Unique Plan Description: ID Hepatitis C Work Up Clinic
Plan Selection Display: ID Hepatitis C Work Up Clinic
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-11-01 07:39:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-01-27 13:27:31
Available at all facilities: Yes

ID Hepatitis C Work Up Clinic
Laboratory
	Hepatitis C Virus RNA Quant PCR
		T;N, Routine, spec type = Blood
	Acute Hepatitis Panel with Rflx to Hepatitis C Confirm
		T;N, Routine
	Hepatitis C Virus RNA Quant PCR with Reflex to Genotype
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Prealbumin
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	Uric Acid
		T;N, Routine, spec type = Blood
	Hepatitis A Antibodies Total
		T;N, Routine, spec type = Blood
	Hepatitis B Surface Antigen
		T;N, Routine, spec type = Blood
	Hepatitis B Surface Antibody
		T;N, spec type = Blood
Diagnostic Tests
	US Abd Complete
		T;N, Routine
	US Abd Limited
		T;N, Routine
Medications
Immunizations
	hepatitis B adult vaccine (Recombivax HB) (In Office)
		1 mL, Solution-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	hepatitis B pediatric vaccine (Recombivax Pediatric) (In Office)
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	hepatitis A adult vaccine (Vaqta) (In Office)
		1 mL, Injection, IM-Intramuscular, Once, NOW, Encounter for immunization
	hepatitis A pediatric vaccine (Vaqta Pediatric) (In Office)
		0.5 mL, Injection, IM-Intramuscular, Once, NOW, Encounter for immunization
Consults/Follow-up

	Follow-up Appointment
		Follow Up Visit, 1 month
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
		Follow Up Visit, PRN
Charges/Supplies
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
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

*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