First Stop Health Physician Policies

Prescriptions

First Stop Health supports responsible, conservative use of antibiotics.

Guidelines:

Medication for diabetes, hypertension, thyroid, cholesterol, behavioral health, asthma, herpes, etc.

  • These medications should be only refilled. You should not make a diagnosis and choose dosage during consultation.

  • The limit is 3 prescription refills within the calendar year. Make sure to review past consults. Only 30 days can be prescribed at a time.

  • For each prescription, the First Stop Health doctor must advise the patient to see PCP/original prescribing specialist.

  • On the 4th prescription, doctors may decline or fill one more time on a case-by-case basis.

Contraception and emergency contraception

  • One 90-day prescription within a calendar year

  • No limit for emergency contraception

  • Make sure to take adequate medical history

  • Plan B One Step can be purchased OTC by anyone of any age and does not require a prescription. Typically covered by insurance with a prescription.

 

Smoking cessation drugs including Zyban and Chantix

The Affordable Care Act of 2010 expanded coverage of FDA-approved smoking cessation medications. It is now considered a preventive service and covers 90 days and 2 quit attempts per year.

Stay up-to-date on our prescription policy here. 

Sick Notes

Sick notes for COVID-related consults can be issued for up to 5 days. Here are a few things to know about sick notes:

  • Sick notes are effective starting the date of the consultation. 
  • Sick notes can only be backdated for one day prior to the date of the consultation.
  • Patients referred to the ER or urgent care should not be given a sick note. (They can get a sick note from wherever they seek in-person care.) 
  • If a patient requests a sick note but has already reached their maximum (see below), you can respond with: "I am sorry, but our records show that you have reached the maximum allowed number of sick note days for this year. I cannot write you a note for more sick days." If the patient objects, please send an issue ticket to Customer Service.
  • Once limits have been exceeded, patients can be treated but must seek a note from their local doctor.

Sick note limits per consult:

  Days
Non COVID-19 4
COVID-19 up to 5

 

 

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First Stop Health Doctors

COVID-19 Policy

Symptomatic Patients

  • What symptoms is the patient experiencing?
  • When did the patient begin experiencing symptoms?
  • Is the patient looking for a prescription or other OTC recommendation to help with symptoms?
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Isolation at home with respiratory precautions until 10 days have passed since onset of symptoms, AND be fever free for 24 hours, AND other symptoms show improvement. This includes patients diagnosed with sinusitis, pharyngitis, strep (without a positive strep test), cough, influenza (without testing) or URI, since under current circumstances all these diagnoses are possibly COVID-19.
  • Obtaining a COVID-19 test (see below for more details on testing)
  • Presumed COVID-19 patients should be isolated in their own private room in the home, preferably with a dedicated bathroom.
  • Food should be brought to the room and left on the floor outside the door.
  • A mask should be worn by the patient outside the room and by any family member who has to go in.
  • Frequent handwashing by all household members.
  • All family members/contacts should be in self-quarantine for 14 days from the last contact with the patient.

Asymptomatic Patients

  • Does the patient’s exposure to the sick person meet the definition of close exposure? (See definition of "close exposure" below.)
  • Has the person the patient was exposed to been tested for COVID-19? If so, was that test positive?
  • When was the patient’s last exposure to that person?
  • Has the patient been tested?
  • Patient was within 6 feet of someone with COVID-19 for a total of 15 minutes or more.
  • Patient provided care at home to someone with COVID-19.
  • Patient had direct physical contact with someone with COVID-19 (hugged or kissed them).
  • Patient shared eating or drinking utensils with someone with COVID-19.
  • Patient was  sneezed on, coughed on, or got respiratory droplets on himself/herself  by someone with COVID-19.
  • Known close exposure to a confirmed test + case of COVID-19 should be under home quarantine for 14 days from the date of last exposure. A 14-day sick note should be entered for the patient.
  • Doctors should exercise their judgment. If the index case has been tested and results are pending it may or may not be appropriate to quarantine (based on individual circumstances) the exposed person until results are available. Once results are back regular guidelines can be followed.
  • Asymptomatic patients who were exposed to someone who was exposed to someone with COVID-19 do NOT need to be directed to quarantine.
  • Asymptomatic patients who test positive for COVID-19 can end quarantine 10 days after that positive specimen has been collected as long as they don’t develop symptoms.

Testing

  • People who have symptoms of COVID-19
  • People who have had close contact (within 6 feet of an infected person for a total of at least 15 minutes) with someone with confirmed COVID-19
  • There are testing options all across the country but how to access them varies widely from county to county. If the patient wants to seek testing in-person this link to a test search tool directory is shared on the automated email.
  • All patients without an employer specific testing resource receive a link shared in our automated email to request an in-home testing kit from LabCorp. Click here for details. 
    • In most cases, there will be out of pocket cost for these tests due to insurance and state/federal grants.
    • The process usually takes 3-5 business days to receive testing kit, collect specimen, ship specimen back, and receive test results. However, due to sporadic limitation in shipping and mailing, you should quote 7 business days.
  • If a patient tests positive for COVID-19 they should isolate themselves for 10 days from the time the specimen was collected provided they do not develop.
  • If a patient tests negative they should still follow quarantine/isolation protocol as recommended by the CDC.

COVID-19 Automated Emails

When a First Stop Health doctor recommends isolation or quarantine, the patient is sent a follow-up email. To trigger these emails, the doctor must select one of the following issues while completing the consult.

When a doctor selects the issue Symptomatic Isolation, the patient's follow-up email will include:

  • CDC guidelines on duration of isolation 
  • Link to visit summary
  • Link to sick note
  • Link to visit rating
  • Labcorp and/or local health testing information 

When a doctor selects the issue Asymptomatic Quarantine, the patient's follow-up email will include:

 
See the automated emails. Note that content may vary based on client nuances (ex. specific testing or return-to-work policies).