Unique Plan Description: OB Postpartum Clinic
Plan Selection Display: OB Postpartum Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-04-30 12:54:28
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-06-26 09:15:33
Available at all facilities: Yes

Postpartum 0-2 Weeks
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
Consults/Follow-up
	Return to Clinic Women's
		Future Order In Approximately 1 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 1, week(s), In Approximately
	Follow-up Appointment
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 6 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, PRN
		Follow Up Visit, See Special Instructions
	Request for Service
		
Charges/Supplies
No Charge / Follow Up
	99024 EVM - Post Op Visit

Postpartum 6 weeks
Laboratory

	CBC with Diff
		T;N, Routine, spec type = Blood
	GYN Request (PAP)
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
		T;N, Routine PAP CERVICAL, Routine
		T;N, Routine PAP CERV & VAG, Routine
		T;N, Routine PAP VAGINAL, Routine
	GYN Pap with HPV High Risk Co-Test
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
	GYN Pap with Reflex to HPV High Risk
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
	HPV High Risk with 16 and 18 Genotyping
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	Glucose Tolerance Testing Panel (0hr, 2hr)
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Urine
		T;N, Routine, spec type = Vaginal
	Wet Prep - PC/FH
		T;N, Routine, spec type = Genital
	Vaginitis DNA Detection - PC
		T;N, Routine, spec type = Genital
	Vaginitis Panel PCR
		T;N, Routine, spec type = Genital
Future
	Glucose Tolerance Testing Panel (0hr, 2hr)
		T;N, Routine, spec type = Blood
Medications

	medroxyPROGESTERone (Depo-Provera) (In Office)
		150 mg, Injection, IM-Intramuscular, Once, NOW
	levonorgestrel (Mirena) (In Office)
		52 mg, Insert, IntraUterine, Once, NOW
Immunizations
	tetanus/diphth/pertuss (Tdap/Adacel) (In Office)
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	measles/mumps/rubella virus vaccine (MMR) (In Office)
		0.5 mL, Injection, SUBCUTANEOUS, Once, NOW, Encounter for immunization
	influenza virus vaccine (*QUADrivalent) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
Consults/Follow-up

	Return to Clinic Women's
		Future Order In Approximately 12 month(s) Grace Period (+/-) 14 Day(s), 14, Day(s), 12, month(s), In Approximately
	Follow-up Appointment
		1 year
		for Colpscopy, Follow Up Visit
		for IUD Insertion, Follow Up Visit
	Request for Service
		
Charges/Supplies
Procedures in Office
	58300 Insert IUD
		
	57420 Colposcopy, Vagina
		
No Charge / Follow Up
	99024 EVM - Post Op Visit

PIH Panel
Laboratory
Urine Studies
	Creatinine Clearance
		T;N, Routine, Routine, Urine Timed, spec type = Urine
	C. Clearance Serum
		T;N, Routine, spec type = Blood
	Protein Urine Timed Set
		T;N, Routine, Routine, spec type = Urine
	Protein Creatinine Ratio Urine
		T;N, Routine, Routine, Urine Random, spec type = Urine
General Labs
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood

*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