Unique Plan Description: Derm Acne Clinic
Plan Selection Display: Derm Acne Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-18 07:38:49
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 08:56:16
Available at all facilities: Yes

Derm Acne Clinic
Laboratory
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	Lipid Panel
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Pregnancy Test Urine
		T;N, Routine, Routine, spec type = Urine
Medications
	amoxicillin 500 mg oral capsule
		1 CAP BY MOUTH BID, X 7 Day(s), # 14 CAP, 0 Refill(s), Hard Stop
		1 CAP BY MOUTH BID, X 10 Day(s), # 20 CAP, 0 Refill(s), Hard Stop
		1 CAP BY MOUTH BID, X 14 Day(s), # 28 CAP, 0 Refill(s), Hard Stop
	doxycycline hyclate 100 mg oral capsule
		1 CAP, BY MOUTH, DAILY, with food, # 30 CAP, 3 Refill(s)
		1 CAP, BY MOUTH, BID, with food, # 60 CAP, 3 Refill(s)
	doxycycline hyclate 150 mg oral delayed release tablet
		1 CAP, BY MOUTH, DAILY, with food, # 30 CAP, 3 Refill(s), Soft Stop
		1 CAP, BY MOUTH, BID, with food, # 60 CAP, 3 Refill(s)
	ISOtretinoin 20 mg oral capsule
		1 CAP BY MOUTH DAILY, with food, # 30 CAP, 0 Refill(s), Hard Stop
		1 CAP BY MOUTH BID, with food, # 60 CAP, 0 Refill(s), Hard Stop
		See Instructions, 2 CAP BY MOUTH QAM and 1CAP QHS, # 90 TAB, 0 Refill(s), Hard Stop
	ISOtretinoin 30 mg oral capsule
		1 CAP BY MOUTH DAILY, with food, # 30 CAP, 0 Refill(s), Hard Stop
		1 CAP BY MOUTH BID, with food, # 60 CAP, 0 Refill(s), Hard Stop
		See Instructions, 2 CAP BY MOUTH QAM and 1CAP QHS, # 90 TAB, 0 Refill(s), Hard Stop
	ISOtretinoin 40 mg oral capsule
		1 CAP BY MOUTH DAILY, with food, # 30 CAP, 0 Refill(s), Hard Stop
		1 CAP BY MOUTH BID, with food, # 60 CAP, 0 Refill(s), Hard Stop
		See Instructions, 2 CAP BY MOUTH QAM and 1CAP QHS, # 90 TAB, 0 Refill(s), Hard Stop
	minocycline 100 mg oral capsule
		1 CAP, BY MOUTH, DAILY, # 30 CAP, 3 Refill(s), Soft Stop
		1 CAP, BY MOUTH, BID, # 60 CAP, 3 Refill(s), Soft Stop
	spironolactone 25 mg oral tablet
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 3 Refill(s)
	spironolactone 50 mg oral tablet
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 3 Refill(s)
	spironolactone 100 mg oral tablet
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 3 Refill(s)
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 3 months
		Follow Up Visit, 1 month
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
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
No Charge / Follow Up
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
Procedures in Office
	10040 Acne Surgery
		
	96999 Laser consult (N/C)
		
	96999 laser, smoothbeam

*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