A S F S U / U C S F S T U D E N T – L E D P R O J E C T
Clinic Logistics in 90 minutes
Clínica Martín Baró: Goals
Free, quality patient care Two-way mentorship between SFSU
and UCSF studentsHealth Empowerment
– For individuals through health promotion– For the community through involvement in
community organizing
Clinical & cultural learning opportunity
Logistics
Clínica sees patients from around 9am-2pm every Saturday
4 MS1s per Saturday Sign-up is handled through a yahoo group calendar The CMB med student wiki has all the information
you need to know, forms to download, etc: http://cmb-admin.wikidot.com/med-student-duties
We will e-mail you links to these resources once we open the calendar to sign-ups!
La La ClínicaMission Neighborhood
Center 3031 24th street
Bathroom
Kitchen
24th street
Balm
y street
Bathroom
Storage
Storage Exam Room 3
Exam Room 2
Exam Room 1
Reception
Pharm
acy
HealthPromotion
Lab
Consult Room
ReceptionReception
24th street
Balm
y street
Reception
24th street
Balm
y street
Reception
IntakeIntake
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Reception
Health PromotionHealth Promotion
HealthPromotion
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Reception
History History & Physical& Physical
HealthPromotion
MonitorMed Student
1. Get a chart from the monitor
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Reception
HealthPromotion
1. Get a chart from the monitor2. Bring the patient to the exam room
3. Gather History & conduct physical exam
History History & Physical& Physical
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Reception
Exam Room 1
Exam Room 2
Exam Room 3
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
Med Student Preceptor
1. Present history & physical, and any ideas you have about assessment and plan
24th street
Balm
y street
Reception
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
1. Present history & physical, and any ideas you have about assessment and plan
2. Visit patient again with preceptor
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Reception
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
Med Student Preceptor
1. Present history & physical, and any ideas you have about assessment and plan
2. Visit patient again with preceptor
2. Create a plan with the preceptor
Exam Room 3
Exam Room 2
Exam Room 1
24th street
Balm
y street
Storage
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#1: #1: Prescriptions Prescriptions
HealthPromotion
Consult Room
Pharm
acy
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#2: Labs #2: Labs
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Fill out form with lab volunteer
2. Get tubes and draw blood with preceptor’s help
3. Give tubes to lab volunteer
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#3: Referrals #3: Referrals
HealthPromotion
Consult Room
Pharm
acy
Lab
1. If outside services are needed, consult referrals volunteer
2. For mental health, refer to Felix Kury
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan: Implement Plan:
#4: Discharge #4: Discharge
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Make sure prescriptions, lab, and referral procedures are complete
2. Consult the monitor
Monitor
3. Ensure the patient understands diagnosis and plan
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Complete Chart Complete Chart
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Update med & condition list
2. Write H&P or SOAP note
3. Fill out Follow-Up form
4. Get preceptor’s signature
Medical Student VolunteersMedical Student Volunteers Arrive at 3031 Mission Street at 7:30AM to help set Arrive at 3031 Mission Street at 7:30AM to help set
up Clinicup Clinic Dress professionallyDress professionally BringBring
– StethoscopeStethoscope– pen lightpen light– UCSF identification cardUCSF identification card– white coatwhite coat– Lunch or $5 to buy lunchLunch or $5 to buy lunch– any reference cards for history taking, exam or any reference cards for history taking, exam or
charting you feel you may needcharting you feel you may need Med Student Coordinator with give you a tour and Med Student Coordinator with give you a tour and
establish patient care teamsestablish patient care teams Tell the monitor if you are fluent in Spanish or would Tell the monitor if you are fluent in Spanish or would
like an interpreterlike an interpreter Participate in Pre-Clinic meeting at 8:30 AM, and then Participate in Pre-Clinic meeting at 8:30 AM, and then
monitor will give you a chart for your first patientmonitor will give you a chart for your first patient
ReceptionReception
24th street
Balm
y street
Reception
Reception
Estela Fuentes– 46 y.o. female– First time at Clínica– Worried about her blood pressure
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
IntakeIntake
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Health PromotionHealth Promotion
HealthPromotion
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
History History & Physical& Physical
HealthPromotion
MonitorMed Student
1. Get a chart from the monitor
Chart from Monitor
9/20/2010 Fuentes, Estela N60
46 4/3/1964 F 84 1.60
37 C 146/94 60 12 0 23
Katie Concerned about high blood pressure
Consult with preceptor about what to focus on in History & Physical…
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
HealthPromotion
1. Get a chart from the monitor2. Bring the patient to the exam room
3. Gather History & conduct physical exam
History History & Physical& Physical
History Identification (ID) Chief Complaint (CC) History of Present Illness (HPI) Past Medical History (PMH) Medications Allergies Family History (FH) Social History (SH) Health Related Behaviors (HRB) ***Health Maintenance***
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
Med Student Preceptor
1. Present history & physical, and any ideas you have about assessment and plan
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
1. Present history & physical, and any ideas you have about assessment and plan
2. Visit patient again with preceptor
Physical Exam
Repeat any essential vital signs– Blood Pressure
Focused physical exam– Listen to 4 heart valves– Listen to the lungs– Feel for peripheral pulse and check for
swelling
Patient Education
Ask-tell-askRealistic behavior change plan
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Confer with Confer with PreceptorPreceptor
HealthPromotion
Consult Room
Med Student Preceptor
1. Present history & physical, and any ideas you have about assessment and plan
2. Visit patient again with preceptor
2. Create a plan with the preceptor
Plan
Patient education about hypertension Behavior change: less salt, exercise Prescription: Hydrochlorothiazide 25 mg
once per day Labs: cholesterol for health
maintenance Referrals: none required Follow-up: in one month for
hypertension follow-up and yearly pap
24th street
Balm
y street
Storage
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#1: #1: Prescriptions Prescriptions
HealthPromotion
Consult Room
Pharm
acy
Estela Robles 4/3/1964
9/20/10
Hydrochlorothiazide 25mg
30 1 1 tablet once per day HTN
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#2: Labs #2: Labs
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Fill out form with lab volunteer
Labs
COMPLETED LAB FORM
X
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#2: Labs #2: Labs
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Fill out form with lab volunteer
2. Get tubes and draw blood with preceptor’s help
Drawing Blood We will train you how to do this at an
evening training session in October
Two poke rule, send to Quest if a difficult draw
We also do urine tests and pap tests
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#2: Labs #2: Labs
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Fill out form with lab volunteer
2. Get tubes and draw blood with preceptor’s help
3. Give tubes to lab volunteer
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan Implement Plan
#3: Referrals #3: Referrals
HealthPromotion
Consult Room
Pharm
acy
Lab
1. If outside services are needed, consult referrals volunteer
2. For mental health, refer to Felix Kury
Professor of Raza Studies at SFSUFaculty advisor to ClínicaLicensed therapist
Felix Kury
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Implement Plan: Implement Plan:
#4: Discharge #4: Discharge
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Make sure prescriptions, lab, and referral procedures are complete
2. Consult the monitor
Monitor
3. Ensure the patient understands diagnosis and plan
24th street
Balm
y street
Reception
Exam Room 3
Exam Room 2
Exam Room 1
Complete Chart Complete Chart
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Update meds & problem list
Medication, Allergies and Problem lists
Only include long term medications and chronic problems:– Medications:
Hydrochlorothiazide 25 mg once a day NOT: ibuprofen as needed for ankle pain
– Problems: Hypertension NOT: strained left ankle
The idea is for it to be a one stop shop for the next provider to see current meds, allergies, and conditions
24th street
Balm
y street
Reception
Exam Room 1
Exam Room 2
Exam Room 3
Complete Chart Complete Chart
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Update med & problem list
2. Write H&P or SOAP note
9/20/2010 Fuentes, Estela N60
46 4/3/1964 F 74 1.60
37 C 146/94 60 12 0 23
Katie Concerned about high blood pressure Charlie
Dr. Johnson 9/20/2010 SUBJECTIVEID/CC: Mrs. Fuentes is a 46 yo female concerned about high blood
pressure
HPI: Patient has had hypertension for 8 years and was on medications in El Salvador, but has stopped taking them. She has not seen
a doctor in 2 years. She has been feeling well, and denies headache, chest pain, or fatigue.
PMH: 8 year history of hypertension. No diabetes or high cholesterol.
Meds: No prescription medications, takes aloe for heartburn occasionally.
Allergies: No known food or drug allergies
FH: Father has 15 year history of diabetes, mother has a 20 year history of hypertension and recently suffered a stroke.
SH: She is originally from El Salvador and came San Francisco two years ago. She lives with her husband and 13 year-old son in Daly City and works at
a hotel cleaning rooms and making beds.
HRB: Patient smoked for 10 years but quit 3 years ago. Drinks casually, a few beers on the weekends. She is sexually active only with her husband.
They do not use condoms, but she has an IUD.
OBJECTIVE46 year old woman in no acute distress. Repeat blood pressure was 152/94
in right arm. Heart sounds normal S1 S2 with no extra murmurs,rubs, or gallops noted. Peripheral pulses are strong in all four extremities and no peripheral edema was noted.
ASSESSMENT1. Primary hypertension, stage one2. Due for health maintenance lipid panel and pap test
PLAN1. Decrease salt intake, exercise by walking briskly for 30 minutes 3 times
per week. Begin Hydrochlorothiazide 25 mg daily. Follow up in one month.2. Draw blood for lipid panel today and follow up in 1 month for pap test.
24th street
Balm
y street
Reception
Exam Room 1
Exam Room 2
Exam Room 3
Complete Chart Complete Chart
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Update med & problem list
2. Write H&P or SOAP note
3. Fill out Follow-up Form
9/20/2010Estela Robles 4/3/1964608-658-2491
Hypertension follow upPap testReview results of lipid panel
10/20/2010
Charlie Cassidy
00000000
24th street
Balm
y street
Reception
Exam Room 1
Exam Room 2
Exam Room 3
Complete Chart Complete Chart
HealthPromotion
Consult Room
Pharm
acy
Lab
1. Update med & problem list
2. Write H&P or SOAP note
3. Fill out Follow-up Form
4. Get preceptor’s signature
RememberRemember We are here in the best interest of the We are here in the best interest of the
patients and to provide quality medical care.patients and to provide quality medical care. Always be PROFESSIONAL and RESPECTFUL Always be PROFESSIONAL and RESPECTFUL
to the patients, their families, CMB staff and to the patients, their families, CMB staff and colleagues, and volunteer preceptorscolleagues, and volunteer preceptors
If you need help, just ask!If you need help, just ask! Mentorship is an equal exchange and always Mentorship is an equal exchange and always
appreciated!appreciated! HAVE FUN! Learning, sharing and giving are HAVE FUN! Learning, sharing and giving are
some of the greatest rewards!!some of the greatest rewards!!
A S F S U / U C S F S T U D E N T – L E D P R O J E C T