Medical Care for Men & Women

Transcription

1 Denise J. Giuffrida, M.D. Internal Medicine Downtown Medical Associates In the Esperson Tunnel Medical Care for Men & Women Internal medicine doctor with an emphasis on preventive medicine The only full-time primary care private practitioner officed downtown Central location within walking distance for most downtown personnel In the tunnel for ease of access Offers a wide range of services to private patients and corporate clients Dr. Giuffrida is an oldfashioned doctor whose office is just steps away from yours. Dr. Denise Giuffrida operates Downtown Medical Associates in the tunnel beneath downtown s busy streets. Her office is at the intersection of the Tunnel Loop and the N. Travis Loop, beneath the Esperson Buildings. This central location gives employees a convenient option for medical care within walking distance of their workplace. Patients can easily fit appointments into their busy schedules, needing only a few minutes to get from their offices to hers. Downtown Medical Associates also partners with corporate clients to bring on-site medical services and wellness initiatives into downtown offices. We have a Corporate Flu Shot program, a Health Screening Program and a Travel Medicine Program. We work with corporations or buildings to offer flu shots, pneumonia shots, health fairs and health screenings in the workplace. The most important tool in her medical bag is her ability to listen effectively to her patients. Monday Tuesday In-Office Flu Shot Clinic Hours 10 am to 4 pm 8 am to 4 pm Wednesday 9 am to 1 pm Downtown Medical Associates also performs random or scheduled drug testing, pre-employment physicals, tuberculosis skin test screenings, and hepatitis B vaccinations. Thursday Friday 8 am to 4 pm 8 am to 4 pm For more information on any of our Corporate Programs, please call Donna Todd at PO Box Houston TX Phone: Fax:

2 Downtown Medical Associates Influenza Vaccine Consent Form for Pennzoil Place PERSON RECEIVING VACCINE: Last First Middle Age Street Address Apt# City State Zip Telephone Date of Birth INFLUENZA VACCINE MEDICAL HISTORY QUESTIONNAIRE: Do you have an allergy to eggs? Yes No Have you ever had Guillain-Baré Syndrome? Yes No Are you allergic to thimerosal: (A common preservative in contact lens solutions; a mercury derivative) Yes No Are you taking either of these medicines? a. theophylline (breathing medication) Yes No b. warfarin (blood thinner) Yes No Are you ill now with a virus or fever? Yes No Do you have an active neurology disorder? Yes No I have had a chance to ask questions which were answered to my satisfaction. I believe that I understand the benefits and risks of the influenza vaccine and request that this vaccine be given to me or the person named above for whom I am authorized to make this request. Signature Date If you have problems or questions over the next 24 to 72 hours, contact Denise J. Giuffrida, M.D. at (713) Physician s comments to any questions answered yes. PLEASE DO NO WRITE BELOW THIS LINE. Physician s signature Date Vaccine Administered: Dose Site Lot Expiration Date Influenza Virus Vaccine Afluria.5cc L R A June 30, 2010 Influenza Trivalent Types Deltoid Thigh A and B (Split Virion Vaccine) Formula Date Signature MD/RN/MA

3 Texas Department of State Health Services Addendum to Pneumococcal Conjugate Vaccine Information Statement 1. I agree that the person named below will get the vaccine checked below. 2. I received or was offered a copy of the Vaccine Information Statement (VIS) for the vaccine listed above. 3. I know the risks of the disease this vaccine prevents. 4. I know the benefits and risks of the vaccine. 5. I have had a chance to ask questions about the disease the vaccine prevents, the vaccine, and how the vaccine is given. 6. I know that the person named below will have the vaccine put in his/her body to prevent the disease this vaccine prevents. 7. I am an adult who can legally consent for the person named below to get the vaccine. I freely and voluntarily give my signed permission for this vaccine. Vaccine to be given: Pneumococcal Conjugate Vaccine Information about person to receive vaccine (Please print) Name: Last First Middle Initial Birthdate (mm/dd/yy) Sex (circle one) M F For Clinic/Office Use Clinic/Office Address: Date Vaccine Administered: Address: Street City County State Zip Signature of person to receive vaccine or person authorized to make the request (parent or guardian): TX Vaccine Manufacturer: Vaccine Lot Number: x Date Site of Injection: Signature of Vaccine Administrator: Date Witness Title of Vaccine Administrator: PRIVACY NOTIFICATION - With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See for more information on Privacy Notification. (Reference: Government Code, Section , , , and ) Privacy Notice: I acknowledge that I have received a copy of my immunization provider's HIPAA Privacy Notice. Notice: Alterations or changes to this publication is prohibited without the express written consent of the Texas Department of State Health Services, Immunization Branch. Instructions: File this consent statement in the patient s chart. Texas Department of State Health Services EC-85 (03/06) CDC VIS Revision 09/30/02

4 VACCINE W H A T Y O U N E E D T O K N O W INACTIVATED INFLUENZA Many Vaccine Information Statements are available in Spanish and other languages. See 1 Why get vaccinated? Influenza ( flu ) is a contagious disease. It is caused by the influenza virus, which can be spread by coughing, sneezing, or nasal secretions. Other illnesses can have the same symptoms and are often mistaken for influenza. But only an illness caused by the influenza virus is really influenza. Anyone can get influenza, but rates of infection are highest among children. For most people, it lasts only a few days. It can cause: fever sore throat chills fatigue cough headache muscle aches Some people, such as infants, elderly, and those with certain health conditions, can get much sicker. Flu can cause high fever and pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. On average, 226,000 people are hospitalized every year because of influenza and 36,000 die mostly elderly. Influenza vaccine can prevent influenza. 2 Inactivated influenza vaccine There are two types of seasonal influenza vaccine: 1. Inactivated (killed) vaccine, or the These seasonal influenza flu shot is given by injection into vaccines are formulated to the muscle. 2. Live, attenuated prevent annual flu. They do (weakened) influenza vaccine is not protect against pandemic H1N1 influenza. sprayed into the nostrils. This vaccine is described in a separate Vaccine Information Statement. Influenza viruses are always changing. Because of this, influenza vaccines are updated every year, and an annual vaccination is recommended. Each year scientists try to match the viruses in the vaccine to those most likely to cause flu that year. When there is a close match the vaccine protects most people from serious influenzarelated illness. But even when there is not a close match, the vaccine provides some protection. Influenza vaccine will not prevent influenza-like illnesses caused by other viruses. It takes up to 2 weeks for protection to develop after the shot. Protection lasts up to a year. Some inactivated influenza vaccine contains a preservative called thimerosal. Some people have suggested that thimerosal may be related to developmental problems in children. In 2004 the Institute of Medicine reviewed many studies looking into this theory and concluded that there is no evidence of such a relationship. Thimerosal-free influenza vaccine is available. 3 Who should get inactivated influenza vaccine? Anyone who wants to reduce the likelihood of becoming ill with influenza or spreading influenza to others. All children 6 months and older and all older adults: All children from 6 months through 18 years of age. Anyone 50 years of age or older. Anyone who is at risk of complications from influenza, or more likely to require medical care: Women who will be pregnant during influenza season. Anyone with long-term health problems with: - heart disease - kidney disease - liver disease - lung disease - metabolic disease, such as diabetes - asthma - anemia, and other blood disorders Anyone with a weakened immune system due to: - HIV/AIDS or other diseases affecting the immune system - long-term treatment with drugs such as steroids - cancer treatment with x-rays or drugs Anyone with certain muscle or nerve disorders (such as seizure disorders or cerebral palsy) that can lead to breathing or swallowing problems. Anyone 6 months through 18 years of age on long-term aspirin treatment (they could develop Reye Syndrome if they got influenza). Residents of nursing homes and other chronic-care facilities. Anyone who lives with or cares for people at high risk for infl uenza-related complications: Health care providers. Household contacts and caregivers of children from birth up to 5 years of age. Household contacts and caregivers of - people 50 years and older, or - anyone with medical conditions that put them at higher risk for severe complications from influenza. Health care providers may also recommend a yearly influenza vaccination for: People who provide essential community services. People living in dormitories, correctional facilities, or under other crowded conditions, to prevent outbreaks. People at high risk of influenza complications who travel to the Southern hemisphere between April and September, or to the tropics or in organized tourist groups at any time.

5 4 6 When should I get influenza vaccine? You can get the vaccine as soon as it is available, usually in the fall, and for as long as illness is occurring in your community. Influenza can occur any time from November through May, but it most often peaks in January or February. Getting vaccinated in December, or even later, will still be beneficial in most years. Most people need one dose of influenza vaccine each year. Children younger than 9 years of age getting influenza vaccine for the first time or who got influenza vaccine for the first time last season but got only one dose should get 2 doses, at least 4 weeks apart, to be protected. Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine. Some people should talk with a 5 doctor before getting influenza vaccine Some people should not get inactivated influenza vaccine or should wait before getting it. Tell your doctor if you have any severe (life-threatening) allergies. Allergic reactions to influenza vaccine are rare. - Influenza vaccine virus is grown in eggs. People with a severe egg allergy should not get the vaccine. - A severe allergy to any vaccine component is also a reason to not get the vaccine. - If you have had a severe reaction after a previous dose of influenza vaccine, tell your doctor. Tell your doctor if you ever had Guillain-Barré Syndrome (a severe paralytic illness, also called GBS). You may be able to get the vaccine, but your doctor should help you make the decision. People who are moderately or severely ill should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine. What are the risks from inactivated influenza vaccine? A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from influenza vaccine are very rare. The viruses in inactivated influenza vaccine have been killed, so you cannot get influenza from the vaccine. Mild problems: soreness, redness, or swelling where the shot was given hoarseness; sore, red or itchy eyes; cough fever aches If these problems occur, they usually begin soon after the shot and last 1-2 days. Severe problems: Life-threatening allergic reactions from vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the shot. In 1976, a type of influenza (swine flu) vaccine was associated with Guillain-Barré Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS. However, if there is a risk of GBS from current flu vaccines, it would be no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe influenza, which can be prevented by vaccination. 7 What if there is a severe reaction? What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at or by calling VAERS does not provide medical advice. 8 The National Vaccine Injury Compensation Program A federal program exists to help pay for the care of anyone who has a serious reaction to a vaccine. For more information about the National Vaccine Injury Compensation Program, call , or visit their website at 9 How can I learn more? Ask your provider. They can give you the vaccine package insert or suggest other sources of information. Call your local or state health department. Contact the Centers for Disease Control and Prevention (CDC): - Call (1-800-CDC-INFO) or - Visit CDC s website at DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Vaccine Information Statement (Interim) Inactivated Influenza Vaccine (8/11/09) 42 U.S.C. 300aa-26

6 PNEUMOCOCCAL POLYSACCHARIDEVACCINE W H A T Y O U N E E D T O K N O W 1 Many Vaccine Information Statements are available in Spanish and other languages. See Pneumococcal disease Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. It is a leading cause of vaccinepreventable illness and death in the United States. Anyone can get pneumococcal disease, but some people are at greater risk than others: People 65 years and older The very young People with certain health problems People with a weakened immune system Smokers Pneumococcal disease can lead to serious infections of the: Lungs (pneumonia), Blood (bacteremia), and Covering of the brain (meningitis). Pneumococcal pneumonia kills about 1 out of 20 people who get it. Bacteremia kills about 1 person in 5, and meningitis about 3 people in 10. People with the health problems described in Section 3 of this statement may be more likely to die from the disease. 2 Pneumococcal polysaccharide vaccine (PPSV) Treatment of pneumococcal infections with penicillin and other drugs used to be more effective. But some strains of the disease have become resistant to these drugs. This makes prevention of the disease, through vaccination, even more important. Pneumococcal polysaccharide vaccine (PPSV) protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease. Most healthy adults who get the vaccine develop protection to most or all of these types within 2 to 3 weeks of getting the shot. Very old people, children under 2 years of age, and people with some long-term illnesses might not respond as well, or at all. Another type of pneumococcal vaccine (pneumococcal conjugate vaccine, or PCV) is routinely recommended for children younger than 5 years of age. PCV is described in a separate Vaccine Information Statement. 3 Who should get PPSV? All adults 65 years of age and older. Anyone 2 through 64 years of age who has a longterm health problem such as: - heart disease - lung disease - sickle cell disease - diabetes - alcoholism - cirrhosis - leaks of cerebrospinal fluid or cochlear implant Anyone 2 through 64 years of age who has a disease or condition that lowers the body s resistance to infection, such as: - Hodgkin s disease - lymphoma or leukemia - kidney failure - multiple myeloma - nephrotic syndrome - HIV infection or AIDS - damaged spleen, or no spleen - organ transplant Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body s resistance to infection, such as: - long-term steroids - certain cancer drugs - radiation therapy Any adult 19 through 64 years of age who: - is a smoker - has asthma PPSV may be less effective for some people, especially those with lower resistance to infection.

7 But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease. Children who often get ear infections, sinus infections, or other upper respiratory diseases, but who are otherwise healthy, do not need to get PPSV because it is not effective against those conditions. 4 How many doses of PPSV are needed, and when? Usually only one dose of PPSV is needed, but under some circumstances a second dose may be given. A second dose is recommended for people 65 years and older who got their first dose when they were younger than 65 and it has been 5 or more years since the first dose. A second dose is recommended for people 2 through 64 years of age who: - have a damaged spleen or no spleen - have sickle-cell disease - have HIV infection or AIDS - have cancer, leukemia, lymphoma, multiple myeloma - have nephrotic syndrome - have had an organ or bone marrow transplant - are taking medication that lowers immunity (such as chemotherapy or long-term steroids) When a second dose is given, it should be given 5 years after the first dose. 5 Some people should not get PPSV or should wait Anyone who has had a life-threatening allergic reaction to PPSV should not get another dose. Anyone who has a severe allergy to any component of a vaccine should not get that vaccine. Tell your provider if you have any severe allergies. Anyone who is moderately or severely ill when the shot is scheduled may be asked to wait until they recover before getting the vaccine. Someone with a mild illness can usually be vaccinated. Although there is no evidence that PPSV is harmful to either a pregnant woman or to her fetus, it is not recommended during pregnancy. Pregnant women who have chronic illnesses should consult their provider before being vaccinated. Women who have underlying conditions known to put them at risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible. 6 What are the risks from PPSV? About half of people who get PPSV have mild side effects, such as redness or pain where the shot is given. Less than 1% develop a fever, muscle aches, or more severe local reactions. A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely small. 7 What if there is a severe reaction? What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at or by calling VAERS does not provide medical advice. 8 How can I learn more? Ask your provider. They can give you the vaccine package insert or suggest other sources of information. Call your local or state health department. Contact the Centers for Disease Control and Prevention (CDC): - Call (1-800-CDC-INFO) or - Visit CDC s website at DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention PPSV (4/16/09) Vaccine Information Statement

8 Denise J. Giuffrida, M.D. Internal Medicine Downtown Medical Associates Primary Care for Men & Women In the Tunnel Downtown Medical Associates Location We are located in the tunnel beneath the Mellie Esperson Building, at 815 Walker Street, Suite T-14. We are easy to spot in the tunnel, as our office is located at the busy intersection of the Tunnel Loop and the N. Travis Tunnel. Our phone number, fax number and PO Box are shown below. Please feel free to drop by and visit our office. The distinctive cupola of the Esperson building is a Houston landmark, visible throughout downtown. Nearby Parking Parking is available in the Esperson Building Garage, which is entered on Rusk Street. Nearby parking is also available in the Houston Club Building, Two Shell Plaza, 801 Travis and the McKinney Garage. PO Box Houston TX Phone: Fax: