Unique Plan Description: PMC Spinal Headache Clinic
Plan Selection Display: PMC Spinal Headache Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-08 12:18:22
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-13 00:03:41
Available at all facilities: Yes

PMC Spinal Headache Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Pain Management Drug Pnl Urine
		T;N, Routine, Routine, spec type = Urine
	Pain Management Drug Scn w/ Interp Urine
		T;N, Routine, Routine, spec type = Urine
IV Solutions
	Lactated Ringers (In Office)
		1,000 mL, IV, T;N, 125 ml/hr
Medications
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN pain, # 60 TAB, 0 Refill(s), Hard Stop
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN pain, # 60 TAB, 0 Refill(s), Hard Stop
	Percocet 5 mg-325 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN pain, # 60 TAB, 0 Refill(s), Hard Stop
	Percocet 7.5 mg-325 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN pain, # 30 TAB, 0 Refill(s), Hard Stop
	Percocet 10 mg-325 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN pain, # 30 TAB, 0 Refill(s), Hard Stop
	Ultram 50 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN muscle spasms, # 30 TAB, 0 Refill(s), Hard Stop
	ondansetron  4 mg oral tablet
		1 TAB, BY MOUTH, Q6H, PRN for nausea, # 10 TAB, 0 Refill(s), Hard Stop
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 1 month
		Follow Up Visit, 1 week
		Follow Up Visit, 1 year
		Follow Up Visit, 3 months
		Follow Up Visit, 3 weeks
		Follow Up Visit, 6 months
		Follow Up Visit, See Special Instructions
Charges/Supplies
	62273 Inj Epidural of blood or clot patch
		
	IV Infusion; Hydration, Initial Hour 96360
		T;N
	IV Infusion; Hydration, Each Add'l Hour 96361
		T;N
	99221 EVM - Initial Hosp Care, per day,Low; 40 min -PF
		T;N
	99222 EVM - Initial Hosp Care, per day, Mod; 55 min -PF
		T;N
	99223 EVM - Initial Hosp Care, per day, High; 75m
		T;N
	99231 EVM - PF Subseq Hsp Care, per Day, Low; 25 Min -PF
		T;N
	99232 EVM - PF Subseq Hsp Care, per Day, Moderate; 35min PF
		T;N
	99233 EVM - Subseq inpt visit, High; 50 m
		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
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

*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