Unique Plan Description: Peds 9 Month Check Clinic
Plan Selection Display: Peds 9 Month Check Clinic
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-11-01 07:52:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-11-07 13:54:34
Available at all facilities: Yes

Peds 9 Month Check Clinic
Laboratory
	Allergens Pediatric Foods/Inhalants Profile  (55300)
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Glucose Level
		T;N, Routine, spec type = Blood
	Hemoglobin
		T;N, Routine, spec type = Blood
	Hematocrit
		T;N, Routine, spec type = Blood
	hsCRP
		T;N, Routine, spec type = Blood
	Lead Screen - PC
		T;N, Routine, spec type = Capillary Blood
	Lead Capillary (0020745)
		T;N, Routine, spec type = Blood
	Influenza A and B Screen PCR
		T;N, Routine, spec type = Nasopharynx
	Rapid RSV Ag - PC
		T;N, Routine, spec type = Nasopharynx
	Respiratory Syncytial Virus (RSV) PCR
		T;N, Routine
	Sed Rate
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	TSH
		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, Urine, spec type = Urine
Medications
Immunizations
	DTaP/HIB/hepB/polio (Vaxelis) (In Office)
		0.5 mL, Suspension, 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
	pneumococcal 13-valent conjugate vaccine (Prevnar 13) (In Office)
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, NOW, Encounter for immunization
	pneumococcal 20-valent conjugate vaccine (Prevnar 20) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, NOW, Encounter for immunization
	influenza virus vaccine (*QUADrivalent) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, NOW, T;N, Encounter for immunization
	90460 Adm Imm w/Counsel First
		
	90461 Adm Imm w/Counsel Ea Add
		
Patient Care

	94640 Inhalation treatment
		
	51701 Insert Non-Indwell bladder catheter
		
	94760 Pulse Oximetry- Single
		
	92552 Pure tone threshold, air only
		
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, 3 months
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 6 weeks
		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
Est Pt Preventive Med
	99391 EVM - Prev Med Estab Patient Less Than 1 yr
		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
New Pt Preventive Med
	99381 EVM -  Prev Med New Patient Less Than 1 yr
		T;N
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		T;N
Procedures in Office
	69210 Remove Cerumen Impaction
		
	17110 Des ben les up to 14
		
	17111 Des ben les 15 or more
		
	10060 I&D abscess simple/single

*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