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reference material in Training and Education, as does the World Health Organization (WHO) through its online training. The FDA offers fact sheets (Pfizer-BioNTech, Moderna , Janssen) for healthcare providers administer- ing the different vaccines under emergency use authori- zation and gives information on vaccine administration, safety, storage, informed consent, and reporting adverse events specific to the manufacturer’s vaccine. Other resources include the CDC’s Prevaccination Checklist for COVID-19 Vaccines (patient screening tool) and The Doc- tors Company’s FAQs About COVID-19 Vaccinations.
Reimbursement: See the Health Resources and Ser- vices Administration’s What Providers Need to Know About COVID-19 Vaccine Fees and Reimbursements.
Staying Diligent
The following recommendations will assist in the on- going screening and management of suspected COVID-19 patients in your practice:
Legislation and Guidance: Reference the CDC, your state licensing board, professional societies, and federal, state, and local authorities daily for public health guid- ance and new legislation, as this continues to be a fluid situation. Monitor for outbreaks of COVID-19 cases within your community. Stay on top of current trends to protect your patients and your practice.
Screening Criteria: Follow the CDC’s patient screening protocol for early disease detection for patients pre- senting to your practice. We recommend that you check this CDC website regularly for any updates in screening criteria. Essential visitors to your facility should also be assessed for symptoms and contact exposure and redirected to remain outside if it is suspected that they could have COVID-19.
Comparing COVID-19 and the Flu: Both the flu and COVID-19 are respiratory illnesses and can present in similar ways. For further guidance, see Flu or COVID-19? Convergence of Two Viruses Creates Risk of Diagnostic Errors.
Accepting Patients: It is strongly recommended
that practices do not turn patients away who are not ful- ly vaccinated or simply because a patient calls with acute respiratory symptoms. All patients should be triaged over the phone or via telemedicine and managed accord- ing to CDC recommendations. Refusing assessment/care may lead to concerns of patient abandonment.
Designated Triage Location: Check with your local pub- lic health authorities for locations designated to triage suspected patients, so exposure is limited in general medical offices. Community emergency preparedness plans have been activated so that parties are coordinat- ing efforts to deliver effective public health intervention.
Telehealth Triage: The CDC recommends alternatives to face-to-face triage and visits, particularly for high- risk patients, if screening can take place over the phone, via telemedicine, through patient portals or online
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self-assessment tools, or through a designated external triage station. Licensed staff should be trained in triage protocol to determine which patients can be managed safely at home versus those who need to be seen either at the office or at a designated community facility. See Managing Healthcare Operations During COVID-19. The CDC provides a Clinical Decision Algorithm to Guide Care Advice Messages, which includes a clinical deci- sion-making tree. The Doctors Company offers resourc- es on telemedicine, as does the CDC in Using Telehealth to Expand Access to Essential Health Services During the COVID-19 Pandemic. For a list of telehealth COVID-19 rules by state, visit Federation of State Medical Boards: COVID-19.
Patient Testing: Practitioners should determine which patients require testing based on presenting symptoms, history, contact exposure, community transmission of disease, and for early identification in special settings (e.g., nursing home admission or elective surgery). See the CDC’s COVID-19 Testing Overviewand Overview of Testing for SARS-CoV-2 (COVID-19). The CDC advises, “Healthcare providers should immediately notify their local or state health department in the event of the identification of a PUI (Person Under Investigation)
for COVID-19.” The CDC offers the Clinician Call Center, which is available to healthcare personnel to assist with diagnosis, clinical management, and infection control protocol. Dial (800) CDC-INFO [(800) 232-4636] and ask for the Clinician Call Center.
Elective Services: If cases of COVID-19 trend upward within your community, check with regional health au- thorities on the provision of nonessential and elective healthcare visits and group-related activities. States and counties vary depending on the number of cases, availability of PPE, and availability of hospital beds. For diagnostic and therapeutic interventions, including sur- gery, the CDC provides Managing Healthcare Operations During COVID-19. Also, the American College of Surgeons (ACS) published Clinical Issues and Guidance on triage and management of surgical cases, including specialty guidelines. Some states may reinstate restrictions on the provision of nonurgent, elective surgeries and pro- cedures. (See ACS: COVID-19: Executive Orders by State on Dental, Medical, and Surgical Procedures). In some states, violations may result in physician jail time, fines, or complaints to the medical board. Check with state and local regulatory agencies for any related mandates.
Office Messaging: Practices should post front-door signage requiring patients and visitors who are ex- hibiting COVID-19 symptoms or who have had contact exposure to immediately notify facility personnel via telephone for instructions on accessing care. Include information on the practice website regarding office policies for appointments, telephone assessment/tele- medicine, and visitors. Also, post COVID-19 resources for patients (e.g., the CDC’s Coronavirus (COVID-19) page and COVID-19 Frequently Asked Questions) with a reminder
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