Unique Plan Description: IM Vaginal Discharge Clinic
Plan Selection Display: IM Vaginal Discharge Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-02 16:18:55
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-01-07 10:31:20
Available at all facilities: No

IM Vaginal Discharge Clinic
Laboratory
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Routine, spec type = Vaginal
		T;N, Routine, spec type = Cervix
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Vaginal
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Urine
		T;N, Routine, spec type = Urine
	Wet Prep - PC/FH
		T;N, Routine
	Vaginitis Panel PCR
		T;N, Routine, spec type = Genital
	Culture Routine
		T;N, Routine, Micro Swab, spec type = Genital
	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
Point of Care
	Wet Mt Physician Perform
		
	KOH Prep Physician Perform
		
Medications

	cefTRIAXone 250mg IM (Rocephin) (In Office)
		250 mg, Injection, IM-Intramuscular, Once, NOW
			Comment: Inject deep into Muscle.
Yeast Vaginitis
	Diflucan 150 mg oral tablet
		1 TAB, BY MOUTH, DAILY, X 1 Day(s), # 1 TAB, 1 Refill(s), Hard Stop
	Cleocin Ovules 100 mg vaginal suppository
		2 supp, VAGINAL, QHS, X 3 Day(s), # 3 supp, 0 Refill(s), Hard Stop
Herpes Vaginitis
		Use these dosages for first episode.(NOTE)*
	famciclovir 250 mg oral tablet
		1 TAB BY MOUTH TID, X 7 Day(s), # 21 TAB, 0 Refill(s), Hard Stop
	Valtrex 1 gm oral tablet
		1 TAB, BY MOUTH, BID, X 7 Day(s), # 14 TAB, 0 Refill(s), Hard Stop
	acyclovir 400 mg oral tablet
		1 TAB, BY MOUTH, TID, X 7 Day(s), # 21 TAB, 0 Refill(s), Hard Stop
		Use these dosages for recurrent episodes.(NOTE)*
	famciclovir 500 mg oral tablet
		2 TAB, BY MOUTH, BID, X 1 Day(s), # 4 TAB, 0 Refill(s), Hard Stop
	Valtrex  500 mg oral tablet
		1 TAB, BY MOUTH, BID, X 3 Day(s), # 6 TAB, 0 Refill(s), Hard Stop
	acyclovir 400 mg oral tablet
		1 TAB, BY MOUTH, TID, X 5 Day(s), # 15 TAB, 0 Refill(s), Hard Stop
Bacterial Vaginosis
	Cleocin 2% vaginal cream
		1 appl, VAGINAL, QHS, X 7 Day(s), # 40 gm, 0 Refill(s), Hard Stop
	metroNIDAZOLE 500 mg oral tablet
		1 TAB, BY MOUTH, BID, X 7 Day(s), # 14 TAB, 0 Refill(s), Hard Stop
	Cleocin HCl 300 mg oral capsule
		1 CAP, BY MOUTH, BID, X 7 Day(s), # 14 CAP, 0 Refill(s), Hard Stop
Trichomonas Vaginalis
	metroNIDAZOLE 500 mg oral tablet
		4 TAB, BY MOUTH, NOW, # 4 TAB, 0 Refill(s), Hard Stop
		1 TAB, BY MOUTH, BID, X 7 Day(s), # 14 TAB, 0 Refill(s), Hard Stop
Chlymydia
	Zithromax 500 mg oral tablet
		2 TAB, BY MOUTH, DAILY, X 1 Day(s), # 2 TAB, 0 Refill(s), Hard Stop
	doxycycline hyclate 100 mg oral capsule
		1 CAP, BY MOUTH, BID, X 7 Day(s), # 14 CAP, 0 Refill(s), Hard Stop
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 OB/GYN
		
Charges/Supplies
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		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
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

*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