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(Don't forget to turn ON fax CoverSheet) SUBJECTIVE
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HPI: Residents/staff=NotForTelehealth
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HPI for Family | Friend | Staff | Other | Only
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IstheFam|Friend|ClsContact|Staff|Symptomatic? Yes / No
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Subjective Notes
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Scribe for Telehealth
• • •
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SHORT ROS
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OBJECTIVE
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Pt | Resident - Yes=Symptomatic | No=Asymptomatic
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Family | Friends | Staff | Other | Close Contact ONLY - Yes=Symptomatic | No=Asymptomatic
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Objective Notes:
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ASSESSMENT
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ON=Keep Scabies Dx! OFF= Hide Scabies DX.
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Dx1: DEFAULT: Contact w/ & (suspected) Exposure 2 Scabies.
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Dx2: SCABIES
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Dx3: Enter Other DXs Here/or Notes
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Assessment Notes:
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PLAN- Counseling Always ON
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1) ETIOLOGY FOR TX
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2) SCABIES...Counseling - LEAVE ON
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3) SCABIES TREATMENT PROTOCOL
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FACILITY ONLY: ON=YES, Spoke 2 Staff. OFF= Did Not.
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4) TREATMENT PLAN: PRESCRIPTION
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Oral Ivermectin
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2 doses- Asymptomatic
• • •
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3 doses- Symptomatic
• • •
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5 doses - Symptomatic
• • •
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7 doses - Symptomatic
• • •
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Topical Permethrin
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1, 2, 3, 5, and 7 doses
• • •
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Topical Steroid
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TAC 0.1% / Cortisone 2.5%/ CLobetasol
• • •
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YES-Facility will order and pay. NO-DermRight will Rx, facility will pay.
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Treatment/ Plan Notes/ Other prescriptions
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FOLLOW UP
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Follow up
• • •
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Follow Up Notes
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2VisitTime - Write the # of Minutes Spent for Each
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1Reconcile Meds
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Reconciling/Reviewing Meds
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1ReviewingPriorVisitNotes
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ReviewingPriorVisitNotes
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1ReviewingLabsImagingPathEtc
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ReviewingLabsImagingPathEtc
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1MeetingWith CG MedTch Nurses
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MeetingWithMedTchNurseCG
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1ConsultWithFamMPOAorFiduciary
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ConsultWithFamMPOAorFiduciary
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1Face2FaceConsult/ExamWithPT.
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Face2FaceConsult/ExamWithPT.
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1Documenting, eRx, Orders, VisitSummary
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Documenting, eRx, Orders, VisitSummary
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Total Minutes for Visit:
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Level of Decision Making Required
• • •
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PICTURES
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SCAB1
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SCAB2
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SCAB3
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SCAB4
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MALE DIAGRAM
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FEMALE DIAGRAM
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DoNotUse Below
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Counseling
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Visit Time
• • •
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