Unique Plan Description: FP Well Adult Male Over 50 Clinic
Plan Selection Display: FP Well Adult Male Over 50 Clinic
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-11-01 07:38:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-03-14 08:39:20
Available at all facilities: Yes

FP Well Adult Male Over 50 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
	Glucose Level
		T;N, Routine, spec type = Blood
	Lipid Panel
		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
	PSA (For Screening Only)
		T;N, Routine, spec type = Blood
	Hemoglobin A1C
		T;N, Routine, spec type = Blood
	Uric Acid
		T;N, Routine, spec type = Blood
	Microalbumin Urine Random (Spot)
		T;N, Routine, Routine, spec type = Urine Random
	Microalbumin Urine MPC
		T;N, Routine, Routine, spec type = Urine Random
	Vitamin D 25-Hydroxy Level (preferred for deficiency)
		T;N, Routine, spec type = Blood
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Urine
	HIV-1/2 Ag/Ab Combo - MH/WH/JE
		T;N, Routine, spec type = Blood
	HIV 1/2 Screen w/ p24 Antigen - FH
		T;N, Routine, spec type = Blood
	Syphilis Total Antibodies
		T;N, Routine, spec type = Blood
	Acute Hepatitis Panel with Rflx to Hepatitis C Confirm
		T;N, Routine
	Vitamin B12 Level
		T;N, Routine, spec type = Blood
	Testosterone Total and Free (Adult Male)
		T;N, Routine, spec type = Blood
	Immunochemical Fecal Occult Blood-PC/FH
		T;N, Routine, spec type = Stool
Point of Care
	Hemoglobin POC - PC (lab)
		T;N, spec type = Blood
Diagnostic Tests

	Chest 2 View
		T;N, Routine
	Complete pre and post PFT's
		T;N
	Colonoscopy to Schedule
		
	zzDXA Scan
		T;N
	ECG
		T;N
	Echo w Doppler resting
		T;N
Medications
	tuberculin purified protein derivative (PPD) (In Office)
		0.1 mL, Injection, IntraDermal, Once, T;N
	cyanocobalamin (Vit B12) (In Office)
		1,000 mcg, Injection, IM-Intramuscular, Once, T;N
	Shingrix intramuscular injection
		0.5 mL, IM-Intramuscular, Once, repeat dose in 2 to 6 months, # 2 EA, 0 Refill(s)
Immunizations
	tetanus/diphth/pertuss (Tdap/Adacel) (In Office)
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	pneumococcal 20-valent conjugate vaccine (Prevnar 20) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
	influenza vaccine, TRIvalent (*FluLaval) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
	zoster vaccine, recomb, adjuv (Shingrix)(In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, NOW, Encounter for immunization
	hepatitis A adult vaccine (Vaqta) (In Office)
		1 mL, Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	hepatitis B adult vaccine (Engerix) (In Office)
		1 mL, Suspension-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	hepatitis B adult vaccine (Recombivax HB) (In Office)
		1 mL, Solution-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	tetanus-diphth toxoids adult/adol (Td-Tenivac)(In Office)
		0.5 mL, Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
Patient Care

	ECG w/ interpretation and report
		
	94760 Pulse Oximetry- Single
		
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, 1 year
		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, 6 months
		Follow Up Visit, See Special Instructions
		Follow Up Visit, PRN
	Consult Cardiologist
		
	Consult Dermatologist
		
	Consult Gastroenterologist
		
	Consult Orthopedics
		
	Consult Pulmonologist
		
Charges/Supplies
	G0402 EVM - WELCOME TO MEDICARE PHYS,,
		T;N
	G0438 EVM - ANNUAL WELLNESS VISIT; 1ST
		T;N
	G0439 EVM - ANNUAL WELLNESS VISIT; SUB
		T;N
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
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		T;N
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		T;N
New Pt Preventive Med
	99387 EVM - Prev Med New Patient > 65 yrs
		T;N
	99386 EVM - Prev Med New Patient 40-64 yrs
		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
Est Pt Preventive Med
	99396 EVM - Prev Med Estab Patient 40-64 yrs
		T;N
	99397 EVM - Prev Med Estab Patient > 65 yrs
		T;N
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99211n EVM - No Charge Professional Service
		T;N
Procedures in Office
	G0102 EVM - DIGITAL RECTAL EXAM
		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