By Dr. A. Carbonell
1. Click on the Consults tab on the left-hand side of the screen under orders
2. To place a general consult, click on the MAIN CONSULT MENU and it will just pull up the dialogue box to search everything.
3. You can type whatever specialty you want and make sure to select the outpatient consult not the inpatient consult.
4. Fill in the reason, the date (tomorrow should be the earliest date that would be appropriate, but things can be scheduled up to one year ahead of time (I.e. GI consult for Repeat colonoscopy due 6 months from now would have the appropriate date t+6M, etc.) and Provisional Diagnosis if required
a. Using the appropriate Clinically Indicated Date is important for scheduling purposes
GENERAL POINTERS
1. GI - You MUST fill the template (the patient can call and self-schedule if they have been seen within the past 2 years, they have to be willing to go to Tampa (or state that they would like fee basis), you also have to make them aware that they will need a driver for the colonoscopy and must be willing to drink the prep). It is easy to fee base if the patient prefers the colonoscopy in community, just put in the consult that you want it fee based, and the GI doctor will order it.
2. Anticoagulation Clinic - For ALL AC patients (warfarin, DOACS) an Anticoagulation clinic consult can be placed so that a pharmacist can do the monitoring of labs, etc. Please be sure to include the indication for AC, duration of therapy and preferred method of AC
3. NIVS Consults - NIVS. all dopplers are ordered with this menu – CP NIVS OUTPATIENT PROCEDURE: arterial, venous and carotid dopplers. Please be sure to use the menu on the right (CP NIVs Future care Outpt procedures) for anything more than 3 months away and change the clinically indicated date to the appropriate date or your consult will be cancelled.
4. Cardiology Consults and non-invasive procedures - this menu has your cardiology diagnostic procedures, Arrythmia clinic, etc. Echo’s, Stress Test, Holter, Event monitors are all ordered via this menu
**Consults Cardiology risk assessment, this consult is used for preop clearance. PCPs are not expected to do preop clearance
5. Obtaining outside Pathology - First must complete an iMed Consent (need to know name, address, fax and phone number where you are requesting pathology from). Then after that is in the chart place a “ROI consult for diagnostic materials” which will again ask you for the information, ROI will then request the materials you would like
6. Community Care ER consults - Community Care-Emergency department. This consult must be placed every time you send a patient from clinic via ambulance to an emergency department that is local and NOT JAHVA
7. Pain Clinic Pain (RMS/neurology) outpatient – these are PM&R/Anesthesia doctors that do the interventions – so these doctors do Botox for headaches, RFA, epidurals – for this they ALWAYS need a UDS before referral. Patient needs 14 or more HA days per month to qualify for Botox for migraines. For any intervention other than Botox they need CT or MRI, MRI preferable within the last 2 years of the area (C spine or L spine for ESI injections)
8. Non-Formulary drugs - Consults PADR(pharmacy prior authorization drug request) – this is the consult that must be placed for any nonformulary drugs (this indicates why you are requesting this medication)
9. PT, OT, EMG, Consults - RMS Consults: this is where you order PT, OT, EMG, Cardiac rehab, voc rehab, pool therapy, driver training
10. Neurosurgery - Must have MRI within the past 2 years prior to consultation. Most are converted to E-consults and they will schedule in clinic if they believe surgery is indicated but if not, they will respond letting you know that they do not feel surgery would benefit the patient and then defer to you for PT, pain management, etc. to deal with the patient’s complaint.
11. Sleep Study - If patient needs a sleep study (never had one or does not have a copy of the prior) you will need to place a “Sleep Studies Outpatient Clinic” consult – please complete the questionnaire and they will schedule the patient for a sleep study – of note most are completed at home and the patient will have to go to Tampa to obtain the equipment the complete the study at home and return the equipment to JAHVA
*** “Sleep E-consult” is to be used if the patient has a sleep study (physical report) from an outside doctor and wants equipment from the VA. This is also used if you have a question for the pulmonologist or would like the patient scheduled in the Sleep Clinic for complex sleep disorders (insomnia, narcolepsy)
*** “Respiratory Care CPAP/BiPAP outpatient” Is used if the patient just needs replacement tubing, machine or would like to try a different mask
12. Audiology Self-Schedule – No consult needed, the easiest thing is to have the phone number in your PACT Plan of Care so that the patient can self-Schedule
13. Eye Clinic Self-Schedule – No consult needed, the easiest thing is to have the phone number in your PACT Plan of Care so that the patient can self-Schedule – you can place a consult though if you would like them to be evaluated for fee basis in the community
14. Telederm (Available at the PCA) “Telederm request outpatient” – Describe the lesion and send the patient to the telederm reader. Pictures will be taken of the lesion and sent to the dermatologist for review, they will then make recommendations and will tag U with the medications they recommend, or they will tag their staff to make an appointment if they would like to see the person in their clinic
15. Pharmacy - Your team pharmacist can assist you with diabetes and hypertension medication management
16. Orthopedics - They always need an x-ray of the area prior to consult being placed
E-Consults
• Every specialty has this – they will NOT schedule a face to face, they will review the chart and make recommendations. This is incredibly useful when you want guidance on a finding, but the patient does not need to be seen i.e. hematology for persistent leukocytosis, pulmonary nodule E-consult for nodule surveillance.
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LAKELAND SPECIFIC CONSULTS - Lakeland Specialists available to you as a Lakeland PCP
• Rheumatology – Rheumatology Lakeland - Outpatient
• Podiatry – Lakeland Podiatry – Outpatient
• Pharmacy – Pharmacy General Consult – this can be used for diabetes management, blood pressure management, medication reconciliation
• Telederm – Tele dermatology request Lakeland Outpatient
• Hepatitis C Treatment – We have an infectious disease Doctor in Lakeland who does this so if they have hepatitis C with positive viral load and are a candidate for treatment. Infectious disease consults and specify for Hepatitis C treatment.
• Joint Injections - If a patient only need a joint injection and not a full eval with orthopedics for joint injections you can use an MSK consult. The Title for the Lakeland MSK clinic is LAK-MSK – OUTPT, the patient needs X-rays of the affected joint within the year and all patients with history of joint replacements should be sent to orthopedics for their injections.