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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

2/28 Milestone Tracking Sheet⁠

⁠

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

https://www.gulfcoastmri.com/wp-content/uploads/Physicians-Referral-Form.pdf⁠

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:

https://liveutmb.sharepoint.com/:p:/r/sites/stvsc/Shared%20Documents/How-to%20Guides/How%20to%20Gulf%20Coast%20Imaging.pptx?d=w8a5fe6ff34c24969905672d18c9f6ac3&csf=1&web=1&e=8BrQ43⁠

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

https://gulfcoastmri.viztek.net/phy/GCMR/login#home⁠

using the following credentials: Username: beachr and password: Welcome1

Casebooks

STV Student-Run Clinic:

Refer to this checklist for a step-by-step guide

https://stvclinic.org/2022/04/27/casebook-applications/⁠

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

https://www.harrishealth.org/access-care/patient-eligibility⁠

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:

If you need to check on the status of a patient assistance application, please go to the teams channel to access the PAP tracker or follow the following link:

https://teams.microsoft.com/l/channel/19%3Aa5dc3697a5c646538eedc3b6ac3ffb3b%40thread.tacv2/tab%3A%3A25b09c96-9137-4c09-a956-a7115ef93e0e?groupId=56613934-579e-4761-a8d1-6b7d85d37adf&tenantId=7bef256d-85db-4526-a72d-31aea2546852&allowXTenantAccess=false⁠

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

https://utmb.us/74k⁠

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

coastewa@utmb.edu⁠

or visit

https://drive.google.com/file/d/1k2RmkTM0K3CIb3MQdJ0GsB0R4z4frjat/view⁠

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:

⁠

https://forms.office.com/pages/responsepage.aspx?id=bSXve9uFJkWnLTGuolRoUrJitblnta9JjWflzVtaHvFUOTk3MVpTODFOMVo4RlU4S0xKNlYyMzlUSC4u⁠

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 (

elgarci4@utmb.edu⁠

) 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.

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