妇科诊所

Women’s 健康 (Complex Gynecology) Referral Guidelines for MAP Handbook

1. 适当的推荐:

条件/ DX: 慢性盆腔疼痛或痛经.

• • 1. 卡式肺囊虫肺炎文档: has condition lasted longer than 6 months? Has the condition not responded to 3 months of medical therapy, i.e. 非甾体抗炎药,(ocp.
    2. 药物列表: documenting 3 months of medical therapy
    3. 诊断一年内盆腔超声检查
    4. 实验室: Recent urine culture, and STD testing within 6 months

条件/ DX:   Vulvodynia (painful vulva), vaginismus, or vaginal/vulvar dermatoses

1. 卡式肺囊虫肺炎文档: has the condition not responded to medical therapy. Any clinic visits where the patient was evaluated for vulvar complaints
2. 实验室: has any skin/allergy testing been performed? has any prior testing that could exclude or confirm a vaginal infection, 比如湿式准备, PCR or culture for the following: gonorrhea, 衣原体, 毛滴虫, 酵母, bacterial vaginosis STI screening within the past 6 months.

条件/ DX:   The patient is experiencing bothersome frequency and/or leakage of urine.

1. 实验室: Urinalysis and culture (+/- micro) within the past 3 months

条件/ DX: The patient has pelvic organ prolapse and/or is complaining that something is falling out of their vagina.

1. 卡式肺囊虫肺炎文档: In the past month, the patient has experienced accidental bowel leakage (gas or stool).
2. 过程: Colonoscopy >=50 yo, 40岁，你和家人在一起, blood in stool (encouraged but 不是必需的) OR current occult blood screening

条件/ DX: The patient has bladder pain with negative urine cultures and symptoms that are consistent with interstitial cystitis.

1. 实验室: Urinalysis and culture (+/- micro) within the past 3 months

条件/ DX: The patient is older than the age of 60 with a history of smoking and has more than 3 red blood cells per high-power field that has been documented by a urine dip followed by a urinalysis. (If there is visible blood in the urine, then the patient should be referred to a Urologist instead)

1. 实验室: Urinalysis with greater than 3 red blood cells per high-power field, Micro UA
2. 诊断: CT Urogram

条件/ DX: 这个病人的风险很低, never smoking woman between the ages of 35 – 50 years old with more than 25 red blood cells per high-power field that has been documented by a urine dip followed by a urinalysis (If there is visible blood in the urine, then the patient should be referred to a Urologist instead)

1. 卡式肺囊虫肺炎文档: Urinalysis with greater than 25 red blood cells per high-power field.
2. 实验室: Micro UA
3. 诊断: CT尿路图

条件/ DX: The patient has a history of two or more urinary tract infections in the past six months or three or more urinary tract infections within the past year that is documented with urine cultures and treatments.      

1. 卡式肺囊虫肺炎文档: Minimum of 2 UTIs within 6 months or 3 UTIs in 12 months.
2. 实验室: All urine culture results for the preceding year
3. 诊断: CT Urogram

2. 文档 安排转诊所需

• 人口统计页面:名称, address, 电话号码(家中), 移动, 白天或交替(如适用), 电子邮件地址(如有), 强加于人, 首选语言, 有保单编号的保险, 请求提供者(包括地址), 电话号码, 及传真号码), primary care provider (include address, 电话号码, 及传真号码)
• 临床信息/评论
• (Master IM)最后的总结笔记 来自转诊提供者
  当前用药清单 (药物名称、剂量、规格)
  问题列表 (发病日期，慢性y/n，备注)
  产科/妇科历史 (# of pregnancies, Results of pregnancy, Complications)
  月经期 (Age at menses, 状态 of menses, Days b/w periods, Days of menstrual flow, Pain with periods)
  家族病史 (Cause of death, Disease detail, Family member, Name, Age, Comments)
  既往病史/手术史 (Disease/disorder, Onset date, Procedure/surgery, Year)
  行为健康 history (Condition, Treatment, Diagnosing provider, 结果)
  社会历史 (关系状态, #在家里, 锻炼频率, 咖啡因摄入量, 吸烟, 饮酒, 娱乐性毒品的使用, 饮食的描述)
• 诊断s/Imaging History within the last 12 months (测试, 日期要求, 完成日期, 状态, 解释, 结果)
• 实验室/病理学 最近12个月的历史记录 (测试, 日期要求, 完成日期, 状态, 解释, 结果), current pap test according to ASCCP guidelines
• If applicable, pelvic floor physical therapy reports
• If a patient has postmenopausal/abnormal uterine bleeding, a current endometrial biopsy is encouraged, 不是必需的.