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COVID-19 Infection Prevention Playbook
Ambulatory (Non-Procedure) & Medical Group/CIN
Last update: 09/09/20 2:00 PM
Updated 5/19/20
1. Updated ambulatory Testing Table 1 (Page 18) 2. Updated Cleaning Checklist (page 42)
Updated 5/27/20 1. Added travel back to epidemiological risk on Quick Screen (pages 13 and 14) 2. Removed chills and added congestion or runny nose, nausea or vomiting and diarrhea to
quick screen symptoms (pages 13 and 14) 3. Updated criteria to test patients (page15) 4. Updated disinfectant list (pages 30-37)
Updated 6/2/20 1. Contact Center Workflow (Pages 24-27)
Updated 6/12/20 1. Removed Chicago/Archer Resp Center from testing grid (page 20)
Updated 6/19/20 1. New PPE Tier guidelines to include eye protection in Tier 1 (page 10) 2. Res Center hours of operation (page 20)
Updated 7/21/20 1. New CDC guidance for isolation of known positive cases (pages 17, 23 and 39) 2. New CDC guidelines for HCP return to work (page 17) 3. New Quick screen to account for shorter isolation in known cases (pages 14, 15, 21, 23) 4. Updated Call center workflow (pages 24-28)
Updated 7/27/20 1. Corrected Mount Prospect Resp center phone # (page 20)
Updated 7/29/20 1. Updated Call center workflow (pages 24-28)
Updated 9/9/20 1. Updated Epidemiological risk factors in Quickscreen to remove travel (pages 14, 15, 21,
23)
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Table of Contents Guidance on Re-Emergence .................................................................................................................................... 3
Guidelines for PPE in Office Setting ...................................................................................................................... 10
Talking Points for Staff Conversations and Patient Questions .............................................................................. 13
Quick Screen: Criteria to Evaluate Patients for COVID-19 – Phone call ................................................................ 14
Quick Screen: Criteria to Evaluate Patients for COVID-19- Patient is in Office .................................................... 15
Criteria to Test Patients with COVID-19-like Illness .............................................................................................. 16
Management of Possible COVID-19 in Ambulatory Setting- Patient is physically present in the office .................. 22
Management of Possible COVID-19 in Ambulatory Setting- Patient is on the phone ............................................ 24
Tips to help decrease COVID-19 transmission ...................................................................................................... 30
Discharge Instructions for Suspected COVID-19 ................................................................................................... 40
Talking Points for patient with positive screen and/or “Possible COVID-19” ....................................................... 42
APPENDIX A: Athena Workflow ............................................................................................................................ 43
APPENDIX B: EPIC Workflow ................................................................................................................................. 45
[Click on section titles to jump to relevant section]
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Guidance on Re-Emergence Re-emergence Plan Checklist
Scheduling and Access
Key Activities Considerations
Practice to create ramp up plan
- Outline how to reach 75% capacity by June 1st and 100% capacity by Sept 1st
Scheduling
- Block specific times throughout day / week for visit mix (e.g. in-person patient visits during morning hours, virtual visits in the afternoon) -Visits will need to be staggered to prevent a full waiting room and to allow for social distancing in the waiting room area and movement throughout the clinic - Prioritization of in-office visits - patients with acute issues (non-COVID), patients with chronic illnesses who need follow-up, patients with quality gaps - Patients with COVID-like symptoms refer to Respiratory Centers - Block time for particularly vulnerable populations (e.g. seniors, at risk, preventative care, pediatric checks (babies and toddlers) - Identify what types of visits can/should be virtual (e.g. no medical component), also ensure there is a safety net to monitor the number of virtual care visits before an in person visit should be warranted. - Modify schedule templates to support new scheduling blocks and types (e.g. add virtual care as an option) - Create script for check-in process to remind patients to bring face covering and to call ahead of visit if symptoms change - Build cleaning buffer into each appointment for staff to turnover rooms
COVID-19 Positive Patient Follow-Up Access
- Determine appropriate care setting (telehealth or respiratory center) for COVID-19 + patients who are still within isolation window. - Identify trigger and create workflow for follow-up care for COVID-19 positive patients (e.g. pre-registration, scheduling scripting, etc.) -Stay up to date with AMITA endorsed algorithm (Symptom-based or time-based) to determine when patient is safe to return to regular care within a practice setting. -Ensure process in place to promote communication between COVID-19 provider and PCP.
Registration and Check-In
Key Activities Considerations
Registration Process
- Encourage pre-registration as much as possible. -Develop a process to promote "touchless" registration (phone calls if not completed, use of Athena capture, develop systems to get registration materials to new patients ahead of time.) -Develop scripting to recognize how pre-registration saves them time and limits potential contact time while at the visit)
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Check-In
- Reconsider all early arrival requests - Determine process for notifying patient if a provider is running behind - Determine process for late arrivals (e.g. reschedule, wait in car, etc.) - Determine process for visitors accompany patient to visit and communicate process to patients during check-in -Keep front desk clean and free of unnecessary documents and paperwork which could become contaminated. Utilize a hands-free check in process as much as possible and when not possible, ensure all items cleaned between patients (pens, electronics, etc.)
Environmental Controls
- Consider opportunity to obtain donated masks for patients/visitors presenting without a face covering. -Ensure chairs are separated at least 6 feet apart in the waiting room -Develop scripting to discourage additional visitors to promote the support of the patient -Ensure Universal masking is in place for ALL associates working within your practice -If caring for patients with respiratory infections, consider the room in which these patients are cared for. Remove any items that are not required in that room to prevent the opportunity for contamination. -Keep hand sanitizer readily available for both guests and staff at the front desk, along with tissues and lined trash cans
Waiting Room
- Identify process and flow of how asymptomatic patients enter the waiting room or facility (e.g. wait in parking lot and wait to be called to office) - Identify process and flow of how symptomatic patients enter the waiting room or facility (e.g. wait in parking lot and wait to be called directly into room) - Create a process for collecting payments (e.g. collecting cash) - Reference national policies regarding past balances, collection of payment, copays, change in insurance status, payment plan.
Delivery of Care and Services
Key Activities Considerations
Alternative sites of care
- Explore the use of respiratory centers, home visits, drive thru options for labs, vitals, and possibly immunizations, use of remote patient monitoring (this may look different for COVID positive patients) - Try to limit unnecessary travel throughout the system - coordinate as much as possible in office utilizing POC tests when available. - Explore the use of wearable devices such (e.g. EKG, Holter Monitor’s, BP, heart rate) - Create a process to integrate device data with EHRs
COVID-19 Testing -Refer to AMITA algorithm for testing for patients and associates. - Coordinate pre-op COVID-19 as per individual facility workflows.
Supplies Needed
- Maintain awareness of pre-COVID-19 par levels for supplies to ensure appropriate stock and inventory. - Complete weekly PPE log. - Escalate critical needs to PPE coordinator
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Procedures and Imaging
-Consider all modalities and limitations for procedures and imaging (e.g. x-rays, mammograms) -For outpatient sites of care with multiple disciplines (Therapy, imaging, specialty) ensure clear guidance provided related to cleaning between patients and appropriate PPE to wear during testing, as well as cleaning of patient restrooms, etc.
EMR templates and order sets
-Create order sets and templates for test resulting for POC tests, send out tests (i.e. COVID19), ensure correct lab compendiums are built based on testing guidelines and where tests are resulted.
Prescriptions - Explore the use of mail orders for pts who do not want to go into pharmacy - Understand prescribing for those who are uninsured - Identify resources available to assist with medication access
Staffing
Key Activities Considerations
Implications of lower office visits
- Repurpose office staff due to online registration and low call volumes - redirect to areas of need within the health system. - Modify schedules based on provider schedules (in-office and virtual) - Modify schedules based on ancillary service schedules (i.e. drive through phlebotomy, x-rays)
PPE
- Identify expectations for PPE with all non-clinical and clinical staff - Identify expectations for PPE with patients (symptomatic and non-symptomatic) - Ensure staff is conserving PPE as outlined - Complete the weekly PPE log
Outreach and Campaigns
Key Activities Considerations
Cancelled appointments
- Reach out to patients that had cancellations during COVID period (cancellation code COVID19)
Gaps in Care
- Outreach to patients to address quality metrics (e.g. closing gaps in care for HgbA1c, colorectal, breast and cervical cancer screening, immunizations, etc.) - Reach out to quality team for lists as needed - Reference Provider portal for Medicare rosters and high-risk members - List of patients not seen in 18 months or longer
Prioritize high needs / high cost population
- Create priority protocols for patients that must be seen/ prioritized based on specific conditions (i.e. COPD, diabetes) and last appointment date range - At risk contracts- review to see if there is potential increase to bring specific contracted revenue
Quality
Key Activities Considerations
Re-engage - Prioritize tests and specific quality protocols (e.g. HgA1C) - Identify tests that can be done outside of the hospitals (e.g. send out of FIT colorectal testing, mammograms at outpatient centers)
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Identify High Risk Populations
- Utilize existing tools and resources to maximize opportunities to identify higher risk populations of DM, CHF, COPD/Asthma, etc. Leverage claims data as needed.
Begin Quality Gap Closures
- Utilize existing tools and resources to maximize opportunities to identify care gaps and identify potential risk areas (Athena, EPIC or Arcadia analytics claims tool)
Consider ways to centralize Care Management and incorporate into system practices
- Explore opportunities with care management team to support across the continuum to support higher risk populations and collaboratively care for patients.
Incorporate new technologies into the management and care of those vulnerable populations we serve
- Utilize Remote Patient Monitoring (such as TapCloud) Home Visits, and Telehealth, etc. as much as possible.
Facility Operations
Key Activities Considerations
Signage around clinic
- Use social distancing signs and reminders (tape on floor, decals, etc.) - Clear instructions on door for entry and visitors– what languages as applicable to each market patient population/ need (i.e. Spanish, Polish & Arabic)
Waiting Room - Ensure social distancing - Remove unnecessary items such as magazines, brochures and self-serve amenities such as coffee machines and water stations.
Clinic Workspace / Patient Flow
- Set up lobbies so chairs spaced appropriately, remove furniture as needed - One-way traffic in the office, as allowable - Identify workspace limitations (e.g. break room, scheduling area)
Vendors
- Ensure that proper cleaning and supplies are available to cleaning vendor. (Check availability and Medexcel involvement (touchpoint and outside vendors) especially in more rural areas where vendor options are more limited). Consider purchasing supplies on behalf of smaller non-Touchpoint vendors to ensure compliance with approved cleaning supplies - Hold vendors to same screening as patients and associates
Appropriate cleaning of a room between patients
- Create workflow for cleaning in between visits, after hours, etc.
Patient Education and Communication
Key Activities Considerations
Scenario Scripting
- Messaging if refuse to come in/ noncompliance with tests recommended- revision of discharge policy if prevalent in market - Review patient messages for call reminders to match the designed solution - Visitor policy/ who can accompany patient to visit
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Practice website - Ensure local website is accurate and up to date regarding hours, services offered at locations, testing, virtual care, etc.
Reassurance Messaging
- Utilize communication and marketing materials to make patients feel more comfortable
High Reliability and Communication
Key Activities Considerations
High Reliability training
Continue to incorporate high reliability practices into our work as we move forward. Many of these tools have been introduced during COVID-19, let's move forward with full integration of the High Reliability practices as we open our practices fully.
Daily Huddles As a result of COVID-19, communication and dissemination of information became more critical than ever. Continue to solidify the practice of daily huddles and transition the focus to practice operations to support the daily efforts and workflow of the markets.
Associate Emotional, Mental and Spiritual Well-being
There will be a need to continue to support the recovery of our associates through this time, and redirect our associates to the valuable resources provided by Ascension. It is also important to ensure we are providing training to our staff and managers to recognize the signs and symptoms of caregiver distress so the appropriate communications can be provided to those in need.
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Safety and Reassurance Talking Points to Patients 1. It is important that our patients feel safe and are reassured before they come for in-person care. Communicate with your patients about the increased safeguards in place to make sure your office and the AMITA facilities are as safe and as clean as possible.
● We’re committed to keeping you safe while you are receiving care with us. ● You can rest assured that our AMITTA facilities—hospitals, emergency rooms, clinics and offices—have implemented safety precautions to minimize the exposure risks related to coronavirus (COVID-19) for our patients and our care teams. ● We continuously monitor guidance from the CDC and adjust our safety practices accordingly. ● We have several new safeguards in place (see below)
2. Reassure patients that we are here to provide them the care they need. ● We understand that this has been a difficult time to take care of your health, but we’re here with you and support you. ● You can still get the care you need for you and your family. ● Don’t delay the care you need for a chronic health condition or other health concern at this time. If you have been delaying care, let us know so that we can discuss options. ● We’re committed to keeping you safe while you are receiving care with us. ● We have more options for care -- let’s discuss whether you and your doctor can have a phone or virtual visit, so that you can get the care you need from home or if you would benefit from treatment at one of our Respiratory Centers. ● If you do need to come for an in-person visit, know that we have implemented safety precautions to minimize the exposure risks related to coronavirus (COVID-19) such as;
➢ All patients and associates are screened before they come to work, using screening tools designed to ensure they are healthy and symptom-free before entering our office or providing care.
➢ Our office staff are performing rigorous procedures to clean and disinfect our sites of care.
➢ Visitor restrictions remain in place at all facilities as we prioritize the health of you and our caregivers, while providing families new ways to stay connected.
➢ We have staggered appointment times to reduce the number of patients with overlapping wait times. We have rearranged the waiting areas, so there is limited interaction with others.
➢ In accordance with CDC recommendations, all patients are asked to wear a cloth face covering when coming to our facilities. We continue to practice social distancing within our office. When you arrive, you will notice that waiting areas have fewer people and special instructions are posted for avoiding exposure.
➢ We ask that you call ahead before your appointment. By calling ahead, special arrangements can be made to reduce your time in contact with others.
➢ We are asking patients who have signs of respiratory illness to call ahead. And we are directing them to specialty care sites set up specifically for them. These separate sites will decrease the risk of infection at our office and the provider will keep your PCP informed about your care.
4. We can offer you a safe environment to get the care that you need. ● Don’t delay care, call ahead and we will be happy to coordinate the safest visit for you. ● You can rest assured that our off and AMITA—hospitals, emergency rooms, clinics and offices—have implemented safeguards to minimize the exposure risks
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related to coronavirus (COVID-19) for our patients and our care teams. ● If you have concerns about a heart attack, stroke, severe emotional or mental health concerns, respiratory distress, or a life-threatening condition, don't put off emergency care – it could make your condition worse and more difficult to recover. ● If you are experiencing a life-threatening emergency or difficulty breathing, go directly to the ER or dial 911.
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Guidelines for PPE in Office Setting Adjustments in these guidelines are subject to changes in standards of care and/or supply chain availability
Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html Advent Health (2020) Standard Operating Procedures (SOP) Personal Protective Equipment Guidance for Novel Respiratory Virus, COVID-19
4/14/20 In addition to donning proper PPE, ALL associates should be screened with a temperature check at start of their shift. If temperature is ≥ 100.0◦F, associate should be sent home and instructed to contact Associate Health. 4/21/20 In addition to the universal masking requirements, AMITA Health Medical Group associates should be practicing conservation methods to help maintain an adequate supply of masks to support the reemergence plan. Please read through the Surgical Mask Conservation Plan in the Office Setting for additional guidance. 6/19/20 CDC and JAHCO both recommend HCP use eye protection in areas with moderate to substantial community transmission.
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Surgical/Isolation Mask Conservation Plan in the Office Setting
Our primary goal in developing this plan is to keep our associates as safe as possible with the prevalence of COVID-19 in our communities. Due to this increase, AMITA Health Medical Group is requiring universal masking for all associates in the outpatient/office setting. Because the supply of face masks is low throughout the country, we must manage this efficiently and effectively by practicing surgical mask conservation methods. Please keep in mind we will make adjustments to this plan at any time to reflect our supply.
AMITA is providing guidance, in accordance with IDPH recommendations, on extended use of surgical masks. Extended use of facemasks is the practice of wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
We strongly recommend that all applicable associates do the following:
• Obtain a surgical/isolation facemask from the assigned leader at your office (daily if supply allows or per extended use protocol if necessary (see bullet 3).
• Wear the surgical/isolation facemask the entire time you are in your work area.
• Extend use of surgical/isolation facemask for multiple days of wear (up to 5 days)
• The surgical/isolation facemask should be removed and discarded in regular trash if soiled or damaged or hard to breathe through. In this instance, a new one will be issued.
• Avoid touching the facemask. Perform hand hygiene immediately if you accidently touch or readjust the facemask.
• At the end of your shift, store the surgical/isolation facemask in a brown paper bag or breathable container labeled with your name.
• Associates may bring their own professionally manufactured masks, if they so desire.
• Associates may wear a handmade cloth mask OVER the surgical/isolation face mask to further extend its use.
When removing your mask during or after a shift, please follow the instructions below for planned reuse.
Doffing for planned reuse
1. Perform hand hygiene 2. Grasp loops and remove mask slowly without touching the front or inside 3. Fold the mask in half so the outside of the face mask is folded inward 4. Place in clean a paper bag with your name and store in a safe location, such as your lab coat
pocket 5. Perform hand hygiene
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Re-Donning
1. Perform hand hygiene 2. Retrieve previously used surgical mask contained in paper bag 3. Visually inspect the product prior to use and discard if soiled or difficult to breathe through 4. Don used surgical mask 5. Perform hand hygiene
PPE requirements remain in place for those in contact with PUIs, Covid-19 + patients, and other patients in isolation precautions.
Further updates are available on the CDC website at:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/ppe-strategy/face-masks.html
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
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Talking Points for Staff Conversations and Patient Questions Please use these talking points to address questions you might get from patients and staff.
Do not copy or distribute!
• Conservation of PPE is extremely important as the number of COVID-19 cases rise. Please review the playbook to ensure you are following all the recommendations. Supplies are in high demand across AMITA and the Nation so everyone in healthcare needs to be mindful of appropriate PPE usage
• COVID-19 is spread by droplets. Good hand Hygiene, respiratory etiquette, social distancing and proper cleaning of shared surfaces are the most effective ways to prevent the spread of the virus.
• Maintaining a distance of 6 feet from those with COVID-19 like illness will decrease the risk of spread.
• Protecting staff and yourselves. o Any consideration of quarantine should be done in conjunction with the Employee Health,
the Quality team and your directors. o For details about HCPs caring for patients with confirmed or possible COVID-19 Infection
visit: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html o For risk assessment of possible HCP exposure visit:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html o You can also contact Board of Health for guidance as to what to do about HCP
exposure. OR CDC has a phone number to call for same 770-488-7100. o If you enter room with a mask and patient is also masked, your risk is low – NO quarantine o Do not quarantine without contacting the Board of Health (or CDC) as noted a couple of
lines above.
• Current Recommendations when caring for COVID-19 infections or PUI: o Surgical Mask with eye protection: Ambulatory and Post-Acute Care o N95/CAPR or PAPR with eye protection: Acute Care
• Anticipated level of risk or exposure necessitating an N95. o We know that the most likely spread of Coronavirus (and other viruses like
influenza) are the droplet route. Surgical masks are appropriate for droplets, which are large sized.
• When aerosol generating procedures (e.g. intubation, extubation, bronchoscopy, suctioning, etc.) are performed then this droplet may get aerosolized (and made much smaller) and then an N95 respirator is necessary to filter it out.
• If this is the case, then engineering controls (e.g. negative pressure room) are also necessary.
• For detailed guidance on what to do if you are sick visit: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fsteps-when-sick.html
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Quick Screen: Criteria to Evaluate Patients for COVID-19 – Phone call
PATIENT NAME: _______________________ DATE: ____________ TIME: __________
Target Population for Evaluation: ALL patients who receive care at an AMITA Medical Practice
▪ AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) for “Criteria to Guide Evaluation of PUI COVID-19” at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
Clinical Symptoms Epidemiologic Risks
Fever (≥100.0) Cough Shortness of breath Loss of taste or smell
Sore throat Myalgias (muscle pain)
Congestion or runny nose Nausea or Vomiting Diarrhea
OR
Personal history of suspected (symptomatic) or laboratory confirmed COVID-19 within the last 10 days
Close contact with a person with suspected or laboratory confirmed COVID-19 within the last 14 days
IF patient answers YES to ANY Clinical Symptoms or Risk Factors
□ Patient at risk for COVID-19 like illness. □ Triage patient appropriately
□ If the patient is mildly or moderately ill in stable condition, recommend the patient stay HOME with supportive care and give instructions to self-isolate
□ Schedule telehealth visit or treatment at Respiratory Center as appropriate (avoid treatment in regular office setting)
□ If needed, obtain clinical decision-making support from a Physician or APC (NP or PA)
□ Physicians and APCs should Refer to “Priorities for COVID-19 Testing” as outlined by CDC
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
□ COVID-19 screening performed, NEGATIVE for COVID-like illness. Proceed with
appointment
Updated 9.9.20 Si
Signature
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Quick Screen: Criteria to Evaluate Patients for COVID-19- Patient is in Office
PATIENT NAME: _______________________ DATE: ____________ TIME: __________
Target Population for Evaluation: ALL patients who receive care at an AMITA Medical Practice
▪ AMITA is following the guidance of the Centers for Disease Control and prevention (CDC) for “Criteria to Guide Evaluation of PUI COVID-19” at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
Clinical Symptoms Epidemiologic Risks
Fever (≥100.0) Cough Shortness of breath
Loss of taste or smell Sore throat
Myalgias (muscle pain) Congestion or runny nose Nausea or vomiting
Diarrhea
OR
Personal history of suspected or laboratory confirmed COVID-19 within the last 10 days
Close contact with a person with suspected or laboratory confirmed COVID-19 within the last 14 days
IF patient answers YES to ANY Clinical Symptoms or Risk factors (do not send patient away)
□ Put Surgical Mask on Patient
□ Immediately escort patient to designated isolation room and CLOSE door
□ Notify Clinician
□ AFTER patient is ISOLATED and clinician has donned PPE (Surgical Face Mask with eye protection, Gown and Gloves), complete additional evaluation and screening.
□ Refer to “Priorities for COVID-19 Testing” as outlined by CDC
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
□ COVID-19 screening performed, NEGATIVE for COVID-like illness. Updated 9.9.20 Signature
Signature
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Criteria to Treat and Test Patients with COVID-19-like Illness
1. If the patient is mildly or moderately ill in stable condition, send the patient HOME with supportive care and instructions to self-isolate. “Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management.” https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
2. If the patient is mildly or moderately ill in stable condition now but clinical decision-making supports testing due to an underlying illness AND the test result will impact the treatment plan, provide the patient an order and COORDINATE testing through an ambulatory test site. Refer to table 1 on page 18 for a list of AMITA sponsored test sites.
3. For additional information on testing priorities or test sites in your area, refer to the CDC or IDPH websites. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
http://dph.illinois.gov/covid19/testing-guidance As testing capacity expands, IDPH recommends testing for all people who:
• Have COVID-19 symptoms (cough, shortness of breath and fever) OR Testing is also available for those with or without symptoms who:
• Work in a health care facility or provide home health services
• Work in correctional facilities, such as jails or prisons
• Are government employees
• Serve as first responders, such as paramedics, emergency medical technicians, law enforcement officers or firefighters
• Support critical infrastructure, such as workers in grocery stores, pharmacies, restaurants, gas stations, public utilities, factories, childcare, eldercare and sanitation
A list of testing sites can be found online at https://dph.illinois.gov/testing Asymptomatic patient testing can be performed at Alverno Patient Service Centers or PCP offices. (see page for list of sites and testing protocol)
• Patients should be screened and proper PPE should be used when collecting nasal specimens (minimally surgical face mask, Eye shield and gloves)
• You can find the Alverno PSC schedule at https://app.acuityscheduling.com/schedule.php?owner=20236182
• Patients need to present themselves to the PSC within 24 hours of the negative screen. If patients present without a copy of the quick screen, they may be turned away.
• Select a location and time for the screening and give a copy of the order and signed negative quick screen to the patient (or fax it) and you should get the results in within 24-48 hours
.
4. If patient is severely or critically ill, coordinate transfer to ED or call 911 “Patients who have severe symptoms, such as difficulty breathing, persistent pain or pressure in the chest, new confusion, inability to stay awake or bluish lips or face should seek care immediately.”
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https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
5. Hospital and ED testing is reserved for the critically ill
.
6. Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting multisystem inflammatory syndrome in children (MIS-C) criteria should report suspected cases to their local, state, or territorial health department. For additional reporting questions, please contact CDC’s 24-hour Emergency Operations Center at 770-488-7100.
7. If patient is requesting 2 negative tests to return to work, AMITA supports that you reference the CDC’s “symptom-based” strategy for symptomatic suspected and COVID + patients and “time-based” strategy for asymptomatic COVID + patients. Compliance has approved of the following script to be used when clearing patients to return to work or stop their self-isolation;
“AMITA Medical Group is not retesting asymptomatic COVID positive patients at this time. According to the CDC’s symptom-based strategy, symptomatic COVID + patients may discontinue isolation if at least 24 hours have passed without symptoms, without the use of medications, and at least 10 days have passed since the onset of symptoms. The CDC’s time-based strategy states asymptomatic patients who tested positive for COVID can discontinue isolation 10 days from the positive test if they continue to be asymptomatic.”
8. As of 7/20/20 the CDC has updated their guidance for removal of isolation in non-hospitalized patients.
a. A test-based strategy is no longer recommended to determine when to discontinue home isolation in confirmed or symptomatic patients, except in certain circumstances.
b. Symptom Based Approach: Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
i. At least 10 days* have passed since symptom onset and ii. At least 24 hours have passed since resolution of fever without the use of fever-reducing
medications and iii. Other symptoms have improved
c. For patients with severe illness, duration of isolation for up to 20 days after symptom onset may be warranted. Consider consultation with infection control experts.
d. Time Based Approach: Persons who never develop symptoms can discontinue isolation and other precautions 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.
9. As of 7/17/20, the CDC has changed the return to work guidance for Health Care Providers (HCP). a. Except for rare situations, a test-based strategy is no longer recommended to determine when to allow
HCP to return to work b. Symptom Based Approach: HCP with COVID-19 who have symptoms and were directed to care for
themselves at home may discontinue isolation under the following conditions: i. At least 10 days* have passed since symptom onset and
ii. At least 24 hours have passed since resolution of fever without the use of fever-reducing
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medications and iii. Other symptoms have improved
c. HCP with severe to critical illness or who are severely immunocompromised1: i. At least 20 days have passed since symptoms first appeared
ii. At least 24 hours have passed since last fever without the use of fever-reducing medications and
iii. Symptoms (e.g., cough, shortness of breath) have improved 10. Discontinuation of isolation in persons known to be infected with SARS-CoV-2 could conflict with
recommendations on when to discontinue quarantine for persons known to have been exposed to SARS-CoV-2. The CDC continues to recommend 14 days of quarantine after exposure based on the time it takes to develop illness if infected. Thus, it is possible that a person known to be infected could leave isolation earlier than a person who is quarantined because of the possibility they are infected.
11. As of 8/16/20 People who have been in close contact with someone who has COVID-19—excluding people who have had COVID-19 within the past 3 months should quarantine for 14 days.
What counts as close contact?
• You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more • You provided care at home to someone who is sick with COVID-19 • You had direct physical contact with the person (hugged or kissed them) • You shared eating or drinking utensils • They sneezed, coughed, or somehow got respiratory droplets on you
Stay home and monitor your health
• Stay home for 14 days after your last contact with a person who has COVID-19 • Watch for fever (100.0◦F), cough, shortness of breath, or other symptoms of COVID-19 • If possible, stay away from others, especially people who are at higher risk for getting very sick from
COVID-19
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AMITA Health Response to COVID-19 Ambulatory Testing via Commercial Lab
Table 1 – COVID-19 Testing ONLY Location Address Order
required Pre-Registration Required Times Special Instructions
AMITA Health
St Alexius Medical Center
1555 Barrington Rd
Hoffman Estates, 60169
Yes Fax order
to 847-590-
2634
Yes
Instruct patient to call scheduling at 877-717-7700
M-F 10am-2pm
• Registrar will contact patient to schedule appointment and coordinate drive through testing
• Tell patient to be prepared to answer the call
• Patients must obtain order from PCP
• Associates contact local Associate Health
• Medical Staff call Medical Staff Hotline at 224-273-3900
AMITA Health
St Francis Hospital
355 Ridge Ave Evanston,
60202
Yes Fax order
to 312-770-2530
Yes
Instruct patient to call scheduling at 312-770-3006
M-F 10am-3pm
• Registrar will contact patient to schedule appointment and coordinate drive through testing
• Tell patient to be prepared to answer the call
• Patients must obtain order from PCP
• Associates contact local Associate Health
• Medical Staff call Medical Staff Hotline at 224-273-3900
AMITA Health
St Joseph Medical Center –
Joliet
333 N Madison St
Joliet, 60435
Yes Fax order
to 844-569-4066
Yes
Instruct patient to call scheduling at 815-741-7555
M-F 9am-3pm
• Registrar will contact patient to schedule appointment and coordinate drive through testing
• Tell patient to be prepared to answer the call.
AMITA Health
Adventist Medical Center
LaGrange
5101 S Willow Springs Rd LaGrange,
60525
Yes Fax order
to 630.856.70
60
Yes
Instruct patient to call scheduling at 877-717-7700
M-F 9am-3pm
• Registrar will contact patient to schedule appointment and coordinate drive through testing
• Tell patient to be prepared to answer the call
• Patients must obtain order from PCP
• Associates contact local Associate Health
• Medical Staff call Medical Staff Hotline at 224-273-3900
AMITA Health
St Mary and Elizabeth Medical Center
1431 N. Claremont
Ave, Chicago, 60169
Yes Fax order
to 312-770-
2530
Yes
Instruct patient to call scheduling at 312-770-3006
M-F 8am-4pm
• Registrar will contact patient to schedule appointment and coordinate drive through testing
• Tell patient to be prepared to answer the call
• Patients must obtain order from PCP
• Associates contact local Associate Health Medical Staff call Medical Staff Hotline at 224-273-
3900
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AMITA Health Response to COVID-19
Table 2 – COVID-19 Respiratory Centers - Evaluation and Testing (if indicated)
Location Address Referral required Pre-Registration
Required Times Special Instructions
AMITA Health Mount
Prospect
1754 W Golf Road. Mt
Prospect, Il 60056
Yes Fax Referral form to
224-265-9041 or
(call 224-265-9010) DO NOT HAVE PATIENTS CALL
DIRECTLY
Yes Patient will be
contacted once referral is received
Mon-Sat 8am-5pm
Closed Sunday
• Independent Physicians fax referral form, patient’s DL, insurance card, medication list, problem list and last office visit note to
• Site will contact the patient to schedule an appointment
• Patient stays in their car and calls front desk upon arrival 224-265-9010
AMITA Health
Lincolnwood
7380 N Lincoln Lincolnwood,
IL 60712
Yes Fax Referral Form to
847-568-7440 or
(call 847-568-7400 if unable to fax) DO NOT HAVE PATIENTS CALL
DIRECTLY
Yes Patient will be
contacted once referral is received
Mon-Fri 1pm-5pm
Sat 10am-1pm
Closed Sunday
• Independent Physicians fax referral form, patient’s DL, insurance card, medication list, problem list and last office visit note to
• Site will contact the patient to schedule an appointment
• Patient stays in their car and calls front desk upon arrival 847-568-7400
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Management of Possible COVID-19 in Ambulatory Setting- Patient is physically present in the office
1. Pre-screen patients over the phone before appointment (Refer to Quick Screen-Phone call page 13). All
Patients screening positive should be managed via Telehealth or at one of the Respiratory Centers. Patients previously suspected of having COVID-19 or who are known to be COVID-19 + should be followed via Telehealth or at the Respiratory Center until their symptoms have resolved for at least 10-20 days depending on the severity of illness (or 10 days after a positive result in asymptomatic patients)
2. Patient presents for appointment
3. First point of contact re-screens EVERY patient for COVID-19-like illness by using Quick screen or by asking Symptom questions (Athena users see Appendix A; EPIC users see Appendix B)
4. If Patient screens
a. Negative-- continue with appointment as usual
b. Positive-- Do not send patient away
i. Mask patient with surgical mask if patient is presenting without a face
covering). If patient is wearing a cloth mask obtain a surgical mask for
patient to don while in the designated isolation room
ii. Immediately escort patient to designated isolation room and CLOSE DOOR iii. If patient presented
iv. Notify Clinician/Provider
c. Unclear/Special Situations
i. Mask patient with surgical mask if patient is presenting without a face
covering. If patient is wearing a cloth mask, obtain a surgical mask for
patient to don while in the designated isolation room.
ii. Immediately escort patient to designated isolation room and CLOSE DOOR
iii. Notify Clinician/Provider
5. After patient is isolated and Clinician/Provider dons PPE (Surgical Face Mask, Eye Protection, Gown
and Gloves):
a. Clinician evaluates the patient.
b. If “Possible COVID-19” and patient is mildly to moderately ill in stable condition, send the patient home to self-isolate, with supportive care. Visit https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html or refer to the handout (page 49-50).
c. If “possible COVID-19” and clinical judgement supports additional testing and patient is stable, in no distress, coordinate COVID -19 testing in a safe environment; such as at an ambulatory test site (see
23
d. table 1).
e. PPE supplies (especially N95 masks, eye protection and gowns) are compromised and should be reserved for those treating the critically ill and/or those performing aerosolizing generating
f. procedures (AGPs). https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. All efforts must be made to avoid improper use of PPE in the outpatient setting. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
g. IF YOU DO NOT HAVE ACCESS TO THE PROPER PPE and A SAFE ENVIRONMENT FOR SPECIMEN COLLECTION as outlined at https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. You should not obtain specimens for commercial COVID-19 testing
h. Call 911 to coordinate transfer if clinical judgement supports patient is critically ill or in distress – be sure to identify case as “possible COVID-19 infection” to allow first responders to take proper precautions.
6. Implement Cleaning processes for Designated Isolation Room. a. Keep door closed until a sufficient amount of time has elapsed (25-35 min for 99% efficiency, 35-55
min for 99.9% efficiency)
b. Clean room per standard protocol with an EPA-approved viral disinfectant. Examples
include CaviWipes Bleach, CaviWipes1, Cavicide Bleach and CaviCide
https://www.cdc.gov/coronavirus/2019-ncov/infection-control/infection-prevention-
control-faq.html and https://www.engineeringtoolbox.com/air-change-rate-room-
d_867.html
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Management of Possible COVID-19 in Ambulatory Setting- Patient is on the phone
1. Patient calls with self-reported COVID-19 symptoms or travel risks OR call is routed from Contact Center
2. AMITA HCP (healthcare personnel) screens patient for COVID-19 by using the quick screen
3. If Patient screens
a. Negative—schedule appointment as needed
b. Positive--- Send to triage
c. If “Possible COVID-19” and patient is mildly to moderately ill in stable condition, tell the patient to stay home to self-isolate and manage symptoms with supportive care. When appropriate, schedule telehealth visit with physician or APC.
Visit https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html or refer to the handout (pages 49-50).
d. If “possible COVID-19” and clinical judgement supports testing coordinate testing through an ambulatory test site (see table 1)
e. If “possible COVID-19” and clinical judgement supports a face to face evaluation with possible testing and patient is stable, in no distress, coordinate a visit in a safe environment such as a Respiratory Center (see Table 2).
f. Patients previously suspected of having COVID-19 or who are known to be COVID-19 + should be followed via Telehealth or at the Respiratory Center until at least 10 days have passed since onset of their symptoms (or 10 days after a positive result in asymptomatic patients) and they have been fever free for 24 hours without medications and all symptoms have improved .
g. Patients who were recently hospitalized with severe illness related to COVID-19 may need to be isolated for up to 20 days from symptom onset. Consider consultation with infection control experts.
h. Asymptomatic patients who are believed to have been exposed to SARS CoV2 should be followed via telehealth for the 14-day quarantine period.
i. Patients requesting clearance to return to work before 10 days if suspected or confirmed COVID +- should be screened via telehealth and given a letter of clearance via the patient portal or other special arrangements (bring letter out to patient in their car, tape sealed envelope to the outside of the door for pick up at a schedule time, etc.)
a. Asymptomatic patients requesting clearance to return to work before 14 days of exposure should be advised to complete the 14 day quarantine period. Refer to approved scripting on page 16.
25
CDC Criteria to Evaluate Patients Calling AMITA Contact Center AHMG Primary Care Regarding Coronavirus
All callers requesting an appointment or have questions about
COVID-19 will be screened for Clinical Symptoms AND Risk
Questions listed below:
Clinical Symptoms
Risk Questions Continue to ask Questions, once the answer is Yes- STOP go to Page 2; follow Action Grid
Script:
“Are you currently experiencing any
of the following symptoms?”
Have you received any evaluation or treatment for COVID-19 like illness or have you been laboratory confirmed COVID-19 within the last 10 days?
Have you had close contact with a laboratory confirmed COVID-19 patient within 14 days?
Have you traveled outside of the state of Illinois in the last 14 days?
Do you live in an assistive living or recently been discharged from a nursing home/rehab facility known to have clusters of influenza or COVID-19 like illness?
Fever ( ≥ 100.0 )
Cough
Shortness of Breath
Loss of taste or smell
Sore Throat
Myalgias (Muscle Pain)
Congestion or runny nose
Nausea or vomiting
Diarrhea
Answer Yes or No To COVID Screening Questions
Follow Action Grid on Page 2
AND
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COVID-19 Clinical Symptoms and Risk Question Action Guide
Clinical Symptoms Risk Questions ACTION
1
Yes- Shortness of breath Difficulty breathing
Yes, to at least one RISK Question
Or No, to all RISK
questions
Transfer the caller to Site Clinical Team- Yellow Flag. Patient needs to speak to a clinical team member or provider.
2
Yes- to at least
one symptom
Yes, to at least one RISK question
Create a patient case (Subject: COVID-19). Site needs to triage patient regarding their symptoms. Special precautions may need to be taken.
3
Yes- to at least
one symptom
No, to all RISK questions
4
No Yes, to at least one RISK question
5
No Yes, TRAVELING RISK
Question only No, to all other RISK questions
Schedule an appointment. ADD “Appointment Note”: Travel <location, date>; otherwise Neg COVID-19 screening as of <date>
6
Experiencing “other”
sick symptoms (not on Clinical Symptom list)
Yes, to at least one RISK Question
Or No, to all RISK
questions
Create a patient case (Subject: Appointment Request). Patient has “other” sick symptoms. Our sites are taking all precautious, trying not to see “sick” patients in the office. Clinical team will contact the patient, triage their symptoms, and determine the best appointment option. Virtual Visit may be offered.
7
No No, to all RISK Question
Schedule appointment- it is not due to Coronavirus or any sick symptoms. Document reason for visit and *document in appointment note: *Screened Negative COVID-19 as of <todays date>. Follow AHMG Scheduling Guidelines. Inform patient AMITA Providers are offering Virtual Visits. If patient is interested in a Virtual Visit send a patient case (Subject: Appointment Request).
8
New Patient Yes
Yes
Create a patient case(Subject: COVID-19). Site will triage New patient regarding their symptoms. Special precautions may need to be taken. *register New Patient in Athena
New Patient Yes
No
New Patient No
Yes, to at least one RISK question
New Patient No
No Follow Action Guide Row 7; AHMG Scheduling Guidelines
Promote Virtual Visits. Inform the patient that AMITA Providers are offering Virtual Visit.
27
If patient is interested create a patient case (Subject: Appointment Request). Site will contact patient to determine best appointment options.
Athena Patient Cases ➢ When sending a patient case regarding COVID-19; ADD to subject line: COVID-19 ➢ Subject Line will assist the practice site to sort patient cases and address timely ➢ This can help us track and gather data
Genesys Wrap-up Code: for Action Grid always use Wrap-Up Code: Coronavirus (Exception: Row 6 use Wrap-Up Code: Scheduled Appt)
Cancelling Appointment due to COVID-19: reason for cancellation utilize “Public Health Alert”
OTHER SCENERIOS Pre-visit instructions Reminders
When scheduling an appointment remind patient:
➢ Must wear a face covering (mask, bandana, scarf) over their nose and mouth when they come in
➢ Bring one companion with them for visits in the office ➢ All patients are being “screened” as they arrive for their appointment.
“Your appointment time is ___ with <Provider> at location <address> Check-in Time is ___ (*15 minutes prior to scheduled appointment time)”
Patient calling with general questions, regarding COVID-19.
To learn about the latest information, refer patient to:
➢ AMITA COVID-19 Resource Center https://www.amitahealth.org/covid-19/
➢ Illinois Department of Public Health by calling 800.889.3931 ➢ CDC COVID-19 Fact Sheet: https://www.cdc.gov/coronavirus/2019-
ncov/downloads/sick-with-2019-nCoV-fact-sheet.pdf
➢ CDC.gov link: https://www.cdc.gov/coronavirus/2019-ncov/index.html
Patient is calling to schedule or reschedule Wellness Visits:
Schedule Wellness appointments as patient requests: “Our sites are taking all precautious, trying not to see “sick” patients in the office. If a patient wants to schedule an appointment, follow AHMG scheduling guidelines.” Adult Wellness / Physicals (in-office appointment) Well Child Visits (in-office appointment) Medicare Patients: Welcome to Medicare (in-office appointment)
Annual Wellness Visit (in-office or Virtual Visit available)
28
Virtual Visits
Promote that AMITA Providers are offering Virtual Visits. If patient is interested in a Virtual Visit send a patient case (Subject: Appointment Request).
Recommended Wording: “During the COVID-19 pandemic we are making every effort to ensure you can continue to see or receive care from your doctor. We can schedule a Virtual Visit with your doctor, from the safety and comfort of your home using your computer, tablet or phone. Our doctors are available for both COVID-19 symptom checks as well as to review chronic or new medical conditions and other acute illnesses that you are experiencing. Would you like me to send a message to your doctor so they can contact you to schedule a Virtual Visit?”
Rescheduling Appointments
Was patient screened when original appointment was scheduled? Ask: Where you screened for COVID-19 symptoms and RISK Questions when scheduling this appointment? NO- patient will need to be screened. Follow Action Grid, Page Two
YES- patient was screened. Ask: “Have there been any changes (new symptoms) since scheduled your appointment?” NO, proceed with rescheduling appointment YES, experiencing new symptoms. Patient needs to be screened with COVID-19 symptoms and RISK Questions. Follow Action Grid, Page Two Document reason for visit and *document in appointment note: *Screened Negative COVID-19 as of <todays date>.
Cancelling Appointments
Our goal is to assist patients by sharing various scheduling options when they need to see their provider. We want to ensure AMITA patients are seeing their Providers for their health care needs during this COVID-19 pandemic. When a patient calls to cancel their appointment, provide the patient with the options listed below.
1. Offer a Virtual Appointment 2. Offer to reschedule in-office appointment (^TIP: use reschedule option) 3. If the patient does not want to re-schedule in-office appointment set up a Reminder
(Tickler) in Athena for Well Visit / Physical or chronic disease follow-up appointment.
Refer to Cancelling an Appointment Job Aid
29
Other workflow items:
Medication Refill Requests: if patient is calling for a prescription refill, Transfer the patient to their pharmacy. The pharmacy will send their prescription request electronically to their PCP. Lab/Test results are being reviewed. Results will be communicated with the patients as quickly as possible. Encourage patients to utilize Athena Portal. Assist patient in activating their portal account, resend the link or reset password.
30
Tips to help decrease COVID-19 transmission
ASSOCIATES: ** Stay Home if you are sick!
*** Screen temperature of ALL associates at the start of their shift. If temperature is ≥ 100.0◦F, send associate home and recommend they follow up with Associate Health.
ENVIRONMENT:
Before Patients Arrive
• Screen for acute symptoms prior to the appointment
• Consider scheduling a telehealth visit if patient has acute symptoms or refer to one of the Respiratory Centers
• Place signage on door indicating use of a mask for entry
• Place signage on door asking patients to call before entering if they have acute symptoms so accommodations can be made such as;
o greet patient at the door and handing them a mask or tissue to cover their nose and mouth
o Instruct patient to enter via an alternate route like a back or side door
o have designated staff in proper PPE escort patient straight back into exam room
31
• Prepare the waiting area by
o placing chairs 6 feet apart
o place tape on the floor or use signs to keep patients within 6 feet of the registration desk
o Remove all non-essential items from the waiting room such as magazines, toys or other community objects that get touched often
When Patients Arrive
• Make every effort to limit the exposure of patients with acute symptoms to common areas
o greet patient at the door and handing them a mask or tissue to cover their nose and mouth
o Instruct patient to enter via an alternate route like a back or side doo
o have designated staff in proper PPE escort patient straight back into exam room as quickly as possible
o ask patient to wait in the car until staff is ready for them to arrive
o create sperate spaces for sick and well by alternating appointments (healthy visits in am, sick visits in PM) or separating parts of your office
When Patients Leave
• Clean all hard surfaces (counters, examine tables, chairs, electronics and monitoring devices) using EPA- approved disinfectants
• Provide appropriate discharge instructions reinforcing symptom management and social distancing/ self-isolation.
Refer to https://www.cdc.gov/coronavirus/2019-ncov/communication/factsheets.html for printable handouts in various languages including English, Spanish, Polish and others.
32
During this COVID-19 crisis please be aware that you may see a variety of disinfectants/wipes for use against COVID-19. The below products are listed on the EPA's website for approved disinfectants against COVID-19. Please be mindful of reviewing the contact time (in minutes) recommended by each manufacturer as it varies per product. *Products noted for killing C. diff spores are noted, these products will also disinfectant against COVID-19. Please be mindful that spray disinfectant of any kind should not be sprayed directly on equipment or monitors. Spray disinfectant will need to be sprayed on a wipe/rag before wiping down equipment of any kind to prevent damage and/or malfunction.
Image of the Product Product Name and number Company Name Contact Time (In Minutes)
Sani-Cloth XLarge 55% Alcohol Q86984
GRAINGER - 9JAJ1 (1), 172H69 (6pk)
Super Sani Large 55% Alcohol
Q55172
GRAINGER - 9RYJ7 (1)
Professional Disposables
International
2 minutes
Sani-Cloth Bleach Germicidal PDI: P54072, P25784, P7007P, P700RF, H58195,
U26595
GRAINGER - 16Z989
Professional Disposables
International
4 minutes
*kills C. Diff spores in 4
minutes
Sani-Cloth AF3 Large Canister P13872
Sani-Cloth AF3 Germicidal Wipes XL
81626514
Professional Disposables
International
Performance Health
3 minutes
SaniPrime (RTU-Wipes)
P25372, P24284, H06182 & U13195
Professional Disposables
International
1 minute
33
Caviwipe1 XL, 65 Wipes/Canister 13-5150
GRAINGER - 6TWF8 - *13-1150
Caviwipe1 Regular 160 Wipes/Canister 13-5100
Metrex For the coronavirus, this wipe does in fact need a 3-minute kill time. All other
pathogens require a 1
minute. But, only the Coronavirus
or in this case, the Adenovirus (most similar) is going to require the use of
3-minute kill time.
Caviwipe Bleach 6"X10". 90 Wipes/Canister 13-9100
Metrex 3 minutes
*kills C. Diff spores in 3
minutes
Cavicide (RTU)
GRAINGER - 3VDJ1 (24oz Bottle), 3VDJ2 (1gal Bottle), 3VDJ3 (2.5 Gal Bottle), 3VDJ7 (2.5 Gal
Easy Pour Jug)
Metrex 3 minutes
Clorox Healthcare® Bleach Germicidal Wipes Office Depot: 439675, 1630225, 265701, 825962,
8373413, 764946, 129202, 8193323, 8193614, 8193080
Medline: CLO30358H, CLO35309, CLO31424Z,
CLO31424, CLO30577H, CLO30577
GRAINGER: 1XEZ3, 4XKR8, 4XKR7, 6VDE9
Clorox Professional Products Company
3 minutes
*kills C. Diff spores in 3
minutes
kills C. diff spores
34
Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant Wipes
Medline: CLO30827, CLO30826Z, CLO30826,
CLO30825Z, CLO30825, CLO30824H
GRAINGER: 401Z41, 401Z45, 401Z42, 401Z40
Clorox Professional Products Company
2 minutes
Healthcare Fuzion Cleaner (Spray)
GRAINGER: 52LC52
Clorox Professional Products Company
1 minute
Oxivir Tb
GRAINGER: 5KRJ0 (32oz Trigger Spray, RTU, 12PK), 48TJ10 (RTU
1 gal jug, 4PK), 5KRJ1 (TB Wipes),
Diversey Inc 1 minute
Oxivir 1 (RTU-Wipe) GRAINGER:
53JX16 (Wipes 6”x7”), 53JX15 (Wipes 7”x8”), 53JX17 (Wipes, Bucket, 11”x12”), 45DW77 (Wipes
Refill)
53JX14 (32oz Bottle, RTU, 12PK)
Diversey Inc 1minute
Oxivir Five 16 (Concentrate-Dip and use method)
GRAINGER: 11Y608 (RTU, 1 Gal Jug), 11Y610 (J-Fill, Chem Dispenser), 15V142 (1.5 Gal Jug, RTU, 2pk),
11Y607 (RTD Chem Dispenser PK), 11Y609 (SmartDose Chem Dispenser),
Diversey Inc 5 minutes
35
Avert Sporicidal (RTU-wipe)
Diversey Inc. 1 minute
*kills C. Diff spores in 4
minutes
Virex II 256 (Concentrate-Dip and use method)
GRAINGER: 11W407 (1 Gal Jug), 10A336 (1.5 Gal
Jug, 2pk), 10C417 (J-Fill Chem Dispenser, 2PK), 11Y654 (RTD Chem Dispenser), 6EFY2 (SmartDose
Chem Dispenser), 11Y653 (32oz Concentrated)
Diversey Inc. 10 minutes
Virex Plus (Concentrate must be at 1:128-Dip and Use
Method)
Diversey Inc. 5 minutes
Noroxycdiff (electrostatic spray application)
Pervasive 7 minutes-15 minutes post
discharge clean process time
Dispatch 69150
GRAINGER: 22D022
Clorox Professional Products Company
1 minute
36
Pericept (Concentrate-Dip and use method)
SSS 2 minutes
*kills C. Diff spores in 4
minutes-contains no bleach or
alcohol
Side Kick Disinfecting Wipes Standard Wipes Model Number: 2060-000-001
Large Wipes Model Number: 2060-000-002
Stryker 2 minutes
Maxim GSC Germicidal Spray Cleaner Product Number: 042000
Midlab 2 minutes
Clorox Commercial Solutions® Clorox® Disinfecting Wipes
Product #: 15949
Clorox Professional Products Company
4 minutes
37
Opti-Cide 3® Wipes Item# OCW06-100
Micro-Scientific LLC 3 minutes
Opti-Cide 3 Item #: OCS12-024
Micro-Scientific LLC 2 minutes
Opti-Cide 3 Item# OCP04-128
Micro-Scientific LLC 2 minutes
Clorox Healthcare® Bleach Germicidal Trigger Spray
Bottle Grainger: Mfr. Model # 68970 Catalog Page # 1512
Clorox Professional Products Company
3 minutes
*kills C. Diff spores in 3
minutes
Discide Ultra Disinfecting Towlettes Palmero Healthcare 2-30 second applications are required. Please
wipe down surfaces, allow a 30 second dwell
time for cleansing, then
please wipe down surface again,
allow a 30 second dwell time for disinfection.
38
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
These approved disinfectants are being utilized frequently during this time of COVID-19. However, please be aware that in the coming months we stay mindful of expiration dates regarding these products. Many of these approved disinfectants use a coding system of a Julian date code for their expiration. An example of this coding is listed below for reference.
Discide Ultra Disinfecting Spray Palmero Healthcare 2-30 second applications are required. Please spray surfaces,
allow a 30 second dwell time for
cleansing, then please spray
surface again, allow a 30 second
dwell time for disinfection.
Ecolab Quaternary Disinfectant Wipes
12 x 85 XL Wipes # 6000169 12x220 Wipes # 6000166
Ecolab 2 minutes
39
40
Discharge Instructions for Suspected COVID-19
Q: What is a COVID-19 (novel coronavirus)? A: A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing COVID-19 is not the same as the coronaviruses that commonly circulates among humans and causes mild illness, like the common cold. Q: What are the symptoms of COVID-19? A: Patients with COVID-19 typically have mild to severe respiratory illness with symptoms of
● Fever (>100.0) ● Cough ● Shortness of breath
Q: How can I protect myself and others? A: You can protect yourself by:
● Practice social distancing o Avoid public places o Avoid gatherings with others o Avoid handshakes
● Maintain six (6) feet distance between yourself and others ● Avoid close contact with people who are sick ● Avoid touching your eyes, nose, and mouth with unwashed hands ● Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
Q: What precautions do I need to take when I am discharged? A: Please see the following:
● If your doctor prescribed a medication(s), you should take them all until complete ● If you have a follow-up appointment, call the doctor’s office ahead of time and inform that you tested positive for COVID-19 ● Wear a facemask when you are around other people or at least when going to the doctor while symptoms still exist or when you doctor tells you not to ● Practice social distancing and avoid crowds ● Stay away from persons with any signs and symptoms of sickness ● Do not share utensils/drinking glasses/toothbrushes ● Do not share pillows/sheets/blankets ● Avoid using public transportation ● Drink plenty of fluids ● Get rest ● Cover your mouth/nose when you cough/sneeze ● Wash your hands with soap and water for at least 20 seconds, especially after blowing your nose, coughing or sneezing ● If soap and water is not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. ● Frequently clean surfaces you touch with wet wipes/disinfectant ● Try to use a separate bathroom just for you
41
● Avoid handling of your pets ● Check your temperature
Q: When will I be able to stop isolation and be able to return to work? A: The answer depends on whether you will be tested by your doctor (primary care) to determine if you are still contagious. In most instances, discontinuation of isolation is based on the improvement in your clinical symptoms, and often there is no need to repeat the test to check on whether the virus is still present. Always follow your doctor’s instructions. If your doctor (primary care) is not going to test you to determine if you are still contagious then all of the below must occur:
● no fever for >24 hours ● symptoms have resolved or improved ● a minimum of ten (10) days have passed since your visit symptoms began or you received a positive test result or 20 days for those who were severely ill or immunocompromised.
Q: When should I seek emergency care? A: Call your doctor if you think your symptoms are worse or you develop new symptoms.
● Call 911 and go to the ER if you are experiencing: ○ Difficulty breathing or shortness of breath ○ Persistent pain or pressure in the chest ○ New confusion or inability to arouse ○ Bluish lips or face For additional information on COVID-19 go to the following website: https://www.cdc.gov/coronavirus/2019-ncov/index.html
Q: When and how will I get my COVID-19 test result? A: If COVID-19 test was performed, your result will be communicated via phone. Results will be forwarded to your Primary Care Provider (PCP). Please follow up with your PCP’s office if you need a copy of the lab results.
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Talking Points for patient with positive screen and/or “Possible COVID-19”
1. You were asked to wear a mask and put into a private room as a precaution, for your safety, the safety of other patients and our staff.
2. COVID-19 is spread through droplets, frequent hand washing, proper respiratory etiquette and
social distancing are the best ways to avoid the spread.
3. Due to your symptoms and current condition, you do not require testing.
4. You do not meet the criteria for COVID-19 testing. A positive result will not change the treatment
plan which is to self-isolate, treat symptoms with Tylenol as needed, drink plenty of fluids and get
adequate rest.
5. COVID-19 testing is not necessary in mildly ill, stable patients. If your symptoms worsen, please call
the office for additional guidance.
6. COVID-19 testing is not readily available and must be collected in a safe environment. We cannot
do the testing in the office so please wait here as we coordinate your care.
7. You have been cleared to return home but should remain in isolation. Monitor yourself for fever or
worsening symptoms. Continue to practice good handwashing techniques and cover your coughs
and sneeze. Avoid close contacts with others until at least 10 days have passed since symptom
onset and at least 24 hours have passed since resolution of fever without the use of fever-reducing
medications and other symptoms have improved. (Give patient handout on page 30 and refer
patient to https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html)
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APPENDIX A: Athena Workflow
Step 1: Screening begins at the first point of contact with the patient which is during patient check in. When the CSR begins check in, they will see 2 questions in the appointment information section. We are limited in how many characters per question we were allowed. Please begin both questions with “in the last 14 days”. The dropdown next to “in the last 14 days” is not able to be populated for this reason. If both questions are answered by the patient as no, then the screen is complete. If one or more answer is yes, continue to step 2.
Step 2:
From the clinicals tab of the patient Quickview click on print forms. Print the Quick Screen: CDC Criteria to Evaluate Patients for COVID-19 and have the patient complete.
Step 3: Transcribe patient answers from the quick screen into the social history section of the patient chart. Fax barcoded screening form into Athena.
CORONAVIRUS SCREENING WORKFLOW
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APPENDIX B: EPIC Workflow
• When Front Desk users check in an appointment, they will receive a Confirmation Message prompting
them to complete the Travel History Questionnaire if they have not done so for the applicable visit.
• Users should then navigate to the top Registration Toolbar while in the check-in workflow and select
Travel History. (Click on the More button if the menu item is not viewable.)
• The Travel History Questionnaire opens. o The User must ask the patient each question shown in the questionnaire. o A positive answer to either question will require additional actions.
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• If either question is answered positively then the Best Practice Advisory pop-up appears, and the user must take the necessary actions to mask and isolate the patient, then notify clinical staff accordingly.
1) After handing a mask to the patient and alerting clinical staff,
Clinical staff escorts patient to desinated isolation area and closes the door, opens the patient’s chart and creates a new encounter.
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2) The encounter defaults to begin under, ROOMING. The “Travel Screening” activity has been added.
(Double-click) to open the Travel Screening activity. Locations: Brazil, China, Japan, South Korea, Italy, Iran*
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When the completed Travel screening has resulted positive, the following BPA will pop up on the screen. (BPA for Brazil, China, Japan, South Korea, Italy, Iran*)
(*BPA for Iran also has MERS Risk)
The hyperlink, , allows the clinician to reference the CDC’s most up to date material related to the COVID-19. The clinician will then proceed with the suggested precautions and send the patient to the Emergency Department.
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APPENDIX C: Miscellaneous Resources
Chicago Metro Region Emergency Department
Site Address/Contact Phone Number AMITA St. Joseph Hospital, Chicago (SJH-C)
Entrance: Security Officer will meet the patient at
entrance 2 wearing PPE and will mask the patient
outside
2900 North Lake Shore Drive Chicago, IL 60657
773-665-3086
Provider and Patient to speak to: ED Charge Nurse
Provider and Patient to call: 773-665-9848
AMITA Resurrection Medical Center (RMC) Entrance: Main ED entrance - remain in car
Charge RN will contact Triage and ED Security to
go to the car and meet patient and escort patient to neg airflow room
7435 West Talcott Avenue Chicago, IL 60631
773-792-5255
Provider to speak to: ED attending
Patient to speak to: Charge Nurse
Provider and Patient to call:
773-990-5255
AMITA Saints Mary and Elizabeth Medical
Center (SMEMC)- St. Mary Campus only
Entrance: Emergency department ambulance bay,
entrance is on Leavitt street
2233 West Division Street Chicago, IL 60622
312-770-2418
Provider and Patient to speak to: Charge Nurse
***Please emphasize to private practitioners to send patients to
St. Mary’s campus on Division and NOT the St. Elizabeth campus
Provider and Patient to call:
312-770-2418 (Emergency Department Pod 1)
AMITA St. Francis Hospital (SFH) 355 Ridge Avenue Evanston, IL 60202
847-316-2440
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Northwest Region Emergency Department
Site Address/Contact Phone Number
AMITA Adventist GlenOaks Entrance: Emergency Room parking lot next to
Ambulance Bay and designated employee will
meet patient in parking lot.
701 Winthrop Ave. Glendale Heights, IL 60139
630-545-5700
Provider and Patient to speak to: Clinical Coordinator/Charge Nurse
Provider and Patient to call: 630-545-5700
AMITA Alexian Brothers Medical Center
(ABMC)
Entrance: Emergency
800 Biesterfield Rd. Elk Grove Village, IL 60007
847-437-4305
Provider and Patient to speak to: Charge Nurse
Provider and Patient to call: 847-981-3599
AMITA St. Alexius Medical Center (SAMC)
Entrance: Emergency
1555 Barrington Road Hoffman Estates, IL 60169
847-490-6930
Provider and Patient to speak to: ED Charge RN
Provider and Patient to call: 847-490-6930
AMITA Mercy Aurora
Entrance: In the physician area by the ED Ambulance Bay Entrance
1325 N. Highland Ave Aurora, IL 60506
630-859-2633
Provider and Patient to speak to: Charge Nurse
Provider and Patient to call: 630-801-2633
AMITA St. Joseph Hospital, Elgin (SJH-E) Entrance: ED Parking lot, Patient would be advised
to not exit the car until the ED Staff come out to
bring patient into building and escorted into the
ED through a side entrance
77 N. Airlite Street Elgin, IL 60123
847-695-5347
Provider and Patient to speak to:
ED Charge RN
Provider and Patient to call:
847-622-2069
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South Region Emergency Department
Site Address/Contact Phone Number
AMITA Adventist Bolingbrook
Entrance: Outside ED DOORS and 630-312-2307 where an ED Tech/RN will escort the patient
500 Remington Blvd Bolingbrook, Illinois 60440
630-312-6700
Provider and Patient to speak to: Charge Nurse
Provider and Patient to call: 630-312-2307
AMITA Adventist Hinsdale
Entrance: Ambulance entrance
120 N. Oak St. Hinsdale, IL 60521
630-856-6700
Provider and Patient to speak to: Charge Nurse
Provider and Patient to call: 630-856-8183
AMITA Adventist La Grange
Entrance: Inform charge nurse what vehicle they are in – staff will meet patient in parking lot
5101 S. Willow Springs Road La Grange, IL 60525
708-245-6700
Provider and Patient to speak to: Charge Nurse
Provider and Patient to call: 708-245-6700
AMITA St. Joseph Medical Center, Joliet
(SJMC-J)
Entrance: ED Entrance and to wait in their vehicle. ED Charge Nurse will have a nurse assigned to receive the patient who will greet patient and
bring to Peds ED Room 34
333 North Madison St. Joliet, IL 60435
815-741-7660
Provider to speak to: ED Physician Patient to speak to:
ED Charge Nurse
Provider to call: 815-741-7660 Patient to call: 815-207-5021
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Environmental Checklist for Terminal and Daily Cleaning
Date:
Room Number:
Name of Staff:
Evaluate the following priority sites for each patient room: High-touch Exam Room Surfaces Cleaned Not Cleaned Not Present in Room
Exam Table
Thermometer
Blood Pressure Cuff
Computer
Mouse
Keyboard
Chair
Sink
Countertop/Desktop
Phone
Room inner doorknob
Evaluate the following priority common spaces:
High-touch Room Surfaces Cleaned Not Cleaned Not Present
in Room
Registration countertop
Phones
Computer
Mouse
Copy/fax machine
Waiting room chairs
Water dispenser
Door handles
Kitchen/break room table
Kitchen/break room chairs
Kitchen/break room countertops
Kitchen/break room doorknobs/cabinet handles/refrigerator handle
Shared items such as coffee machine
Evaluate the following priority sites for public/shared restroom within office
High-touch Room Surfaces Cleaned Not Cleaned Not Present
in Room
Bathroom light switch
Bathroom sink/faucet
Toilet seat
Toilet Flush handle
Bathroom inner/outer doorknob
Wipe all high touch surfaces in the room once per shift using the approved disinfectant.
Allow surface to remain wet for the contact time listed on label.
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IDPH Contacts
IDPH Chicago PHMSRR Local Health Department Business/After-Hours Contact
County Health Department Regular Business Hours After-Hours
Cook 708-633-2000 708-906-0748
DuPage 630-682-7400 630-682-7207
Evanston 847-448-4311 847-448-4311
Grundy 815-941-3404 815-942-0336
Kane 630-208-3801 630-208-3801
Kankakee (Non CRI) 815-802-9400 815-937-8479
Kendall 630-553-9100 630-553-0911
Lake 847-377-8000 847-377-8000
McHenry 815-334-4510 815-344-7421
Oak Park 708-358-5480 708-771-9110
Will County 815-727-8480
815-727-8670
IDPH Edwardsville PHMSRR Local Health Department Business/After-Hours Contact
County Health Department Business Hours After-hours number Method of contact /After hours
Bond (618) 664-1442 618-664-5020 Health Dept
Calhoun (618)576-2428 618-576-2417 Sheriff
Clinton (618) 594-2723 618-594-4555 Sheriff
East Side Health District (618) 271-8722 618-409-7855 Cell
Fayette (618) 283-1044 618-463-2404 Sheriff
Greene (217) 942-6961 217-942-6961 Health Dept
Jersey (618) 498-9565 618-463-2921 answering service
Macoupin (217) 854-3223 217-854-3135 Sheriff
Madison (618) 692-8954 618-463-6957 answering service
Monroe (618) 939-3871 618-939-8651 Sheriff
Randolph (618) 826-5007 618-826-5484 Sheriff
St. Clair (618) 233-7703 618-301-2907 Cell
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\
IDPH Springfield PHMSRR Local Health Department Business/After-Hours Contact
County Health Department Business Hours After-Hours General Line After-Hours Method
ADAMS 217-222-8440 217-214-4000 Administrator - Jerrod Welch
BROWN 217-773-2714 217-242-9013 Mary Reich
CASS 217-452-3057 217-473-0070 Administrator- Teresa Armstrong
CHRISTIAN (217) 824-4113 (217) 820-1651 Administrator- Denise Larson
HANCOCK (217) 357-2171 309-255-2418 Administrator - Amy Mcalister
LOGAN 217-735-2317 217-671-2106 Salena Matteson
MASON 309-210-0110 309-222-0213 Administrator-Curt Giben
MENARD 217-535-3102 217-753-6666 other - Diana Wade
MONTGOMERY 217-532-2001 217-556-1455 Administrator -Hugh Satterlee
MORGAN 217-245-5111 217-245-5111 Other
PIKE 217-285-4407 800-377-8130/217-370-6160 After hours Nurse
SANGAMON 217-535-3102 217-753-6666 other - Diana Wade
SCHYULER 217-322-6775 217-322-6775 Administrator - Lynnette
SCOTT 217-742-8203 217-742-3141 Administrator - Steve Shireman
IDPH Peoria PHMSRR Local Health Department Business/After-Hours Contact
County Health Department
Business Hours After-Hours General Line After-Hours Method
Bureau 815-872-5091 815-875-3344 Sheriff Dispatch
Fulton 309-647-1134 309-547-2277 Sheriff Dispatch
Henderson 309-627-2812 309-867-4291 Sheriff Dispatch
Henry 309-852-0197 309-852-0197 Answering Service
Knox 309-344-2224 309-343-9151 Sheriff Dispatch
LaSalle 815-433-3366 815-433-2161 Sheriff Dispatch
Livingston 815-844-7174 815-822-2178 Cell
Marshall 309-246-8074 309-246-2115 Sheriff Dispatch
McDonough 309-837-9951 309-837-9951 Answering Machine with Instructions
McLean 309-888-5450 888-865-9903 PATH/211
Mercer 309-582-3759 309-582-5194 Sheriff Dispatch
Peoria 309-679-6000 309-679-6000 Answering Service
Putnam 815-872-5091 815-925-7015 Sheriff Dispatch
Rock Island 309-793-1955 309-794-1230 Sheriff Dispatch
Stark 309-852-0197 309-852-0197 Answering Service
Tazewell 309-925-5511 309-303-1375 On-Call Cell
Warren 309-734-1314 309-734-8505 Sheriff Dispatch
Woodford 309-467-3064 309-467-2375 Sheriff Dispatch
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IDPH Marion PHMSRR Local Health Department Business/After-Hours Contact
County Health Department
Business Hours After-Hours After-Hours Method
Clay 618-662-4406 618-662-4406 Connects to Answering Service
Egyptian 618-273-3326 618-518-0513 Cell Phone Number
Franklin-Williamson 618-993-8111 618-993-8111 Connects to Answering Service
Hamilton 618-643-3522 618-643-3522 Connects to Sheriff’s Office After Hours
Jackson 618-684-3143 800-875-0162 Answering Service
Jefferson 618-244-7134 618-383-3025 Cell Phone Number
Marion 618-548-3878 618-322-3878 Cell Phone Number
Perry 618-357-5371 618-357-5371 Telephone System Allows Callers to Connect to Staff After Hours
Southern Seven 618-634-2297 800-358-7367 Answering Service
Wabash 618-263-3873 618-262-6715 Cell Phone Number
Washington 618-327-3644 618-327-3644 Answering Machine with After Hours Contact Information
Wayne 618-842-5166 618-842-5166 Connects to Answering Service
IDPH Champaign PHMSRR Local Health Department Business/After-Hours Contact
County Health Department Business Hours After-Hours General Line
After-Hours Method
Champaign-Urbana
Public Health District 217-352-7961 217-352-7961 Regular Business Phone-With After Hour
Options
Clark 217-382-4207 217-826-6393 Clark County Sheriff's Office
Coles 217-348-0530 217-345-0060 Coles Sheriff's Office Non-Emergency
Crawford 618-544-8798 618-546-1515 Crawford County Sheriff's Office
Cumberland 217-849-3211 217-232-3211 Administrator
Dewitt-Piatt 217-935-3427 DeWitt or 217-762-7911 Piatt
Offices
217-519-3380 Administrator
Douglas 217-253-4137 217-253-2913 Douglas County Sheriff
Edgar 217-465-2212 217-251-5440 Administrator
Effingham 217-342-9237 217-342-2101 Effingham County Sheriff's Office
Ford 217-379-9281 217-766-4902 Administrator
Iroquois 815-432-2483 815-432-4918 Iroquois County 911 Dispatch (ICOM)
Jasper 618-783-4436 618-783-8477 Jasper County Sheriff
Lawrence 618-943-3302 618-943-5766 Lawrence County Dispatch
Macon 217-423-6988 217-875-8567 Decatur Memorial Hospital
Moultrie 217-728-4114 217-728-4386 Moultrie County Sheriff's Department
Shelby 217-774-9555 217-774-3941 Shelby County Sheriff' Office
Vermilion 217-431-2662 217-304-3234 Administrator
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IDPH Rockford PHMSRR Local Health Department Business/After-Hours Contact
County Health Department
Business Hours After-Hours
Boone 815-544-2951 Amanda Mehl 815-262-2625
Carroll 815-244-8855 Craig Bantema 815-244-2635 - Sheriff’s Office
DeKalb 815-758-6673 Lisa Gonzalez 815-758-6673 - Option 6
Jo Daviess 815 777 0263 815-777-2141 Sandra Schleicher
Lee 815-284-3371 815-973-0830 - Cathy Ferguson-Allen
Ogle 815-562-6976 815-732-2136 Kyle Auman
Stephenson 815 235 8271 815-235-8252 – Craig Beintema
Whiteside (815) 626-2230 815-564-5610 – Cheryl Lee
Winnebago (815)720-4000 815-720-4000 – Theresa James
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(enter number here)
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