Unique Plan Description: FP Dementia Profile Clinic
Plan Selection Display: FP Dementia Profile Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-27 19:16:40
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-06 11:16:40
Available at all facilities: Yes

FP Dementia Profile Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	Urogram
		T;N, Routine, Routine, spec type = Urine
	UA
		T;N, Routine, Routine, spec type = Urine
	UA (Culture if Positive)
		T;N, Routine, Routine, spec type = Urine
	Vitamin B12 Level
		T;N, Routine, spec type = Blood
	Folate
		T;N, Routine, spec type = Blood
	Protein Electrophoresis Serum with Immunofixation
		T;N, Routine, spec type = Blood
	Protein Electrophoresis Serum w/Reflex to Immunofixation
		T;N, Routine, spec type = Blood
	Syphilis Total Antibodies
		T;N, Routine, spec type = Blood
Point of Care
	Urine Dipstick POC - PC
		T;N, Urine
	Hemoglobin POC - PC (lab)
		T;N, spec type = Blood
	82962 Blood Glucose POC - PC
		T;N, Blood
Diagnostic Tests
CT
	CT Head w & w/o Contrast
		T;N, Routine
	CT Head w Contrast
		T;N, Routine
	CT Head w/o Contrast
		T;N, Routine
MRI
	MRI Brain w & w/o Contrast
		T;N, Routine
	MRI Brain w Contrast
		T;N, Routine
	MRI Brain w/o Contrast
		T;N, Routine
Consults/Follow-up

	Return to Clinic Primary Care
		Future Order In Approximately 1 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 1, week(s), In Approximately
		Future Order In Approximately 2 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 2, week(s), In Approximately
		Future Order In Approximately 3 week(s) Grace Period (+/-) 3 Day(s), 3, Day(s), 3, week(s), In Approximately
		Future Order In Approximately 6 week(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, week(s), In Approximately
		Future Order In Approximately 1 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 1, month(s), In Approximately
		Future Order In Approximately 2 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 2, month(s), In Approximately
		Future Order In Approximately 3 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 3, month(s), In Approximately
		Future Order In Approximately 4 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 4, month(s), In Approximately
		Future Order In Approximately 6 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, month(s), In Approximately
		Future Order In Approximately 12 month(s) Grace Period (+/-) 14 Day(s), 14, Day(s), 12, month(s), In Approximately
	Follow-up Appointment
		Follow Up Visit, 6 months
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 3 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
		Follow Up Visit, PRN
	Communication to CLINIC Nurse
		Perform mini mental health assessment.
	Consult Neurologist
		
	Consult Neuropsychologist
		
	Consult Psychiatrist
		
	zzConsult Geriatric Medicine
		
	Consult Occupational Therapy
		
	Consult Physical Therapy
		
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
		T;N
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N

*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