WRIISC Health Concerns and Corresponding Recommendations Form             V20181023

    DATE:           TIME (24hr):      Patient Code:  

Health Concerns & Corresponding Recommendations
Respiratory (Lung) Health
Gastrointestinal (GI) Health
Cognitive (Brain) Health
Cardiac (Heart) Health
Pain
Muscular Skeletal (Muscles and Bones) Health and Neuro-Muscular Health
Eye Health
Ear Health
Oral Health
Dermatological (Skin) Health
Reproductive Health
Endocrine HealthOverall Wellbeing

 RESPIRATORY (LUNG) HEALTH

To address your respiratory concerns, we recommend the following to improve or maintain your respiratory function:

 RECOMMENDED REFERRALS
 Pulmonologist Referral:
         Follow up to discuss results of consult performed.
         Discuss and consider follow up to investigate health status of your lungs.
 Ear Nose Throat (ENT) Referral:
         Follow up to discuss results of consult performed.
         Discuss and consider follow up to investigate best management strategies.
         Evaluate for vocal cord dysfunction.

 Care And Management With Your Treating Provider(S)
 Report signs and/or symptoms of respiratory compromise: shortness of breath, difficulty breathing, wheezing, excessive cough (unrelieved with intervention), use of accessory muscles, chest pain, cyanosis (bluish tinged lips and/or skin).
Discuss Reactive Airway Disease Diagnosis:
         Follow up with Primary Care or Pulmonologist.
         Investigate Best Management Strategies to address your care needs.
Discuss Asthma Diagnosis: Investigate best management strategies for (new) diagnosis.
 Discuss Chronic Obstructive Pulmonary Disease (COPD) Diagnosis: Investigate best management strategies for (new) diagnosis.
Discuss Medication(s):
 Follow up and discuss which prescription is most appropriate to meet respiratory demands.
Review appropriateness of prescription(s) to ensure your understanding of if, when, and how to use.
Inhalers:
Discuss prescription to ensure appropriate use.
Maintain use.
Cleanse Nasal Passage: Consider use of container such as Neti pot to minimize allergens.
Weight loss strategies: Work toward a healthy body mass index (BMI) to decrease respiratory demands.
Smoking: Abstain from and/or minimize use to restore and/or maintain healthy lungs.
Discuss continuous positive airway pressure (CPAP) device: consider alternative adaptive devices to help support use
Other

 Diagnostic Tests

Pulmonary Function Test (PFT):
Follow up to address changes noted.
Follow up to receive pulmonary function test.
Pulmonary Function Test (PFT): Discuss results of and follow up with recommendations, if indicated.
Cardio Pulmonary Exercise Test (CPET): Discuss results of the test and follow up with recommendations, if indicated.
Lung Biopsy: Discuss possible need for referral.
Sleep study:
Discuss need for sleep study to rule out underlying cause for difficulty breathing.
Follow up to have test performed.
Allergy testing (skin):
Discuss results of test performed.
Follow up to have test performed.
Allergy Radioallergosorbent test (RAST):blood test using radioimmunoassay test to detect specific IgE antibodies, to determine the substances a subject is allergic to.
Discuss results of test performed.
Follow up to have test performed.
Computed Tomography (CT) of chest:
Follow up to obtain referral.
Follow up with discussion of results.
Chest x-ray:
Follow up to have test performed.
(Asbestos exposure only) Recommend x-ray be read by B-Reader and referral to Pulmonary clinic if abnormality is detected.
Follow up and discuss test results.
 Sniff Test (diaphragm fluoroscopy): Follow up to evaluate for weakness of muscle surrounding lungs.
Other

 Gastrointestinal (GI) Health

To address your GI concerns, we recommend the following to improve or maintain your GI function:

 RECOMMENDED REFERRALS



Gastroenterology (GI) referral:
Discuss and consider follow up to evaluate your symptoms.
Follow up with a gastroenterologist to evaluate your test results.
Follow up with gastroenterologist to have results of your liver function test further evaluated.
Discuss referral to have gastric pH evaluation
Discuss referral to have a gastric motility study performed.
Infectious disease (ID) consult: Follow up to evaluate for ongoing infectious process or impacts of previous infections.
Nutritionist or dietician referral: to learn best management of ongoing symptoms.Care And Management With Your Treating Provider(S)
Medications:
Discuss which medications are best to manage your symptoms.
Discuss your (over) use of over the counter (OTC) medications.
Dietary modifications: Maintain food plan changes helpful in addressing irritable bowel concerns.
Elimination food plan: Consider and discuss implementing to determine food sensitivities.
Consider implementation of the 4 R's to support digestive health (remove irritants, replace agents for digestive support,re-inoculate with friendly bacteria and foods they need to grow, repairing lining of the intestine).
Consider gluten-free food plan.
Fiber intake:
Consider including daily in food plan.
Discuss and consider high fiber intake.
Probiotics: Consider use to re-inoculate intestinal flora with friendly bacteria.
Anti-inflammatory food plan: Consider implementation to help manage inflammation.
Avoid unhealthy fats, eat fruits and vegetables, eat fiber and include Omega-3 fats, like fish oil and flax oil.
Discuss and consider a cardio-metabolic food plan: A plan which combines strategies for meal options, exercise and behavior modification to most assist with management of your gastrointestinal disorder.
Discuss the best lifestyle and dietary modifications with your primary provider to best assist with management of your gastrointestinal disorder.
Discuss and consider strategies for management of gastroesophageal reflux disease (GERD)
Avoid/eliminate foods that trigger symptoms: Coffee, tea, and carbonated drinks, fatty, fried, or spicy food, mint, chocolate, onions, and tomatoes, any other foods that seem to irritate your stomach or cause you pain,
Review handout for additional management strategies.
Consider gluten-free food plan.
Recommend smoking cessation and eliminating use of tobacco products.
Discuss and consider inclusion of anti-inflammatory agents and other vitamin supplementation:
Alpha Lipoic Acid, Vitamin B complex, Vitamin C, Coenzyme Q10, Vitamin D, Fish oil, omega 3 fatty acids,
Consider a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) food planExplanation: FODMAP is a collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives. Examples of high FODMAP foods include barley, yogurt, apples, apricots, pears, and cauliflower.Tests
Allergy testing:
Discuss results.
Follow up to obtain test to determine sensitivities.
Abdominal sonogram:
Discuss and consider follow up to receive.
Discuss results of your abdominal sonogram.
Abdominal x-ray
Barium x-ray
Upper GI and small bowel series
Discuss and consider genetic testing to increase awareness of health impacts of diagnosed conditions.
Follow up with a stool analysis.
Follow up with a stool analysis to test for occult blood.Cognitive (Brain) Health To address your cognitive concerns. we recommend the following to improve or maintain your brain function:Recommended Referrals
Neurology: Discuss follow up to
Evaluate your concerns.
Follow up on your concerns
Monitor your concerns.
Psychotherapy: Follow up to receive referral for individual therapy to gain insight into your symptoms and subsequent behaviors.
Address self-harm behaviors in individual psychotherapy.
Psychiatrist to evaluate need for resumption of medication(s) to help manage mood and impulse control.
Anger management class.
Military Sexual Trauma Program.
Sleep Study:
Follow up to retrieve results
Follow up to receive referral for sleep study
Residential treatment program: Discuss and consider referral to learn new coping strategies for PTSD.
Cognitive rehab: Discuss follow up for referral
Consider cognitive rehabilitation with speech therapist to learn coping strategies for PTSD.
Consider cognitive rehabilitation with Poly Trauma or Traumatic Brain Injury (TBI) service to learn management strategies for TBI.
Vestibular Rehab: Discuss referral Explanation: a form of physical therapy that uses exercise to facilitate gaze and gait stabilization.
Cognitive Behavior Therapy (CBT): Consider referral to gain insight into your symptoms and subsequent behaviors.
Category of CBT include:
Behavioral Activation: Discuss referral to learn new coping strategies to increase engagement in activities.
Cognitive Behavior Therapy for insomnia (CBT-i): Discuss and consider follow up for CBT-I to learn strategies to better manage CBT-i symptoms.
Prolonged Exposure (PE) therapy: Consider and discuss referral to PE to learn new coping strategies for PTSD symptoms.
Eye Movement Desensitization Reprocessing Therapy (EMDR): Discuss and consider EMDR to learn new coping strategies for PTSD symptoms.
Imagery rehearsal therapy: Discuss and consider referral to therapist specializing in Imagery Rehearsal to learn strategies for coping with PTSD symptoms.
Acceptance Commitment Therapy (ACT): Discuss and consider ACT to learn coping strategies for your PTSD symptoms.
Cognitive Processing Therapy (CPT): Discuss and consider CPT to gain insight into your symptoms and subsequent behaviors.
Dialectical Behavior Therapy (DBT): DBT therapists use cognitive behavior therapy techniques to encourage you to change your behavior and learn more effective ways of dealing with your distress.
Case-manager: Discuss and work with a case manager ongoing to support your efforts to independently manage your health concerns.
Counseling: Consider referral to gain insight into your symptoms and subsequent behaviors.
Individual psychotherapy
Family Counseling
Support group
Counseling:Maintain referral to gain insight into your symptoms and subsequent behaviors.
Health Coach: Consider and discuss referral to follow up to gain insight into best management strategies.Care And Management With Your Treating Provider(S)
Alcohol consumption: Consider reducing/eliminating to improve brain function.
Sleep hygiene: Consider tips to improve quality of sleep.
Insufficient sleep: Continue to report if poor sleep continues.
Symptom monitoring: Continue with support of healthcare professionals and support networks.
MIND diet: Implement foodplan to support brain function, overall health and day to day function.
Anti-inflammatory foodplan: Consider implementation to help manage inflammation.
Graded exercise: Consider gradually increasing movement through
physical medicine and rehab (PM&R),
 yoga, and/or
Qi gong to increase muscle strength and facilitate stress reduction.
Integrative approaches to managing poor sleep:
meditation
deep breathing
mindfulness
Stress Management:
Incorporate Relaxation Techniques:to minimize stress and increase coping skills.
Medications:
Consider resumption of medication(s) to help manage mood and impulse control.
Discuss use of prazosin for sleep and nightmares.
Opioid prescription: Discuss weaning to optimize brain function.
Melatonin: Discuss and consider use to promote sleep.
Pacing Strategies: Utilize simple, short, regulated steps to support ability to function in day to day activities.
Compensatory strategies: Include memory tips to aid your memory and help to maintain function and prevent decline.
Establish a structured routine of daily tasks.
Consistently use memory aids such as calendars and notebooks to record tasks.
Write down new tasks inthe memory notebook.
Medications may also be placed in a medication dispenser to remind you of if you have taken it already or not.
AIMS program (Anger and Irritability Management Skills): Consider self-paced online program to learn strategies for coping with anger.Tests
Neuropsychological Test: Follow up on receiving a neuropsychological exam to address symptoms.
Tilt-Table Testing: Discuss referral to address balance and measure how your blood pressure and heart rate respond to gravity.
Brain magnetic resonance angiogram (MRA) to address headaches:
Follow up to receive referral.
Brain magnetic resonance imaging (MRI):
Follow up on results.
Follow up to receive referral.
PET SCAN: Discuss need for follow up to further evaluate cause for headache.
Sleep Study:
Discuss and consider follow up for referral.
Follow to receive sleep study results.Cardiac (Heart) HealthTo address your cardiac concerns, we recommend the following to improve or maintain your heart function:Recommended Referrals
Continue to report symptoms of cardiac compromise including: shortness of breath, difficulty breathing, chest pain, light headedness, dizziness, fainting, swelling of extremities, excessive perspiration, pale complexion;
Cardiologist:
Discuss and consider referral to address symptoms.
Maintain care with cardiologist.
Follow up to address changes noted on your cardio pulmonary exercise test (CPET).
Discuss and determine need for follow up on echocardiogram.
Discuss and follow up on referral for Holter monitor.
Discuss current blood pressure readings and learn options for treatment.
Discuss your need to monitor blood pressure at home with automated blood pressure cuff.
Discuss results of laboratory studies with cardiologist or primary care provider.
Discuss best management strategies to improve your cholesterol level.
Discuss and review prescribed cardiac medications as needed.
Discuss and consider medications to manage heart health.
Discuss and consider medications to manage blood pressure.
MOVE program:Explanation: an evidence-based self-management program developed for Veterans that focuses on health and wellness through healthy eating, physical activity, and behavior change.
Discuss and consider referral to MOVE program to increase movement.
Tele-Move program - Discuss and consider referral to Tele MOVE program if there is difficulty accessing in hospital/clinic service. Care And Management With Your Treating Provider(S)
Live the American Heart Association Simple 7: Manage Blood Pressure, Control Cholesterol, Reduce Blood Sugar,
Be Active, Eat Healthy, Manage Body Mass Index (BMI), Live Tobacco Free.
Life style changes: Discuss and consider implementing proper nutrition plan and seeking & following recommended exercise plan.
Nutritional counseling: Seek support to learn about heart healthy food plan via registered dietician or nutritionist as indicated by primary care.
Consider and discuss implementation of a detox food plan.
Follow a mitochondrial food plan: Participate in a graded exercise regimen;
’Avoid or eliminate ingredients that are toxic to your mitochondria, including processed flours, all sugars and refined sweeteners, trans fats, gluten, and dairy products; Eat six to nine cups of fresh vegetables and fruits daily; Dine on fiber-rich foods to help detox the harmful substances; Up your omega-3 fat intake; Eat a diet rich in amino acids;
Consider an anti-inflammatory meal plan:
Avoid unhealthy fats, eat fruits and vegetables, Eat fiber and include Omega-3 fats, like fish oil and flax oil.
Consider a Mediterranean meal plan: Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts, replacing butter with healthy fats such as olive oil and canola oil, Using herbs and spices instead of salt to flavor foods, limiting red meat to no more than a few times a month, Eating fish and poultry at least twice a week drinking red wine in moderation (if not contraindicated for your health), Getting regular exercise. Consume anti-inflammatory, mitochondria-protective and energy-boosting micronutrients, such as fish oil,Coenzyme Q 10, curcumin, magnesium threonate, N-acetyl cysteine, Vitamin D, Vitamin C and Vitamin B complex, alpha-lipoic acid, and resveratrol.Tests
Tilt table testing: Discuss referral to measure how your blood pressure and heart rate respond to gravity.
Genetic testing: Discuss and consider follow up for test to increase awareness of health impacts of diagnosed conditions.PainTo address your pain concerns, we recommend the following to improve or maintain your quality of life:Recommended Referrals
Medication Reconciliation
Referral for prescription for Flavoccoxid (limbrel).
Vitamin D supplements to help support bone health.
Muscle relaxant such as flexeril.
Capsaicin cream to affected area.
Pain Management: Consider and discuss referral for pain management clinic.
Tampa Pain Clinic
Cleveland Clinic
Rheumatology referral.
Orthopedic referral.
Allergy testing
Integrative approaches to managing poor pain:
Acupuncture
Meditation
Deep breathing
Mindfulness
Alternative Treatment to address headache:
Botox
Oxygen therapy
Oil of peppermint to temples
Rolfing, a somatic sensory-motor approach to movement education which facilitates patients to optimize and
sustain structural ease through balanced movement behavior (exploration of freer and more fluid motion during breathing, walking, bending, lifting, and other simple daily movements).
Biofeedback.
TENS unit
Physical Medicine and Rehab (PM&R):
Physical Therapy
Occupational Therapy for fine motor strength and development.
Consider referral to support graded exercise.
Aqua-therapy.
Home evaluation to assess need for safety devices and intervention to prevent falls.
Consider alternative approaches to pain management to build stamina and muscle strength:
Yoga
MOVE program
Qi gong
MOVE program (on site):
Tele-Move program
Sleep Study: Manage poor sleep to minimize perception of pain.
Follow up to receive referral for sleep study.
Follow up to retrieve results of study.Care And Management With Your Treating Provider(S)
Medication reconciliation: Discuss referral to determine best medications to address and better manage pain symptoms.
Elimination food plan to rule out food sensitivities.
Anti-inflammatory food plan.
Supplementing diet with 3gm of fish oil, curcumin, Alpha lipoic acid.
Pacing strategies to support ability to function in day to day activities.Tests
Allergy testing
EMG
Sleep Study: Manage poor sleep to minimize perception of pain.
At home.
In lab.Muscular Skeletal (muscles and bones) Health and Neuro-Muscular Health To address your muscles and bones concerns and neuromuscular health concerns, we recommend the following to improve or maintain your muscles and bones concerns and neuromuscular health functions:Recommended Referrals
Pain Management: Consider and discuss referral for pain management clinic.
Tampa Pain Clinic
Cleveland Clinic
TENS unit
Biofeedback.
Rolfing
Vestibular Rehab: a form of physical therapy that uses exercise to facilitate gaze and gait stabilization.
Vitamin D supplementation: to address low Vitamin D level.
Neurology:
To address neuromuscular health concerns.
Evaluate for autonomic dysregulation.
Physical Medicine and Rehab (PM&R):
Physical Therapy
Occupational Therapy
Consider referral to support graded exercise.
Aqua-therapy.
Home evaluation to assess need for safety devices and intervention to prevent falls.
MOVE program (on site):
Tele-Move
Integrative approaches to improving muscular skeletal health:
Yoga: increase strength and endurance.
Qi Gong: healing practice to increase strength and endurance.
Tai Chi: increase strength and endurance.
Meditation: Two forms include mindfulness or concentrative purposeful to improve mental focus.
Acupuncture: fine-needle stimulation to specific points of the body purposeful for chronic pain, headaches and PTSD.
Deep BreathingCare And Management
Vestibular Rehab: maintain physical therapy that uses exercise to facilitate gaze and gait stabilization.
Vitamin D supplementation: to address low Vitamin D level.
Maintain Vitamin D supplementation.Tests
Dexa scan: to evaluate and monitor health of bones.
Electromyography (EMG): a diagnostic procedure to assess the health of muscles and the nerve cells that control
them.
The Creatine Kinase (CK): level in the blood is the most sensitive indicator of muscle injury.
Nerve Conduction Studies
Needle Electromyography
Quantitative Sudomotor Autonomic Reflex Testing
Cardiovascular Autonomic Testing
Quantitative Sensory Testing
Biopsy:
Muscle
Nerve
Computed tomography (CT), also known as a CAT scan (computerized axial tomography), including CT
angiography.
Magnetic resonance imaging (MRI): an imaging test that uses powerful magnets and radio waves to create pictures of the body.
Magnetic resonance angiography (MRA): MRA is an MRI exam of the blood vessels. Unlike traditional angiography that involves placing a tube (catheter) into the body, MRA is noninvasive.
Positron emission tomography (PET) scan: shows how organs and tissues are working.
Ultrasound
Mammography
X-rays: An x-ray machine sends individual x-ray particles (a type of electromagnetic radiation) through the body.
The images are recorded on a computer or film.
The following are common types of x-rays: (these are links)
Abdominal x-ray
Barium x-ray
Bone x-ray
Chest x-ray
Dental x-ray
Extremity x-ray
Hand x-ray
Joint x-ray
Lumbosacral spine x-ray
Neck x-ray
Pelvis x-ray
Sinus x-ray
Skull x-ray
Thoracic spine x-ray
Upper GI and small bowel series
X-ray of the skeletonEye Health - Care and managementTo address your eye concerns, we recommend the following to improve or maintain your eye functions:Recommended referrals
Ophthalmologist.
Maintain care.
Follow up to receive referral.
Vestibular Rehab: a form of physical therapy that uses exercise to facilitate gaze and gait stabilization.
Videonystagmography (VNG) The VNG is a series of tests designed to document a person’s ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system. This test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem.Ear Health – Care and managementTo address your ear concerns, we recommend the following to improve or maintain your ear functions:Recommended referrals
Ear, Nose and Throat (ENT):
to assess balance
to assess hearing
to address pain
evaluate need for vestibular rehab
Vestibular Rehab: a form of physical therapy that uses exercise to facilitate gaze and gait stabilization.
Audiology consult for evaluation
White noise device.
Videonystagmography (VNG) The VNG is a series of tests designed to document a person’s ability to follow visual objects with their eyes and how well the eyes respond to information from the vestibular system. This test also addresses the functionality of each ear and if a vestibular deficit may be the cause of a dizziness or balance problem.
Speech Pathology
address cocktail party syndrome.Oral healthcare and managemenTTo address your oral healthcare and management concerns, we recommend the following to improve or maintain your oral health:Recommended referrals
Dental clinic
Oral hygiene needs.
Mouth guards to minimize teeth grinding.
Mouth device for CPAP machine.Care And Management With Your Treating Provider(S)
Modify Tobacco Use
(smoke) cessation program.
chewing tobacco
reduce or eliminate use of tobacco.Dermatological (Skin) HealthTo address your skin concerns, we recommend the following to improve or maintain your skin health:Recommended referrals
Dermatology clinic: to evaluate
Rash
Lesion
Culture test
Rheumatology
Infectious Disease (ID) consult.
Hematologist.Care And Management With Your Treating Provider(S)
Skin block to protect skin from Ultra Violet sun rays.
Hibiclens wash: a liquid anti-microbial skin soap that provides up to 6 hours of fight against microbes.Reproductive Health and FunctioNTo address your reproductive concerns, we recommend the following to improve or maintain your reproductive health and function:Recommended Referrals
Urologist
Gynecologist
Genetic testing: to increase awareness of health impacts of (un) diagnosed conditions.
Marital counseling.Endocrine HealthTo address your endocrine concerns, we recommend the following to improve or maintain your endocrine function:Recommended Referrals
Medication review
Review Diabetic medication regimen to ensure you understand what meds to take and how to take meds.
Endocrinologist
Follow up to monitor Hemoglobin A1C blood levels.
Follow up to address elevated Hemoglobin A1C levels.
Discuss appropriate methods of gaining tight control of diabetic symptoms.
Hormone replacement.Care And Management With Your Treating Provider(S)
Diabetic quality of life care: foot care, oral care, and eye care.Tests
TSH level to rule out hypothyroidism or alternate reason for elevated TSH level.
Genetic testing to increase awareness of health impacts of diagnosed conditions.Overall WellbeingTo address your overall wellbeing, we recommend the following to improve or maintain your wellbeing:Recommended Referrals
Social Work service through your PACT Team to support coping with life stressors and enhance understanding of
services available through your VA hospital.
Case-manager ongoing to support your efforts to independently manage your health concerns.
Immunization Health Board to discuss any concerns for immunizations received in the military.
Health Coach.
Talk therapy to support you with stress relief and better management of your health symptoms.
Pastoral counseling and supportive counseling available in the community.
Grief counseling
Therapy Dog.
Vocational Rehab services to help support your insight into varying and available work opportunities.Care And Management With Your Treating Provider(S)
Safety plan:
Locking guns up, and limiting access;
Crisis line
AIMS program (Anger and Irritability Management Skills) to improve coping strategies.
Driver’s safety evaluation.
Medic Alert Bracelet
Home evaluation to assess need for safety devices and intervention to prevent falls.
Address self-harm behaviors in individual psychotherapy.
Veteran Service Organization (VSO) to help support you.
 Advanced Directive. Last update: 10/23/2018

Advanced Directive.

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HCCR DATA FILE

Last update:  10/23/2018