the last note
Health Maintenance
-colon cancer screen (colonoscopy or FIT if appropriate) – MUST have report from outside to clear reminder
–45 for AA, 40 for +FH < Age 60, 50 All others, FIT cannot be used for rectal bleeding or IDA
-Lung Cancer Screen: Age 55-80, 30 PY history, quit < 15 years ago
-a1C annually
-Lipid Panel annually – calculate ASCVD risk to determine need for statin, all diabetics merit at least moderate
-Vaccinations – reminders will alert which are indicated
-ASA: F>65 yo; M>50 yo if indicated (CAD, multiple risk factors for CAD or CVA)
MEN
-prostate cancer screen: PSA age 55-69, DRE if elevated
-AAA screen: M age 65-75 who ever smoked
WOMEN
-Pap Smear: Every 3 years from 21 to 29, Every 5 years with co-testing for HPV for ages 30 to 65
-Breast cancer screen: Yearly starting between age 40-50 depending upon patient preference, FH
-DEXA Scan: Age 65+
ANNUAL LABS OPTIONAL LABS DIABETICS RENAL LABS
CBC
CMP
A1c
Lipid Panel
+/- PSA if indicated TSH
B12/Folate/Iron/
Ferritin/Retic if anemic
Hep C Ab – At least once
HIV – Offer yearly
Vitamin D A1c every 3 months if not controlled, every 6 if controlled
Yearly:
-Microalbumin Panel
-Urinalysis
-A1c
-BMP -CBC/CMP (albumin)
Cystatin C
PTH
Vitamin D
Magnesium
Phosphate
UA
Urine Protein
Urine Creatinine
Urine Microalbumin
DIABETICS
-Yearly Eye Examination with Eye Clinic
-Foot Examination Yearly – Can provide diabetic shoes 1x/year, diabetic socks once every 3 months in PAVE 3
-MEDS:
1. Orals and/or insulin
2. ALL diabetics should be at least on a moderate intensity statin
3. ALL diabetics should be on Ace I or Arb if the BP tolerates
AT CHECK OUT
***PACT PLAN OF CARE NOTE must be completed once a year for every patient***
1. RTC order at appropriate interval
2. Labs for the following year
3. PACT plan of care
4. Renew meds for the year