Unique Plan Description: Breast Ctr MH Clinic
Plan Selection Display: Breast Ctr MH Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-01 13:25:13
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-02-19 09:58:59
Available at all facilities: Yes

Breast Ctr MH Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemoglobin
		T;N, Routine, spec type = Blood
	Hematocrit
		T;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	PTT - MH/WH/JE
		T;N, Routine, spec type = Blood
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	Type and Screen (No Product on hold)
		T;N, Routine, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Routine, For Possible Transfusion
Diagnostic Tests
Diagnostics
	ECG
		T;N
	Mammo Bil Diag
		T;N, Routine
	Mammo Implant Diag Lt
		T;N, Routine
	Mammo Implant Diag Rt
		T;N, Routine
	Mammo Implants Diag
		T;N, Routine
	Mammo Implants Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	Mammo Bil Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	Mammo Unilat Diag Lt
		T;N, Routine
	Mammo Unilat Diag Rt
		T;N, Routine
	Chest 2 View
		T;N, Routine
CT
	CT Abd Pelvis w & w/o Cont
		T;N, Routine
	CT Abd Pelvis w/o Contrast
		T;N, Routine
	CT Abd Pelvis w Contrast
		T;N, Routine
	CT Chest w & w/o Contrast
		T;N, Routine
	CT Chest w Contrast
		T;N, Routine
	CT Chest w/o Contrast
		T;N, Routine
MRI
	MRI Breast w Contrast Bil
		T;N, Routine
	MRI Breast w/o Contrast Bil
		T;N, Routine
Ultrasound
	US Breast Bil Complete
		T;N, Routine
	US Breast Bil Limited
		T;N, Routine
	US Breast Lt Complete
		T;N, Routine
	US Breast Lt Limited
		T;N, Routine
	US Breast Rt Complete
		T;N, Routine
	US Breast Rt Limited
		T;N, Routine
Medications

	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 or 2 TAB, BY MOUTH, Q4H, PRN pain, # 30 TAB, 1 Refill(s), Hard Stop
	cephalexin 500 mg oral capsule
		1 CAP, BY MOUTH, Q8H, X 7 Day(s), # 21 CAP, 0 Refill(s), Hard Stop
	levoFLOXacin 500 mg oral tablet
		1 TAB BY MOUTH DAILY, X 7 Day(s), # 7 TAB, 0 Refill(s), Hard Stop
	tamoxifen 20 mg oral tablet
		1 TAB BY MOUTH DAILY, # 30 TAB, 3 Refill(s)
			Comment: Extremely Hazardous Drug | Antineoplastic |  PPE Requirements: Dispensed From Pharmacy In Rx Crush Bag, Double Gloves, Gown, Face Shield If Tube Admin Or Splashing Risk.
	Arimidex 1 mg oral tablet
		1 TAB BY MOUTH DAILY, # 30 TAB, 3 Refill(s)
			Comment: Extremely Hazardous Drug | Antineoplastic |  PPE Requirements: Dispensed From Pharmacy In Rx Crush Bag, Double Gloves, Gown, Face Shield If Tube Admin Or Splashing Risk.
Patient Care
	Patient Instructions
		Patient to shower with chlorhexadine gluconate evening before surgery.
		Patient to shower with chlorhexadine gluconate morning of surgery.
		No food or drink 8 hours before surgery.
Consults/Follow-up
	Follow-up Appointment
		
	Surgery to Schedule
		
	Request for Service
		
	Consult Oncologist
		
	Consult Radiation Oncologist
		
	Consult Primary Care Provider
		
	Consult Cardiologist
		
Charges/Supplies
New Pt Visit
	zz99201 EVM-New Pt Visit Problem focused 10m
		T;N
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		T;N
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		T;N
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		T;N
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		T;N
Est. Pt Visit
	99211 EVM - OP visit estab patient, minimal care < 10 min
		T;N
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		T;N
	99213 EVM - OP VISIT ESTAB PATIENT, LOW LEVEL 20 MIN
		T;N
	99214 EVM - OP VISIT ESTAB PATIENT, MODERATE 30 MIN
		T;N
	99215 EVM - OP VISIT ESTAB PATIENT, HIGH LEVEL 40 MIN
		
No Charge / Follow Up
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
Procedures in Office
	19100 Breast bx percu needle core
		
	zz96372 Injection Ther/Proph/Diag   SC/IM
		
	19000 Puncture asp breast cyst
		
	10160 Puncture aspirat abscess hematoma cyst

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase