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1 1/29/2007 Fernald Medical Monitoring Program Sort Code Physician Exam - Recommendation Codes Code Description need primary care MD go to ER if needed follow-up abnormal findings follow-up with primary physician yearly/annual physical routine preventative health care send stool hemocult cards forward medical records have chest x-ray discontinued use of snuff decrease smoking stop smoking continue not to smoke discontinued chewing tobacco limit alcohol intake no alcohol intake alcoholism counseling/rehab/detox decrease caffeine intake decrease cola intake stop use of marijuana/other drugs weight loss weight gain take vitamins avoid Na/Sodium decrease potassium intake avoid lactose use lactaid with milk products high fiber- low fat diet eat regular meals exercise program kegal exercise program decrease isometric, increase aerobic exercise lift carefully and do back exercises calcium supplement watch for signs of infection mumps immunization 48
2 189 MMR tetanus and/ or diptheria update/ repeat flu shot measles immunity update hepatovaccine pneumonia vaccine allergy shots immunizations HIV test TB tine test any drug therapy/ prophylaxis (including antibiotics) OTC (over the counter) meds continue taking medications decrease medication drug therapy for allergies call in proper drug dosage/drug name regular times to take Rx; not PRN decrease medication watch narcotic meds dermatology referral yearly skin exam needs biopsy identify drug causing a reaction discontinue/ change drug causing reaction selsun blue sunscreen/ avoid sun exposure watch for change in mole/skin lesion (report to PMD) decrease tanning bed moisturizing cream for dry skin wear protective gloves/equipment antibacterial soap regular skin exams anti-fungal cream removal of skin tags excision of cyst occusive dressing and ointment for skin lesion stop nail biting opthology consult eye exam continue regular glaucoma checks fill eyewear prescription wear your glasses 97 98
3 300 otology consult audiograml and R ENT referral decrease vigorous nose blowing disimpact ear wax discontinue Q-tip use deep in ear canal ear irrigation wear ear protection for loud noise antibiotics B/A invasive procedure (dental, etc.) dental referral daily dental care orthodontic referral oral biopsy annual cardiac exam cardiology consult follow-up on cardiac murmur EKG halter monitor chest pain consultation HT (hypertension) control stress test aortic ultrasound re-check pulse repeat EKG echocardiogram compare EKG to previous EKG's cardiac rehab re-check blood pressure need better HTN control prudent cholesterol diet get total cholesterol vascular studies repeat fasting lipid update lipid profile lipid control endocrine consult control of diabetes better diabetic control glucose tolerance test repeat blood sugar continue monitoring for diabetes DM (diabetes) control thyroid profile thyroid control sweat chloride test 148
4 repeat LFT (liver function test) check CPK repeat CBC (complete blood count) repeat blood tests no blood or urine frozen for storage per pateint's request PFT reevaluate PFT CT of lungs CT of head MRI cough evaluation nephrology referral chest x-ray CXR after pregnancy increase use of inhaler pulmonary referral annual breast exam biannual breast exam monthly breast exam twice yearly breast exam annual mammogram mammogram every other year repeat mammogram mammogram base ( at age 35) consult expert on breast disease breast biopsy watch breast implants follow-up on breast cysts annual PAP biannual PAP repeat PAP annual pelvic exam return for pelvic examination/ PAP gynecological referral pelvic ultrasound ultrasound of uterus ultrasound of abdomen continued monitoring for abnormal PAP atrophic vaginitis- MD evaluation gynecologist re: irregular menstrual period, vaginal infection 198
5 564 continued monitoring by OB/GYN for endometriosis pap after pregnancy pelvic after pregnancy estrogen replacement determine in utero DES exposure prostate and rectal exam ultrasound and/ or of prostate PSA (prostate specific antigen test) follow-up assessment for prostatic nodularity testicular self exam testicular exam and/ or ultrasound circumsion wear boxer urological evaluation genitourinary evaluation urine repeat analysis barium swallow annual rectal biannual rectal flex sigmoidoscopy colonoscopy sitz bath use laxative, fiber, fluid, metamucil ulcer medication should be taken stool for occult blood yearly gastrointestinal consult surgical referral report SXI condition to workplace follow-up with plastic surgeon have stitches removed follow-up on hernia orthopedic consult periodic evaluation bone spur physical therapy x-rays of problem joints podiatry reference daily foot inspection/ care arch supports elevate extremities wear support stockings 248
6 983 ambulatory aid (cane, walker) rheumatology referral consultation for neck pain consultation for back pain notify MD of any neurological changes neurology consult consultation for dizziness electromyelogram needed discuss migraine diagnosis and therapies with MD Sleep apnea consult sleep on back sleep studies oncology consult internal medicine consult serologic evaluation hematology consult repeat blood tests HIV tests follow-up lymphadenopathy consultation for depression psychiatric consultation continue to see psychiatrist on a regular basis stress reduction allergy evaluation improve safety habits wear seat belt wear helmet use condom and discretion, re: sexual activity see hearing/speech specialist for speech defect evaluation for learning disorder consider radiotherapy improve posture evalation of scoliosis
7 137 osteoporosis screening bone density studies (DEXA) check for CO leak wear gold post earrings, and use ointment for jewelry allergy warm compresses avoid soaking in H 2 O polio pap test every 3 years don't drink and drive dilute vinehar for ear infection follow-up w/ hysterectomy surgery get more sleep increase humidity in bedroom wear gold post earrings, and use ointment for jewelry allergy allergy evaluation wrist splint 316
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Providence Medical Group To our valued patients: In order to provide you with our full attention when you come for an appointment, we would like to ask you to be aware of the following guidelines. Insurance
More informationMedicare Preventive Visit Form Office: Use this form if not using EPIC. Patient Name:
Medicare Preventive Visit Form Office: Use this form if not using EPIC G0402 IPPE G0438 AWV G0439 - subsequent REQUIRED EXAM Patient Name: DETAILS (Include description of all abnormal Body Mass Index Ht.
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