Unique Plan Description: Breast Ctr MH Clinic
Plan Selection Display: Breast Ctr MH Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-01 13:25:13
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-08 08:52:19
Available at all facilities: Yes

Breast Ctr MH Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemoglobin
		T;N, Routine, spec type = Blood
	Hematocrit
		T;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	PTT - MH/WH/JE
		T;N, Routine, spec type = Blood
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	Type and Screen (No Product on hold)
		T;N, Routine, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Routine, For Possible Transfusion
Diagnostic Tests
Diagnostics
	ECG
		T;N
	Mammo Bil Diag
		T;N, Routine
	Mammo Implant Diag Lt
		T;N, Routine
	Mammo Implant Diag Rt
		T;N, Routine
	Mammo Implants Diag
		T;N, Routine
	Mammo Implants Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	Mammo Bil Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	Mammo Unilat Diag Lt
		T;N, Routine
	Mammo Unilat Diag Rt
		T;N, Routine
	Chest 2 View
		T;N, Routine
CT
	CT Abd Pelvis w & w/o Cont
		T;N, Routine
	CT Abd Pelvis w/o Contrast
		T;N, Routine
	CT Abd Pelvis w Contrast
		T;N, Routine
	CT Chest w & w/o Contrast
		T;N, Routine
	CT Chest w Contrast
		T;N, Routine
	CT Chest w/o Contrast
		T;N, Routine
MRI
	MRI Breast w Contrast Bil
		T;N, Routine
	MRI Breast w/o Contrast Bil
		T;N, Routine
Ultrasound
	US Breast Bil Complete
		T;N, Routine
	US Breast Bil Limited
		T;N, Routine
	US Breast Lt Complete
		T;N, Routine
	US Breast Lt Limited
		T;N, Routine
	US Breast Rt Complete
		T;N, Routine
	US Breast Rt Limited
		T;N, Routine
Medications

	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 or 2 TAB, BY MOUTH, Q4H, PRN pain, # 30 TAB, 1 Refill(s), Hard Stop
	cephalexin 500 mg oral capsule
		1 CAP, BY MOUTH, Q8H, X 7 Day(s), # 21 CAP, 0 Refill(s), Hard Stop
	levoFLOXacin 500 mg oral tablet
		1 TAB BY MOUTH DAILY, X 7 Day(s), # 7 TAB, 0 Refill(s), Hard Stop
	tamoxifen 20 mg oral tablet
		1 TAB BY MOUTH DAILY, # 30 TAB, 3 Refill(s)
	Arimidex 1 mg oral tablet
		1 TAB BY MOUTH DAILY, # 30 TAB, 3 Refill(s)
Patient Care
	Patient Instructions
		Patient to shower with chlorhexadine gluconate evening before surgery.
		Patient to shower with chlorhexadine gluconate morning of surgery.
		No food or drink 8 hours before surgery.
Consults/Follow-up
	Follow-up Appointment
		
	Surgery to Schedule
		
	Request for Service
		
	Consult Oncologist
		
	Consult Radiation Oncologist
		
	Consult Primary Care Provider
		
	Consult Cardiologist
		
Charges/Supplies
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
		
No Charge / Follow Up
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
Procedures in Office
	19100 Breast bx percu needle core
		
	zz96372 Injection Ther/Proph/Diag   SC/IM
		
	19000 Puncture asp breast cyst
		
	10160 Puncture aspirat abscess hematoma cyst

*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