Adult Respirology. A request may be completed if a patient has any of the following conditions and meets additional criteria:
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1 Referring - Adult Respirology Adult Respirology This service will be provided by Dr. Martha Anslie, Respirologist, at the Health Sciences Centre using the MBTelehealth econsult (Store and Forward) application. Dr. Ainslie may provide a diagnosis and treatment plan based on relevant history, physical findings and diagnostic investigations. This service is available to adult patients only for the management of non-urgent respiratory illnesses including, but not limited to tuberculosis, chronic obstructive pulmonary disorder, asthma, and concerns about lung nodules or abnormal lung imaging. A request may be completed if a patient has any of the following conditions and meets additional criteria: Any respiratory illness/condition - including but not limited to; tuberculosis, chronic obstructive pulmonary disorder, asthma, and concerns about lung nodules or abnormal lung imaging x Pediatric patients x Pulmonary hypertension Attachment Most recent chest X-ray either via PACS or a digital picture of the X-ray Spirometry/PFT s (if available) CT-scan (if available) Blood work (LFT s, CBC if available) Sputum AFB (if available for TB referrals) DOTS record (if available for TB referrals) rev 30Jan2018
2 Referring - Dermatology Dermatology You MUST provide a valid PHIN and Provincial Health Number before submitting a referral. econsult (Store and Forward) is NOT appropriate if the patient does not have a valid PHIN or Provincial Health Number. If a valid PHIN or Provincial Health Number is not available you must follow the referral process for a face to face specialist appointment. Dr. Hurst x Scalp (unless bald) x Genitals x Full body rash Exclusions Dr. Keddy-Grant x Scalp (unless bald) Photograph There are three photos required per area involved: 1 Anatomic part image Shows the anatomic part involved. (e.g. from arm to hand) 2 Close up image As close to having the affected area fill the frame as possible. (e.g. the forearm with the affected area) 3 Close up 45 degree image Fills the frame at 45 degrees. (e.g. 45 degree image of the forearm showing the height of the affected area ) Photo Management The photos will be taken with an approved digital camera and then uploaded to the econsult (Store and Forward) referral via the USB cable provided with the camera. Once the photos are uploaded a short description of each image should be provided. This helps to identify the image for the specialist. Please delete all pictures from the camera following submission of the referral. Additional Attachment Additional attachments (other than images) can also be added to the econsult (Store and Forward) referral when required. These attachments are added in the same manner as images. The user should double check that the attachments open properly and the images are suitable within the MBT scheduling system before sending notification of the new referral to the specialist. There is no maximum number of attachments for a referral but only 3 attachments can be added to a referral at the same time. Click here to view the econsult Reference Guide. rev 30Jan2018
3 Referring - Ear Nose Throat Ear, Nose and Throat This service will be provided by Dr. Bernard Thess and Dr. Michael Gousseau, Otolaryngologists, at the Portage Clinic using the MBTelehealth econsult (Store and Forward) application. Dr. Thess or Dr. Gousseau may provide a diagnosis and treatment plan based on relevant history, physical findings and diagnostic investigations. This service is available to both adult and pediatric patients for the management of specific ear, nose, and throat conditions. A request may be completed if a patient has any of the following conditions and meets additional criteria: Ear infections Hearing loss Tonsillitis Sleep apnea/sleep disordered breathing Facial skin lesions on the ears, nose, face and neck Chronic sinusitis in adults Nasal fracture in adults Ear deformity in patients 16 years of age and under x Swallowing disorders x Hoarseness x Voice disorders x Neck or thyroid mass x Vertigo x Facial trauma Attachment Hearing loss (adult and pediatric): Hearing test results are required. Chronic sinusitis in adults: CT scan results are required. Nasal fracture in adults: Picture 4 days after injury is required. (Full face - frontal view: nose should be pointing directly towards the camera with equal amounts of both sides of the face in the picture.) Ear infection adults: Hearing test results are required. rev 07May2018 Page 1 of 2
4 Referring - Ear Nose Throat Ear deformities pediatric (age 16 years and under): 2 pictures are required. 1. Full face (frontal view) nose should be pointing directly towards the camera with equal amounts of both sides of the face in the picture. 2. Top of head hair should be pulled back so that the ears are visible. 1 2 Lesion removal adults: Previous pathology if applicable and 2 pictures are required Anatomical image showing the anatomical part involved (face, neck or ear). 2. A close up image - as close to having the lesion fill the frame as possible. Sleep apnea in adults: Picture of inside of the patient s mouth and a sleep study result are required. rev 07May2018 Page 2 of 2
5 Referring - Infectious Diseases Infectious Diseases This service will be provided by Dr. John Embil, Infectious Diseases Specialist, at the Health Sciences Centre using the MBTelehealth econsult (Store and Forward) application. Dr. Embil may provide a diagnosis and treatment plan based on relevant history, physical findings and diagnostic investigations. This service is available to adult patients for the management of non-urgent infectious diseases including, but not limited to; abscesses, infections, pressure ulcers and lesions. Adult patients only Any infectious diseases illness/condition - including but not limited to; abscesses, infections, pressure ulcers and lesions x Pediatric patients Attachment There are three photos required per area involved: 1 Anatomic part image Shows the anatomic part involved. (e.g. from arm to hand) 2 Close up image As close to having the affected area fill the frame as possible. (e.g. the forearm with the affected area) 3 Close up 45 degree image Fills the frame at 45 degrees. (e.g. 45 degree image of the forearm showing the height of the affected area ) 17Jan2018
6 Referring - Nephrology Nephrology (St. Boniface Hospital and Seven Oaks General Hospital) This service will be provided by Nephrology specialists at the St. Boniface Hospital and Seven Oaks General Hospital Nephrology Clinics using the MBTelehealth econsult (Store and Forward) application. Specialists may provide a diagnosis and treatment plan based on relevant history, physical findings and diagnostic investigations. This service is available only for the management of non-urgent kidney-related illnesses. An econsult may be requested if a patient meets the following criteria: Refer to the Kidney Health Referral Pathway Single issue questions, including but not limited to: optimal drug choices and dosing in CKD workup of AKI general guidance for patients with early stage CKD or those at low risk of CKD progression x egfr <15 x Life-threatening elecrolyte imbalances Attachment Previous egfr value(s) are required Previous Albumin/Creatinine Ratio (ACR) value(s) are required A medication list is required Renal Ultrasound Report if available Other lab results if available 19Mar2018
7 Referring - Orthopedics Inclusion Criteria Orthopedic econsult Photograph Orthopedics This service will be provided by the Manitoba Orthopedic Trauma Group (MOTG) at Health Sciences Centre (HSC) using the MBTelehealth Store and Forward (SAF) application. The MOTG group will provide diagnosis and support at a distance in the management of non-urgent musculoskeletal (MSK) injuries for northern providers based on x-ray images and concise relevant history and physical findings. They may also offer rehabilitation advice where applicable. The primary care of the patient will remain with the referring provider. A request may be completed if a patient s condition meets the following criteria: All patients with a musculoskeletal injury, who have already received initial emergency management and do not need urgent transfer for additional care All patients who require additional X-ray interpretation by an MSK specialist All patients who require additional advice for an MSK injury Exclusion Criteria for Orthopedic econsult x Patients with neurovascular compromise x Patients under the age of 17 years x Spine injuries x Open injuries x Hand injuries x Infections Images of the standard X-ray (trauma series) of the injured extremity or joint. Documentation Note The MOTG group will not maintain a record for any patient they do not see. The referring provider/site is responsible for maintaining a copy of the completed consult from the MBTelehealth Store and Forward (SAF) application based on the site s documentation procedures. rev 30Jan2018
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