Clinic Flow

St. Vincent’s Master Resource Guide

Last updated 4/19/2023
For now, this document is just a draft. The first half of this document (Clinic Flow) will serve as a central location for different teams to add notes about their specific protocol/way of doing different things so that we can iron out details and achieve clinic-wide consistency. The second half (Resources for Patients) will serve as a place to share information about various other programs that patients often have questions about but which students have found difficulty answering in the past (Ie: questions about food bank, other community programs). Please feel free to add sections as you see fit based on what your committee/group handles. This document will be kept up to date by P&P and QI/RD after each St. Vincent’s monthly meeting or more frequently if needed, and by any other parties involved in clinic flow.
Goals for this document as outlined by Dr. Farr in

Clinic Flow

Referrals

Referrals for most services offered at St Vincent’s are no longer needed. Patients may schedule appointments for the following specialties directly at the front desk: Neurology, dermatology, neurology, psych, OB/GYN and ENT.
Ophthalmology and Physical Therapy clinics are the only clinics that cannot be scheduled directly at the front desk and still require a referral order placed in Epic.
Imaging Services
St Vincent’s does not offer imaging services directly. Patients who need imaging services have two options, they can apply for casebook if they meet the requirements or they can go to Gulf Coast Imaging Center. If referring to Gulf coast imaging fill out this form and provide the patient with a written prescription for the needed test. They will need to call GCI to schedule their appointment. For more information you can follow the steps outlined here:
Imaging Cost
The prices for each test are outline here:
MRI with contrast is $500, Without contrast: $450 and with and without contrast: $650.
MR Angiogram is $450. Arthrogram: $850. Pain management - ESI injection level 1: $600 per visit, a Level 2 is $700 per visit and level 3: $800 per visit
Myelogram: $850
Oral Sedation between 8am-4pm is $10 and after hours is $60. IV Sedation costs $60
CT Thorax with contrast is $250, without contrast: $200, with and without contrast is $375. CT Pelvis/abdomen with contrast is $375, without contrast: $300 or with and without contrast is $400
XRay 2 view: $35, 3 view: $40, 4 view: $45, 5 view: $50, 6 view: $65, Scoliosis Series: $105
Ultrasound (US) is $120. Prostate US is $150 (only offered in Pasadena), pelvic/transvaginal US is $200, Carotid duplex US is $175, Venous Arterial US Unilateral is $140 and bilateral: $200
IVP is $140
Barium Enema is $150 and Barium Swallow is $120
UGI is $130 and with small bowel it costs $250
Nuclear Medicine exams: A bone scan is $200, bone scan full is $250, Bone scan 3 phase: $250, a spect scan is $800, HIDA test is $240, Thyroid uptake test is $400, Parathyroid is $450 and Renal is $350
** If your patient is unable to afford the cost of the imaging study they need and they do not qualify for casebook funding or are unable to wait, you need to ask the patient how much of it they can pay. The Student clinic may be able cover the rest if the imaging study may change the course of the patient’s treatment. If you need further assistance please email the finance commitee about this.
** To check on results there are two different processes. If the studies were requested from the day clinic, the results should have been faxed directly to the clinic and may be found in the providers box by the MA office. If they were order from the Student Clinic with Dr. Beach as the provider you may login to Gulf Coast Imaging Online Portal at using the following credentials: Username: beachr and password: Welcome1

Casebooks

STV Student-Run Clinic:
Refer to this checklist for a step-by-step guide
First, make sure the patient has been a legal resident of Galveston/Brazoria County for >6 months
If they are from Harris County, we can walk them through the process for a GOLD card, additional information for the Gold Card can be found at
Be sure to hand the patient a copy of the casebook application and instruct them to complete the application in its entirety and to place close attention to the additional documents (found on page 7) that need to be included when application is mailed or faxed.
If patient leaves clinic with no application in hand: Place a blank copy of the casebook application form (available in English and Spanish) with the patient’s name on it into the med lockers in the front office.
Make sure to log what you place in the lockers in the Blue Binder.
Call the patient and tell them they can stop by during clinic hours (either day clinic or student clinic) to pick up the form from the lockers.
Be sure to fill out the online form under step 2 on the casebook website.
Your work is now done.

PAPs

To initiate a patient assistance program in the clinic you can use one of the two iPAPs. If outside of the clinic, you need to VPN and access the online form via the stvclinic.org website.
Once inside the form, complete the form accurately with all the required information.
Make sure to collect the patient’s signature.
Please input the patient’s income correctly. If the patient has an income, proof is required. Most companies accept a W2, 1099, pension statement, Social Security statement, first two pages of their income tax, or at least 2 consecutive pay stubs. Patients can submit their proof of income by coming to the clinic in person and dropping it off at the front desk, or they can submit it via the following link: sqr.co/POI (This link is automatically sent via text to the patient after completing the online PAP form)
In case the patient does not have any income, a no income letter will be generated automatically and sent directly to the pharmaceutical company.
It is crucial to ensure that you fill out ALL the necessary information on the application form.
Both the patient's signature and the provider's signature should be included on the form.
By following these steps, you can initiate the patient assistance program efficiently and ensure that all the required documentation is provided.
Once submitted, the application will be faxed by the admin committee. You can see a copy of the generated PDFs on the team's channel.
Available PAPs on iPAP
The following medications are available on the iPAP and can be done using the automated software found at stvclinic.org: Eliquis, Entresto, Farxiga, Lantus, Admelog, Lispro, Trulicity, Fiasp, Tresiba, Levemir, Novolin R, Novolin N, Novolin 70/30, Ozempic, Victoza, Rybelsus, Symbicort, Skyrizi, Shingrix, Proair RespiClick, QVAR Redihaler, Jardiance, Atrovent HFA, Combivent Respimat, Glyxambi, Spiriva HandiHaler, Spiriva Respimat, Stiolto Respimat, Striverdi Respimat, Synjardi, Synjardi XR, Tradjenta, Trijardy XR and Eylea.
** If the PAP website is not working, please make sure you are logged in to the UTMB VPN or that you are connected to the UTMB wifi.
Checking on the status of a PAP:
Receiving PAP medicines in the clinic:
Every PAP that comes in goes to Amanda; there is a sign in and sign out book at front of clinic. Please log medications when they are brought to the front and when they are picked up using the Pap tracker located in Teams.
Dispensing a PAP medication to a patient:
First check the PAP tracker to see the location of the medication, verify the name of the patient and the medicine, and log the date using the Picked-Up section. All medications need to be logged out in the tracker. For more information see:

Mammograms

To refer a patient for a mammogram, you can go to the following link to fill out the form with the patient. This can also be done by getting a mammogram referral packet from the binder located at the front desk.
Fill out with patient
Make sure to have provider sign it
Leave the packet at the front desk for day clinic they will process it and schedule the patient

St. Vincent’s Student Clinic Resources

Specialty Clinic Schedules:

Dermatology Night
1st Thursday of the month
Neurology Night
2nd Saturday of the month (except June)
Psych Night
2nd and 4th Thursdays of the month
OB/Gyn Night
3rd Tuesday of the month
ENT Night
3rd Thursday of the month
Almost always has openings
Urology Clinic
2nd Wednesday of the month from 4:30 pm - 8:30 pm. For more information, please call 832-910-7621 or email or visit .
Our Urology Clinic offers only vasectomies, a permanent form of birth control for men. You can find more information at

OT Clinic

PT Clinic

CHF Clinic

Dental clinic

Dental committee established Feb 2023, housed under IPC (responsible for recruiting volunteers, community dentists, and general liason with Dr. Kaiser).
If your patient needs dental extractions, you have two options. You can refer them to the walk-in clinic on Saturday mornings here at St Vincent’s clinic where the first 6 patients will be seen, recommend patients to come early to get a spot, people usually start lining up at 8am. If the patient prefers, they can be referred to the Day Clinic (NP Clinic) for a referral to Dr. Glenn Family Dental where they can get up to 2 dental extractions. The procedure is covered by a grant. Patients must pay the day clinic copay and bring the receipt to their appointment at Dr. Glenn’s office.

Hep C Clinic/Screening

For more information contact Jacob Harper and David Clark
If you’re working the front desk, please do NOT give patients Hepatitis C medications. These patients need to be given special instructions from the Hep c team on how to take them.
There is a specific Hep C locker at the front office. The Hep C team will coordinate a date with patients to come and pick them up

Ophthalmology scheduling (Optometry resources listed below) (3/22/2023)

All patients needing to be seen by ophthalmology MUST be screened by the ophtho screening team first. To set this up, please make a referral to ophthalmology AND schedule the patient for an ADMIN visit (not injection visit) on a Tuesday/Thursday Gen Med Night. Please right “ophtho screening” in the appointment notes.
DO NOT schedule patients for Ophtho on Saturday!
When patient is scheduled, please make sure that they are aware of this appointment!
Please DO NOT schedule a patient to see ophthalmology for glasses
We do have OPTOMETRISTS for eyeglasses through two programs:
Fill out this form and Liz will take it from there:
The Lions Club of Galveston sees patients downstairs at STV on the 1st and 3rd Fridays of every month. To get patients scheduled for this, please email Liz () with the patient’s name, DOB, and contact phone number.
Please be warned that they are booked out for several months! We are working on trying to get more availability.
Prevent Blindness Texas will also host free optometry evals on the 4th Monday of the month from 9am-12pm downstairs. Patients need to walk in by 11:30 (They will not be here in May because of Memorial Day weekend).
If you have any questions, please reach out to Pearson, Bryan G. and Sneha Gajarla!

Pulmonary Rehab Clinic

UTMB Respiratory Care faculty and students will begin a Pulmonary Rehabilitation (PR) Clinic with a Smoking Cessation program on Tuesdays from 12:30-5:00pm
Tuesdays from 12:30pm – 5:00pm. For patients with COPD, ILD, or pulmonary conditions that limit ADLs, can schedule for an initial visit with Respiratory Therapy on Wednesdays during the IP clinic.
If the patient is a candidate for Pulmonary Rehabilitation, they will enter the 6-week program
Services:
Pulmonary Function Tests (PFTs)
6 Minute Walk Test
Disease Education
Medication Education
Breathing Techniques
Individual exercise plan
Smoking cessation (if applicable)
Fr additional questions please contact Melissa Yanes and Daneen Nastars

Gender/Endocrine Clinic

2nd Tuesday of every other month (April, June, August, October, and December 2023)
Only 4 scheduled slots per clinic night. As of April 2023 already scheduling into December 2023 for new patient appointments
1-2 tele visit overbook spots for established patients only
Prioritize Gender care clinic patients, if patients need endocrine care please casebook
If unable to casebook for endocrine, we can then schedule with Gender/Endocrine clinic
For any questions contact Haris Pepermintwala: (214) 668-1669

Counseling Services

Through a partnership with Family Service Center of Galveston County St Vincent’s clinic offer mental health services 6 days a week by appointment. Family and individual counseling are available. If you or someone you know might benefit from talking with a counselor, please call 409-762-8636 for an appointment.
This is a self-referred service.
Tony can provide therapy and counseling services during day clinic hours or during the early hours of Thursday psych nights. Patients may contact him via his email address is or his phone number 4097652217 to schedule an appointment.
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Alcoholics Anonymous

Meetings occur downstairs on every ____ at ____
Lab Appointments
Patients who have labs signed can be scheduled for any STV evening clinic (including specialty clinics)
Patients who have difficulty making it to the clinic during the evening may come in during Day as walk-ins for lab work only Monday through Friday between 8 and in 11am.

Affiliated STV Clinics

Nursing Appts with Martha

If urgent follow up is required sooner than available, your patient needs a blood pressure check, hypertension protocol or diabetes education you may be able to schedule a nursing visit with Martha or Andrea. Nurse visits are available Monday afternoon, Wednesday all day, and Friday mornings and they must be scheduled from the CEE context. RN visits are only to be scheduled as RN PROVIDER or RN RM (IP clinic only). Do not use an admin visit as they will not show up on the schedule. When scheduling a nursing appointment for your patient please leave very detailed instructions in your Epic note of what you want her to check on, otherwise, she will not know what is needed. Also, please put the detailed reasoning in the appointment notes as well.

Wound Care Clinic (Day Clinic)

I-COPE Program

Grace Clinic
Walk in clinic every Thursday morning at Galveston Central Church. Volunteers primarily consist of MS3 I-COPE students assigned to Grace Clinic who are excused every other Thursday morning to volunteer there. The patient population primarily consists of unhoused, uninsured patients. Medications dispensed at clinics are usually taken to Central Church on Thursday afternoons, or if understaffed, medications will be taken to Central Church on Tuesdays.
Services Offered: Includes SW, PT, lab services, RN visits, foot baths, and medical care
Reach out to Dr. Farr with any questions
Fisherman’s Clinic

County Based Resources (from Shellie)

UTMB CHP (Community Health Program):

Requirements/Criteria:
Brazoria and Galveston County (only)
Unfunded
Citizen/Non-Citizen
Adults
DX: asthma, DM, HTN, COPD, CHF, Cirrhosis, CVA
It is not Home Health Care
Services:
Assist with community applications
Education on disease management
Assist in navigating local, state and federal health care systems of paperwork and community resources
Provide glucometers, blood pressure cuffs, and scales
Please check chart prior to making a referral to see if a CHP worker is already involved
Make referral to Shultis, Latonia L. and add EPIC order for CHP referral

RMCHP - Regional Women’s Services & Pediatrics:

Requirements/Criteria:
Unfunded
Female
Citizen/non-citizen
Services Provided
Well Women
Birth Control
Screenings
Pregnancy
Brochures are on the door by resource racks
Providers make the referrals

Galveston County Indigent Health:

Please be sure that the pt is first not eligible for STV Social Service Casebook before initiating these applications often times patients do not need to do these county applications:

Requirements/Criteria:
Galveston County residents
Who don’t qualify for Medicaid or Medicare
Under 100% below poverty line
Must have Driver’s License, Social Security Card and Birth Certificate
Address on application MUST match driver’s license
Covers hospital and specialty care once approved with a referral from county, if approved patients will need to continue following up at Coastal Health & Wellness
Look for applications on the racks

Brazoria County Indigent Health:

Same information
Look for application on the racks

In Basket

In Basket
Primarily handled by IPC subcommittee, but In-Person support and front desk leadership should still work on the In-Basket during their time in clinic so that things aren’t missed
Please check to see if a patient is an I-COPE patient before sending to student clinic; this should be sent to the CEE pool for management.
IPC Contact: Maddy Rock (Chair) and Haris Pepermintwala (Director)

LAB RESULTS COMMUNICATION

For NORMAL results, we can just call/message the patient and inform them of their results.
For ABNORMAL results, we need to wait for the provider to comment on them.
If the provider has not commented on them and the patient is calling to ask, you can re-route the results to the provider
If they don’t reply, we can make an appt (a full appointment, NOT an admin visit – because this will require doctors to see the patient and comment on the results) for the purpose of review labs/results
c. Remember, we cannot make recommendations or share abnormal results unless explicitly told to us by a provider

Inventory

Please take items from front closet, not back closet anymore.

Resources for Patients

Food bank:

***

Walking group:

***

Vision Resources

Jacob Moran: “I added a form to the Team for anyone who needs optometry services at the last monthly meeting. The details change often, and the form emails contact information to Liz so she can get the patient set up with Lions Club, Prevent Blindness, whatever they're doing at the time.”
Sight for All (Dr. Susie Mehta)
Client/patient sees Dr. Mehta for an Optometry exam (except dilation), and glasses are ordered through the Life Through Lenses program. It takes 4-6 weeks for the client/patient to receive their glasses, which they pick up from the SVH front desk.
If further evaluation is needed, Dr. Mehta will refer to Ophthalmology clinic
2X per month from 9am to 12pm, schedule varies. Upcoming dates are 3/16, 3/23, 4/6, and 4/20
Appointment required-Liz or Bethanie can add the client/patient to the schedule. Please send patient/client name, DOB, and contact phone number to schedule appointment
Prevent Blindness
PBT conducts a visual acuity test. If the client/patient fails, they are given a voucher to receive an Optometry exam and glasses from a preferred provider. It is the client/patient’s responsibility to then schedule an appointment with an optometrist from the provider list
Last Monday of each month from 9am to 12pm (see attached flyer)
No appointment necessary
This program is for uninsured or underinsured people only
NP clinic/day clinic
Student clinic
Grace Clinic
Every Thursday morning at Galveston Central Church. Volunteers primarily consist of MS3 I-COPE students assigned to Grace Clinic who are excused every other Thursday morning to volunteer there. The patient population primarily consists of unhoused, uninsured patients. Medications dispensed at clinic are usually taken to Central Church on Thursday afternoons, or if understaffed, medications will be taken to Central Church on Tuesdays.
Mobile Clinic/CEE

Other Situations

What to do if my patient is TUBERCULOSIS positive:

Know that when you have a TB positive patient, these cases are monitored and treated by the county health district! These patients do NOT need to be casebooked
Patient must be refer to the county immediately. Two contacts in:
Kelly Kanon (409) 938-2354
Laurie (409) 938-2217
Fax for their department: 409-938-2220

People interested in volunteering at STVSC

Patient who receive a bill for STVSC Services

Email ____

Epic Tips

Useful Smart Phrases:

.AFU
Will list out future UTMB appointments, including appointments that you can’t see in the Appts tab in the STVSC Context (ex. UTMB Nephrology appointments)

How to add instructions for patients in the AVS:

Under Wrap up tab:
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