General Recommendations
AAFP Preventive Healthcare Schedule (pg 3-4)
Search USPSTF Recommendations
Advanced Care Planning: Ohio DNR Form, values worksheet (give patient a whole packet)
Vision Resources: .VISIONCENTERS2024
Dentists: .DENTALUPDATE2024

Vaccines
Vaccine Schedule: Adults - CDC

RSV for Adults - Two new vaccines, Arexvy and Abrysvo, have been approved to prevent severe lower respiratory tract illness from RSV. 
- Both are approved in adults > 60 years old. CDC recommends shared clinical-decision making and recommend more strongly for patients at higher risk of severe RSV disease. Risk factors include: Cardiopulmonary disease, kidney disease, liver disease, neurologic / neuromuscular disorders, hematologic disorders, diabetes, moderate or severe immune compromise, frailty, advanced age, residence in nursing facility
- Abrysvo is also approved for pregnant women between 32 and 36 weeks gestation to prevent RSV hospitalization in infants during first 6 months of life.
*We do not have in clinic, but Hoxworth pharmacy has Abrysvo. 

ASVCD Risk Reduction
Cholesterol Management, based on 2018 ACC recs (chart on p 12) .lipidmanagement has all the charts in it
ASCVD Risk Calculator, ACA/AHA pooled cohort calculator (also .ASCVD but make sure DM dx and smoking hx are updated).

Aspirin for primary prevention:
2019 ACC/AHA recs Consider for 40-70 y/o with high risk of ASCVD and no increased bleeding risk
USPSTF recommendation is under review (previously: use low dose for 50-59 y/o if 10y risk>10%)   

Omega-3 fatty acids
2020 Cochrane Review no clear benefit, may slightly reduce coronary outcomes but not overall ASCVD outcomes
2021 Lancet Review EPA alone has benefit but DHA + EPA does not

Cancer Screening (see below)
Specific Populations (see below for Elderly and Adults with Disabilities) 

Advanced Directives
Help filling out advance directives: PREPARE (prepareforyourcare.org)

Childhood Cancer Survivors
Screening Guidelines from Children's Oncology Group

Adults with Down Syndrome
2020 guidelines: Screening Checklist, full guideline, recommendations table on page 16 from Global Down Syndrome Foundation
Down Syndrome Medical Interest Group, Resource Library from Advocate's Adult Down Syndrome Center for patients, caregivers, and health professionals
Early Detection Screen for Dementia

Sickle Cell
2019-2021 ASH Clinical Guidelines for SCD (can also download the ASH Practice Guidelines app, which has lots of other info as well!)

Allergies
If you have patients who would benefit from being seen in Allergy Clinic, Melissa Martin can help get patients scheduled.

Chest Pain
Pretest probability model for CAD: CAD Consortium
ACC algorithm for stable chest pain: no known CAD, known CAD

Diabetes
DM Medical Management Diagrams, from ADA 2020 standards of Care
full document here, abridged for PCPs here
for medication info for discharge instructions, try .diabetesmedsinstructions
Diabetes Education Videos from Penn Medicine

Evidence for CGMs:

• Evidence shows that CGMs are helpful for allowing clinicians to review glucose data and make treatment recommendations. But did you know that just wearing a CGM can lead to reduction in A1c even without medication changes? CGMs put patients in control and give them real-time data so that they can make real-time lifestyle changes to improve their glucose. "Doc, did you know mashed potatoes really increase your glucose?!?"

Coverage for CGMs:

• Medicare: Covered for patients with a diagnosis of DM1 or DM2 who are on at least 1 daily insulin injection or have had documented severe hypoglycemia (see below).

  • Hypoglycemia definitions for CGM coverage: 

    • One or more hypoglycemic events (glucose < 54) that persist despite modification to the treatment or medication plan 

    • One hypoglycemic event (glucose < 54) requiring third party assistance for treatment (i.e. EMS, Emergency Room, family member). 

  • You must prescribe a sensor that has an available receiver or reader (e.g. Dexcom G7 or Libre 2 or 3). The patient does not have to use the receiver/reader if they want to use their phone, but the prescribing a receiver/reader is a Medicare requirement.

• OH Medicaid: Covered for any patient with a diagnosis of DM1, DM2, or Gestational Diabetes. No therapy requirements! 

• KY Medicaid: Covered for patients with DM1, DM2 on at least 1 insulin injection, or Gestational Diabetes. 

• Commercial: Varies based on the patient plan. You can always try to prescribe for patients with a Type 2 Diabetes diagnosis and see if it is covered. 

Popular Types of CGMs:

• Dexcom G7

  • Can connect to smart phone app, but also has an available receiver for patients whose phones are not compatible or if they don't have a smart phone. 

  • Data Provided - Automatically uploads glucose reading every 5 minutes. Provides arrow indicators if glucose is trending, up, down, or stable. 

  • Sensor size = quarter sized 

  • Sensor life = 10 days + 12 hour grace period

  • Alarms = Customizable hyper and hypoglycemic alarms. Non-modifiable urgent low alarm for glucose < 55.

• Libre 2

  • Can connect to smart phone app, but also has an available reader for patients whose phones are not compatible or if they don't have a smart phone. 

  • Data Provided - sensor must be scanned once every 8 hours to upload data. If not, data is lost. 🙁Provides arrow indicators if glucose is trending, up, down, or stable. 

  • Sensor size = quarter sized 

  • Sensor life = 14 days

  • Alarms = Customizable hyper and hypoglycemic alarms. Non-modifiable urgent low alarm for glucose < 55.

• Libre 3

  • Can connect to smart phone app, but also has an available reader for patients whose phones are not compatible or if they don't have a smart phone.

  • Data Provided - Automatically uploads glucose readings every 1 minute. Provides arrow indicators if glucose is trending, up, down, or stable. 

  • Sensor size = dime-sized 

  • Sensor life = 14 days

  • Alarms = Customizable hyper and hypoglycemic alarms. Non-modifiable urgent low alarm for glucose < 55.

• Libre 3 Plus

  • Very similar to the Libre 3, but it has a 15-day wear time and can integrate with insulin pumps.

• Stelo

  • NOT covered by insurance. This is an over-the-counter continuous glucose monitor marketed for patients with prediabetes or who are fitness/health conscious and glucose-curious. 

  • Very similar to the Dexcom G7 in terms of data, but there are no hypo/hyper alarms. App gives insights and reflective questions.

  • Each sensor lasts 15 days.  Pack of 2 sensors costs $89. 

Reviewing Your Patient's Data:

• You can review your patient's data by viewing their app on their phone or their receiver/reader. Look at their "Time in Range" — the goal is more than 70%!  You can also see their estimated A1c, which means you can see the effects of therapy changes sooner than waiting every 3 months for a new A1c! 

• Information is hanging in clinic about how to do this for your patients! 

Headaches
Formal Classification System
Red Flags: new headaches >50 y/o, positional, new type, brainstem aura, unexplained weight loss, immunocompromised, focal neuro exam
Migraines make up  75-90% of headaches presenting to primary care
Try the primary care treatment app for med help diagnosis and 4 short good learning modules
Acupuncture often covered for migraines (see Chronic Pain below)

HTN
for medication info for discharge instructions, try .hypertensionmedsinstructions
Simplified Management Protocol - AMA

Infections
ABx Coverage Chart

Iron Deficiency Anemia
Create Infusion Treatment Plan --> OP IRON REPLACEMENT INFUSION PLAN
Will ask for an attending physician at some point.
Aa. Pre-Cert Authorization
        UCH Non-Chemo Authorization Urgency Attestation
Category: Aa. Pre-Cert Authorization
Ref to Department: UH INFUSION SVCS GNI
Comments: Include as much information as possible about the need for iron infusions. 
MD Communication II
Has the patient failed other IV iron regimens?: Asking about the use of Venofer if attempting to order Monoferric (the one-time, 1g version rather than 300mg x3 weeks)
Has the patient failed oral iron therapies?: Either treatment failure or side effects of oral iron (constipation, GI upset, etc.)
Comments: If selecting an IV iron plan that is NOT the one that was initially selected, indicate what you'd like them to do if it is not approved (ie: If unable to obtain prior authorization for MONOFERRIC, please switch to VENOFER 300mg weekly.)
Medications
Calculate iron deficit using Ganzoni equation (MDCalc)
Select between iron regimens (usually Venofer 300mg weekly, but if <1g deficit can try for Monoferric 1x dose)

Lung Disease (Asthma, COPD)
Make sure to use the new referral panel to make sure your patients get connected with the most appropriate care!

Inhalers: Wheezy Puff Inhaler Guide
Inhaler Videos from American Lung Association: Instruction Videos
Inhaler Chart, inhalers4u.org
Asthma Severity Criteria, Asthma Treatment Steps (GINA & NIH charts), Inhaler Intensity Chart
GOLD app, COPD Tx Recs from the American Thoracic Society
CAT (COPD Assessment Test) >10 => choose LAMA/LABA combo for treatment even if no exacerbation

Ordering Home Oxygen: Patient needs to have a 6-minute walk test, which we can do in clinic. RN can perform and use MPWALKTEST or DMEOXYGEN dot phrases to document. The provider must place an order for Home Oxygen. 

Musculoskeletal Pain
.backpainvideos
University of Michiganvideos targeted based on a set of questions
Stretches for acute relief of sciatica from herniated disc from Spine Universe
AAOS Targeted Exercise Programs PDFs: Spine, Shoulder, Knee
Rheumatology Criteria- American College of Rheumatology, includes various diseases includes some kids stuff, click "excerpt" link if available

Sleep Concerns
CBT for Insomnia - evidence based tx for insomnia - CBTI Coach is an app intended as an adjunct but may help if CBTI is not accessible
Sleep Apnea - try home sleep study for pts with fewer comorbidities, type home sleep and go to database
Epworth Sleep Scale, Stop Bang

Need for Dietician -  Order "diabetes education" and select "initial medical nutrition therapy"

Need for Outpatient Therapy - New! When you search for "outpatient therapy" in orders it is under Database. Opening it up has some more specific therapy types that you can refer your patients to, like vestibular therapy (under OT) and lymphedema therapy! 

Pre-Operative Management of GLP1-RA
There is increased concern that GLP1-RAs cause delayed gastric emptying and may predispose patients to aspiration during surgeries or endoscopies. Please take a look at the attached document for more information on managing these medications in the pre-operative setting.

E-consults are available for Neurology, ENT, and Infectious Disease. See guide here.

Combined Guidelines with Special Cases

Breast Cancer
ACP Guidance Statement 2019
For average risk women: Mammogram every year or every other year from 40-50 years old until 75 or 10 years life expectancy, breast self awareness, no screening clinical exam
Breast Imaging at UC (513) 584-PINK  .breastcancerscreening
Tyrer-Cuzick RIsk Calculator
Breast & Cervical Cancer Project 1-844-430-BCCP (2227) covers screening <300% FPL ~45k/y for single ~90k/y for family of 4

Cervical Cancer
21 to 29 every three years with cytology alone
30 to 65 with cytology and high-risk human papillomavirus cotesting or high-risk human papillomavirus testing alone
Guidelines on follow up of cervical cancer screening, $10 app or free online but more cumbersome since you have to verify email to use https://app.asccp.org/

Colon Cancer
American Cancer Society
Screen all patients 45-75, shared decision making for 76-85
multitargeted stool DNA test every 3 years (Cologuard) OR colonoscopy every 10 years OR CT Colonography or flexible sigmoidoscopy every 5 years
Cologuard: order through EPIC, associate with encounter for colorectal cancer screening (Z12.11, Z12.12)

Lung Cancer
USPSTF: Annual low-dose CT 50 to 80 y/o with a 20-pack-year history who currently smoke or quit within the past 15 years

Prostate Cancer
USPSTF: Shared decision-making: Discuss PSA screening for average risk men 55-69 - Grade C
ACS: discuss PSA screening for average risk: 50-69y; consider at 45 for African Americans
American Urological Association Guideline agrees with the above, emphasizes that African Americans and patients with a family history of prostate cancer may benefit from screening 

DO NOT screen for Ovarian or Pancreatic Cancer for average risk patients

SPECIAL INDICATIONS BASED ON FAMILY HISTORY
Family History of Colon Cancer 
Recommendation from the the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF)
IF One 1st degree relative <60 has colorectal cancer or documented advanced adenoma
OR IF two 1st degree relatives at any age have colorectal cancer or documented advanced adenoma  
THEN screen by colonoscopy every 5 years starting at 40 or 10 years prior to the youngest onset of cancer (whichever is sooner) 

Family History of Breast Cancer or Family History of BRCA or other Syndromes
Recommendation from the American Cancer Society 
IF lifetime risk is 20-25% or more (i.e. if two 1st degree relatives have breast cancer)
Breast Cancer Risk Assessment Tool (most commonly used, DOESN'T HAVE DENSE BREAST)
Tyrer-Cuzick RIsk Calculator (more detailed BUT JUST FILL OUT ALL OF IT)
Black Women's Heath Study Calculator
OR IF a first degree relative has known BRCA (assuming patient has not tested negative)
OR IF a first degree relative has Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome
THEN screen for breast cancer with MRI and mammogram annually starting at age 30
Dense Breast Tissue - cancer risk similar to 2 1st degree family members with breast cancer recommend MRI screening 

Family History of Prostate Cancer
From the American Cancer Society 
1 first degree relative with prostate cancer prior to 65y: discuss PSA starting at 45
2+ first degree relatives with prostate cancer prior to 65y: discuss PSA starting at 40

Special Indications Based on Personal History/Factors

HIV: Increased risk of cervical, liver cancer
Cervical Cancer Screening, per ACOG, assuming normal results:
<21 y/o: start screening when sexual activity begins
<30 y/o: new cytology at HIV diagnosis, then annual screening, then can do q3y cytology
>30 y/o: new testing at dx then: either co-testing q3y or 3 annual cytology tests followed by cytology q3y
lower threshold for colposcopy in general 
Cervical Cancer: annual pap and HPV testing
Hepatocellular Cancer: controversial rec for ultrasound screening if Hep B or Hep C is positive
Immunosuppression: solid organ transplant, IBD, RA with immune modulators

Trisomy 21 (Down Syndrome): Increased Risk of Leukemia, gonadal cancers
Leukemia: annual CBC
Gonadal/pelvic cancers: annual testicular exam, Pap smear and pelvic exam (every 1-3 yrs. after first intercourse). If not sexually active, singlefinger bimanual exam with finger-directed cytology exam. If unable to perform, screen pelvic ultrasound (every 2-3 years). Breast exam (annually). 
Breast Cancer - annual breast exam (less likely do notice a lump themselves?)
Cirrhosis: screen for HCC q6m with ultrasound +/- AFP

Chest Radiation
Recommendation from the American Cancer Society 
IF radiation to the chest between 10 and 30 years old
THEN screen for breast cancer with MRI and mammogram annually starting at age 30

BRCA
Rec from the American Cancer Society: Screen for breast cancer with MRI and mammogram annually starting at age 30
Rec from ACOG
Breast Cancer 25-29: MRI annually, 30+ MRI and mammogram annually
Ovarian Cancer: Consider CA-125 and/or Ovarian ultrasound starting at age 30-330-35
NCCN Recs  if +fam hx of  pancreatic cancer, consider EUS or MRCP starting at the earlier of 50 y/o or 10y before earliest dx

Lynch Syndrome (hereditary non-polyposis colon cancer, HNPCC)
Consider Lynch if 3+ family members with cancers in 2+ generations AND at least 1 pair are 1st degree relatives AND 1+ <50y at dx AND FAP is excluded
American College of Gastroenterology Recommendation
Screening colonoscopy starting at 20-25y, at least q2y, prefer annually if confirmed carrier
Consider EGD once for gastric, duodenal cancer at 30-35, consider 3-5y repeat
Endometrial bx and transvaginal ovarian ultrasound annually if no surgery

Familial Adenomatous Polyposis (FAP), also MAP and AFAP
American College of Gastroenterology Recommendation
Annual colonoscopy starting at puberty

Pending...
MEN2A
MEN2B
MEN1
NF1

Check out the PPT Logan Walker made about mental health management in clinic!

Assessment Tools
PHQ-9, GAD-7, Both: Can also find these in the Screening section in a patient encounter or enter into flowsheets
Geriatric Depression Scale: simpler than PHQ-9, validated tool for elderly patients, normal is <5
MDQ: Bipolar screener to detect mania/hypomania, positive if 7 or more yeses in question 1 and question 2 is yes and question 3 is moderate to severe
PCL-5: PTSD eval developed by the VA, updated for DSM 5 (scale changed so scores not comparable to previous version), not re-validated, cutoff score for benefit from treatment is a total ~32, clinically significant improvement is a decrease of 10 or more

Smoking Cessation
Ohio Quit Line, free coaching by phone & text, 8 weeks free NRT
Kentucky Quit Line, free coaching by phone & text, may have to pay for NRT
SmokeFree.gov
Quit Plan, helps patients create a quit plan based on their current smoking habits

Finding a Counselor (try .therapistresources)
Lifestance.org: 844-468-5050 [has psychiatry as well as in-person and telehealth resources, formerly psychbc]
Psychology Today: can search by area of focus, insurance, sex of therapist, etc.
Thecounselingsource.com: tele-therapy available for patients on Medicaid

At UC
LGBTQIA Psychotherapy: Maya Daeufel, PsyM will be starting the week of July 10th, 2024. Refer by putting in Psychiatry - Therapy or Counseling referral and entering her name in the provider section.
Triple Board Residency Clinic: As of 6/2024, they are looking for adult therapy patients! They cannot see Medicare/Medicaid, but can see private or uninsured. Email Alex Marcovicci with referrals.

Dual Diagnosis (as well as additional general resources)
GCB (Greater Cincinnati Behavioral Health: care management, dual diagnosis as well as substance use or mental health concerns alone, housing and criminal justice services, adolescent mental health transition services, employment services [contact info by location]
Talbert House: same day outpatient services for addiction and mental health, MAT, services for survivors of abuse, youth employment, halfway houses [513-221-HELP (4357), 24/7 Crisis Line: 513-281-CARE (2273) or text:TALBERT to 839863]
Center for Addiction Treatment: medically supervised detox, residential, residential substance use treatment, outpatient treatment, MAT, support groups for family members [Access Team: (513) 381-6672]

Substance Use
HARC Clinic - Led by Dr. Michael Binder and Dr. Carolyn Chan on Friday mornings. They will see patients with alcohol use disorder, opioid use disorder, polysubstance use, and cannabis use disorder. Services provided include: medication management (not methadone), harm reduction and overdose prevention, Hepatitis C treatment. Send Drs. Binder and Chan a message to refer patients. If your patient is being seen in MP Clinic on Friday morning and is interested, send them an Epic chat - they take walk-ins!

Medications
NAMI: has great info pages on specific medications.

Emergencies and Urgent Needs
988:National mental health crisis / suicide hotline
Psychiatric Emergency Services (PES): when there is an immediate risk of harm to self or others [(513) 584-8577]
Mobile Crisis Team: mental health crises in the community [(513) 584-5098, after hours call PES]
Crisis Stabilization Center at MHAP: an alternative to in patient hospitalization (for non-emergencies), partial hospitalization available
Mental Health Access Point, part of Central Clinic: (513) 558-8888
Talbert House: same day outpatient services for addiction and mental health, addiction medicine allows week day walk-ins from 8-9am

Additional Community Resources
One page phone # list for multiple resources
UC Stress Center: specialized individualized treatment program for PTSD, order a psych referral, choose the PTSD/stress option (513-558-5872)
NAMI SW Ohio (National Association of Mental Illness)
Treatment Locator from Substance Abuse and Mental Health Services Administration, a division of HHS
24/7 National Referral Helpline: 1-800-662-HELP (4357) English and Spanish
24/7 National Suicide Prevention Lifeline: 1-800-273-TALK (8255) 

Harm Reduction
Hamilton County Public Health Department Programs
FREE Narcan: can be through the mail
Syringe Program: Rotating sites

If you counsel any of your patients about firearm safety during any visit, you can now use the dot phrase .FIREARMSAFETYCOUNSELING in your A&P!

Curable an online pain psychology program/app, $5/month

UC Chronic Pain Guidelines, (Sign into UC mail first) Naloxone requirements, Med Peds Clinic: Opioids

Type "integrative" into the orders search bar, all but massage should be covered by insurance (acupuncture is usually covered for LBP and migraines)

UC Integrative Medicine
Personal Health Inventory
National Center for Integrative Care
VA Whole Health
Academic Consortium of Integrative Medicine and Health
IM4US, integrative medicine for the underserved
Integrative Medicine Textbook, Rakel
Dr. Wayne Jones: How Healing Works books
HOPE note and process

www.nhs.uk/medicines/ good general reference for patients with simple clear info, some name differences exist, e.g. acetaminophen is paracetamol there

Pill identifier at drugs.com based on the imprint

Affordability/Access
Do a medication access referral through Hoxworth pharmacy for our patients
Ohio Medicaid Drug List All Ohio Medicaid managed care plans use the same preferred drug list
Ohio Medicaid Drug Coverage Lookup Tool May need to use the brand name
St. Vincent dePaul Charitable PharmacyReferral Form "last resort" pharmacy for people who cannot afford meds, meds mostly donated so limited and variable formulary, must certify to qualify
GoodRx - legit discounts when insurance won't cover meds

Specific Patient Needs/ Medical Issues
crediblemeds.org - info on QT prolonging meds
LactMed database on medications and lactation
LiverTox database on meds and supplements that cause liver injury
NIH Supplements complementary medicine treatments and supplments safety page
mothertobaby.org- website for medication safety during pregnancy, YOU CAN MESSAGE AN EXPERT!
Excellent fact sheets about specific meds, foods, medical conditions, drugs, cosmetics, etc. They also have ongoing studies.
Beer's List
Gluten Free Med Listnot updated often, but very there is no required reporting for this, from glutenfreedrugs.comrun by a peds GI pharmacist

Toxicology
Micromedex: good resource for toxic effects of meds (DPIC uses it)
Children's Centerlink > Residents > Patient Care links > Clinical Resources > Micromedex
within it look up substance/med, then in the left panel there is a toxicology section
choose in-depth answers tab on top if available for that med
within the treatment section there may be a disposition bullet point to tell you observation time  

DPIC will do pill ID if they have the specific pill.

Safe Medication Disposal
Take Back Locations -  includes many pharmacies including hoxworth and the main UC lobby
General Disposal Guidelines
FDA flush list - benefit of getting rid of med considered higher than harm from flushing

STIs, Treatment and Prevention, Sexual Safety in general
CDC's STI Treatment Guidelines 2021 changed for chlamydia, trichomonas, PID
Expedited Partner Therapy Guidelines, EPT Law in Ohio
Screen more than genitals, MSM STD Fact Sheet, MSM Shigella
Free CondomsOhio only, lube + 25 condoms or dental dams mailed if 16+ y/o, can do every 30 days, no income restrictions, DOTPHRASE .freecondomsohio
Condom Do's and Dont'sSpanish version
Try .douching .poppers for patient information on these topics

PrEP
PrEPline National Clinician consultation Center – 855-448-7737 open 9a-8p EST
1 Pager on how to do PrEP
National Ready Set Prep Program, free coverage for prep meds if no insurance coverage
Preventon Assistance Program Interventions (PAPI)Ohio Program to cover all PREP related care for certain incomes
Dot Phrases [can be found under .MPDOTPHRASES]:

.PREPDISCUSS [when discussing at visit]
.HMPREPDISCUSSED [to fulfill Care Gap]
.PREPSTART [when starting PrEP, either during visit or on phone visit if starting after]
.ORALPREPMONITOR [for monitoring guidelines for Truvada, Descvoy]
.CABOTEGRAVIRMONITOR [for monitoring guidelines for Apretude]

Contraception
Effectiveness, Use, and Side Effects Chart from CDC
Contraception Effectiveness from bedsider.org
Emergency Contraception Chart from bedsider.org
CDC's Missed Contraception Recommendations
CDC Medical Eligibility for Contraceptive: which contraception options can and can't be used with various medical conditions

Abortion (as of June 2024)
abortionfinder.org
Abortion pills by mail: Information from Plan C read for details on legality and safety
Help with funding:National Network of Abortion Funds, www.chicagoabortionfund.org, Ohio organization: Women Have Options
Help with transportation, lodging, childcare: brigidalliance.org, www.midwestaccesscoalition.org
In Cincinnati (counseling and abortions): Planned Parenthood - Cincinnati Surgical Center 2314 Auburn Avenue · Cincinnati OH, 45219 · Contact Phone: (513) 287-6488 (website not updated yet)

Need 2 separate appointments >24 hours apart (appointment with UC OBGYN will NOT count as one)
1st appointment: $200 (can get some financial assistance, but typically need at least $100 up front)
2nd appointment: $500 if 5w-13w6d with sliding scale payment plan

Now as of 10/7/2022 an injunction is in place to negate the new Ohio law. Legal up to 21w6d in Ohio. But if it goes back in to effect, the following will be law again:

Ohio Law:
Now illegal in Ohio for intrauterine pregnancies if a heartbeat is detected and provider has to look for one (externally), ~6 weeks.
Exceptions: "to prevent the death of the pregnant woman or to avoid a serious risk of the substantial and irreversible impairment of a major bodily function of the pregnant woman"
Explicit exceptions include: pre-eclampsia, inevitable abortion, and premature ROM, extrauterine pregnancies
No exception for rape or incest
No exception for mental health related problems including suicidality
Doctors providing abortions are subject to felony charges, potential loss of license and potential fine of up to $20,000 per case.
Women seeking abortion are not subject to criminal or civil liability.

Indiana Law
Goes into effect 9/15/22. Abortion outlawed at any stage. Exceptions: rape or incest, fatal fetal abnormality, risk of death or severe health risk to the pregnant person

Kentucky Law
Abortion illegal at every gestational age. The only exception is if the pregnancy threatens the life of the mother.

Transgender/Gender Diverse Patients
Affirming Hormone Therapy
Hoxworth Protocol 1-Pager
Guidelines: WPATH 8th Edition 2022 widely cited global guideline, Endocrine Society 2017 has a few good quiz MCQs in the slidedeck, UCSF 2016 includes good guidelines on VTE

Additional Gender Resources
Equitas Provider Listgender affirming providers of various types, therapists, dentists, community groups
Gender Unicorn (additional languages)
Trans Legal RightsOhio name change ID etc, LGBT Legal Clinic (free for certain incomes)  855-LGBT-LAW
Trans Lifeline excellent resource for emotional and practical support, for trans by trans including a hotline
Try .binders for patient information on this topic

Mental Health
LGBTQIA Psychotherapy: Maya Daeufel, PsyM will be starting the week of July 10th, 2024. Refer by putting in Psychiatry - Therapy or Counseling referral and entering her name in the provider section.

Trans Lifeline by trans, for trans individuals hotline for emotional and practical support (877) 565-8860
The Trevor Project 24/7 free confidential crisis counseling by text, chat or phone for young LGBT people
Central Clinic's LGBTQ+ Program for adult Medicaid patients or Hamilton county uninsured patients
National LGBTQIA+ Health Education Center (from Fenway Health)
LGBT Resource Lookup Tool
Parenting Resourcesclick LGTBQIA+ Parents
College Guide for LGBT Students

Elderly Patients
Mini-Mental State Exam (doesn't test executive functioning)
MoCA (does test executive functioning)
Mini-Cog
Advanced Care Planning: Ohio DNR Form, values worksheet
Geriatric Depression Scale Y/N, simpler than PHQ-9, validated tool, normal is <5
Beer's List
Anticholinergic Burden Reference,ACB Score calculator
Each definite anticholinergic may increase the risk of cognitive impairment by 46% over 6 years.
For each on point increase in the ACB total score: a decline in MMSE score of 0.33 points over 2 years has been suggested. Has been correlated with a 26% increase in the risk of death. 
Council on Aging SW Ohio(513) 721-1025
Help to stay independent at home, in home care, meals, caregiver support
Senior's Guide to Online Safetyfrom Connect Safely silicon valley non-profit
Elder Abuse Suspicion Index, any yes except the first question is a positive screen
Adult Protective Services Ohio, Kentucky (call during business hours)

Patients with Disabilities
Screening -- See above in "Routine Health Maintenance"

Medical Management
One-Pagers: Enteral feeding tubes, trachs, airway clearance, shunts, baclofen pumps, and autonomic dysfunction
Cerebral Palsy for the PCP(screening & management)

Guardianship: See Social Work Info above

Transportation
Disability Placard Guide: Letter is called "Gen to Third Party Disability Parking Prescription"
Metro Fare Deal Program: Discounts fare for those who are elderly, have disabilities, use Medicare, must apply in person during limited hours
Metro Access Program: Origin to destination service for those unable to ride the bus, complex application and in person assessment process

Community Resources
Stepping Stones: Child, teen, and adult day programs, respite care, summer programs, clubs, private pay only
The TALL Institute: Classes and community groups for adults with disabilities, including life skills (cooking, money management), relationships, fishing, and more
Hamilton County Developmental Disabilities Services: Connects children and adults with services, coordinates early intervention
Cincinnati Zoo Access for All: Information about all the accessible opportunities and accommodations available about the zoo (there are a TON, including sensory maps, sensory-friendly restrooms, adult changing tables, and more)

Therapy
Physical Therapy: Refer to Lauren Niehaus and put "patient with IDD" or "transition" in the referral comments so that it will go to someone with experience if Lauren is full

Patients who are Deaf/HOH
Communication Card for Police

General Information
Ohio Solid Organ Transplantation Consortium (OSOTC): Explore OSOTC resources to understand the review process, selection criteria, and policies as they relate to organ transplants at member hospitals.

People with Disabilities
Autism Self-Advocacy Network (ASAN): Toolkit for Advocates on Ending Discrimination

The “Know Your Rights” guide provides people with disabilities and their families with information on existing laws and policies that may protect them from discrimination, and information on who to contact if they experience discrimination.

The Guide for Advocates provides information on ways that advocates can help fight organ transplantation discrimination on a wider basis, such as through legislative advocacy and outreach to the medical community.

The Model Legislation on organ transplant discrimination provides an example of effective anti-discrimination legislation that advocates can propose to their state legislatures.

The Guide for Clinicians and Checklist of available supports and services gives doctors and other health professionals concrete advice on how to serve people with disabilities who may need an organ transplant.