Unique Plan Description: Peds 13-19 Year Physical Clinic
Plan Selection Display: Peds 13-19 Year Physical Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-11-01 07:46:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-04-28 15:25:04
Available at all facilities: Yes

Peds 13-19 Year Physical Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	Urogram
		T;N, Routine, Routine, spec type = Urine
	UA
		T;N, Routine, Routine, spec type = Urine
	UA (Culture Pos)
		T;N, Routine, Routine, spec type = Urine
	Culture Urine
		T;N, Routine, spec type = Urine
	Lead Screen - PC
		T;N, Routine, spec type = Capillary Blood
	Lead (0020098)
		T;N, Routine, spec type = Blood
	Cholesterol
		T;N, Routine, spec type = Blood
	Lipid Panel
		T;N, Routine, spec type = Blood
	Strep Group A PCR
		
Point of Care
	Hemoglobin POC - PC (lab)
		T;N, Routine, spec type = Blood
	Cholesterol POC-PC
		T;N, Routine, spec type = Blood
Medications
Immunizations
	hepatitis A pediatric vaccine (Vaqta Pediatric) (In Office)
		0.5 mL, Injection, IM-Intramuscular, Once, NOW, Encounter for immunization
	hepatitis B pediatric vaccine (Recombivax Pediatric) (In Office)
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	human papillomavirus vaccine (Gardasil 9) (In Office)
		0.5 mL, Solution, 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
	measles/mumps/rubella/varicella virus vaccine (MMRV) (ProQuad) (In Office)
		0.5 mL, Injection, SUBCUTANEOUS, Once, T;N, duration: 1 Dose(s)/Time(s), Encounter for immunization
	meningococcal conjugate vaccine (MenQuadfi) (In Office)
		0.5 mL, Solution, IM-Intramuscular, Once, T;N, Encounter for immunization
	meningococcal group B vaccine (Trumenba) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
	pneumococcal 20-valent conjugate vaccine (Prevnar 20) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, NOW, Encounter for immunization
	tetanus/diphth/pertuss (Tdap/Adacel) (In Office)
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	90460 Adm Imm w/Counsel First
		
	90461 Adm Imm w/Counsel Ea Add
		
Patient Care

	Vision Screening - PC
		
	92552 Pure tone threshold, air only
		
	94760 Pulse Oximetry- Single
		
	94640 Inhalation treatment
		
	51701 Insert Non-Indwell bladder catheter
		
	92567 Tympanometry
		
	92583 Select picture audiometry
		
Consults/Follow-up
	Return to Clinic Primary Care
		Future Order, 2, Day(s), 1, week(s), In Approximately
		Future Order, 2, Day(s), 2, week(s), In Approximately
		Future Order, 3, Day(s), 3, week(s), In Approximately
		Future Order, 7, Day(s), 6, week(s), In Approximately
		Future Order, 7, Day(s), 1, month(s), In Approximately
		Future Order, 7, Day(s), 2, month(s), In Approximately
		Future Order, 7, Day(s), 3, month(s), In Approximately
		Future Order, 7, Day(s), 4, month(s), In Approximately
		Future Order, 7, Day(s), 6, month(s), In Approximately
		Future Order, 14, Day(s), 12, month(s), In Approximately
	Follow-up Appointment
		1 year
		1 week
		2 weeks
		3 weeks
		6 weeks
		1 month
		3 months
		6 months
		See Special Instructions
		PRN
	Consult Allergist
		
	Consult Ear Nose and Throat
		
	Consult Otolaryngologist
		
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
Est Pt Preventive Med
	99394 EVM - Prev Med Estab Patient 12-17 yrs
		T;N
	99395 EVM - Prev Med Estab Patient 18-39 yrs
		T;N
New Pt Preventive Med
	99384 EVM - Prev Med New Patient 12-17 yrs
		T;N
	99385 EVM - Prev Med New Patient 18-39 yrs
		T;N
No Charge / Follow Up
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
Procedures in Office
	96110 Development testing, limited

*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