Lincoln Medical and Mental Heath Center 1C2 (Pediatric Ambulatory Clinic)

Clinic Information Clinic Phone 5619 Clinic Fax 4987 Appointments 4900 24- hour Telephone triage 718-579-KIDS(5437) Poison Control 212-POISONS (764-7667)

Clinic Hours Monday 8:30 a.m. - 5:00 p.m. Tuesday 8:30 a.m. - 5:00 p.m. Wednesday 8:30 a.m. - 8:00 p.m. Thursday 8:30 a.m. - 5:00 p.m. Friday 8:30 a.m. - 5:00 p.m.

Chief, Pediatric Amb. Clinic Katherine Szema, MD Beeper #28582 x6290 Assistant Head Nurse Cecilia Negron, RN x3536 Coordinating Mgr. Cheryl Abraham Beeper #27695 x5527 Director, Ambulatory Care Akinola Fisher MD x5640 Chairman, Pediatrics Shefali Khanna, MD Beeper #28582 x4972

Pediatricians Beeper# Shafi Choudhury, MD #27756 Monique Collier, MD #27102 Ponchai Kemawikasit, MD #27755 Aliya Khan, MD #27175 Magda Mendez, MD #34064 Abdolrasool Nasab, MD #27180 Randolph Nunez #27874 Antonio Pierre, MD #27366 Sridevi Pinnamaneni, MD #27171 Gerard Prosper MD, #27712 Subha Rangsiyakul, MD #27160 Shanti Yogananda, MD #27159

RNs LPNs PCAs PCAs Corazon Pasamba Alina Suarez Cheryl Burke Vicki Lopez Cynthia Madayag Ayodele Oni Clarissa Samuels Virginia Almodovar Emmerlisia Taylor Henry DePalma Doris King Estrellita Marcial Karen Aponte Lydia Vargas Clerks Joey Sinanan Mabel Boakye Martha Diaz Alesa McFadden Kang Chung Maxine Sosa Olive Jordan Carmen Dumani M.L. Bacatan Rebecca Aquaye Carol Perrotte Magalli Rivera Sanjita Sharma Jessica Sanchez Esther Soriano Rosa Guadalupe Tricia Joyner

1 Subspecialty Clinics We have 15 subspecialty clinics and 22 subspecialist physicians.

Suspecialty Clinic Physician Beeper Adolescent Monique Collier 27102 Allergy/Asthma Smita Kumar, MD 917-219-4481 Katherine Szema, MD 28582 Cardiology Sarita Kalentre 917-399-2446 Jayendra Sharma, MD 917-233-0019 Diabetes Swati Dave-Sharma, MD 27758 Endocrine Swati Dave-Sharma, MD 27758 Gastroenterology Diana Volpert, MD 917-899-2100 Genetics Ernest Lieber, MD 27221 Hematology/Oncology Maria Sulis, MD 917-899-0178 Immunology Katia Sitnitkskaya, MD 27769 Neonatology Marilyn Guerrero, MD 27671 Sunanda Kandi, MD 27281 Rasila Lala, MD 27266 Anasuya Nagaraj, MD 27614 Zehra Panjavani, MD 27261 Neurology Sergei Prokhorov, MD 27751 Pulmonology/Chest Dora Alvarez, MD 27988 Renal Consolacion Pimentel, MD 27260 Gerard Prosper, MD 27712 Surgery (refer to Harlem Hospital) Tuberculosis Katia Sitnitskaya, MD 27769 Urology Lori Dyer, MD 914-264-0161 Jeremy Wiygul, MD 914-491-7320

Health Educators/Consultants Patients may be scheduled for further education/evaluation/assistance by the following providers: Client Navigator: George Neira #27192 Dietician Ilana Heching #27521 Ext. 5397 Room 595 Asthma Health Educator: Hester Dowdy-Sow Ext. 6139 Room 609

Obesity Health Educator: Carisol Maniego #28797 Ext. 4194 Room 595

HIV counselors: Martha Morales #28589 Ext. 5926 Room 594 Michelle Gonzalez #27426 Ext. 4979 Lactation Consultant: Elana Taubman #28559 Smoking Cessation: Cindy Germosen Ext. 4934 Room 10C-78 Social Workers: Kara Goldschmidt #27506 Ext. 5519, 6278 Room 597 Kenya Sanders #27494 Ext. 5519, 6278 Room 597

Diabetic Educator Miriam Lugo, RN #27119 Tsae Su, RN #34080

2 Resident Group Practice (GP) Clinic As per the Program Requirements for Residency Education in Pediatrics, the Continuity Clinic Experience provides residents an “opportunity to develop an understanding of and appreciation for the longitudinal nature of general pediatric care, including: aspects of physical and emotional growth and development; health promotion and disease prevention; management of acute, chronic, and end-of-life medical conditions, family and environmental impacts; coordination of patient-centered care both within practice and with multidisciplinary providers; and practice management.

Residents will be exposed to a variety of patients, including well patients, sick patients, and those will complex and chronic medical problems. Ideally, residents should provide continuity of care for their patients and continue to follow them when they are hospitalized or seen for acute illnesses. Residents should facilitate school-related evaluations and specialty referrals (including social work) and report any cases to ACS if necessary due to medical, physical or emotional neglect/abuse. The curriculum will emphasize the generalist approach, including anticipatory guidance, developmental and behavioral issues, immunizations practices and heath promotion, and residents must learn to serve as the coordinator of comprehensive primary care for children with complex and multiple heath-problems.

Residents must attend continuity clinic for one half–day session per week for a minimum of 36 clinic weeks per year. PGY-1 and PGY-2 residents have continuity clinic one afternoon per week while PGY-3 residents have two sessions (one morning, one afternoon) per week. According to RRC guidelines, each PGY-1, PGY-2, and PGY-3 resident must see a minimum of 3, 4, and 5 patients, respectively.

GP Color Teams Each resident is assigned to one of the following color teams (11-12 pediatric residents). Each team may have 1-2 LPN/RNs, 1-2 PCAs (patient care assistant), and one financial clerical associate. You will be precepted by one of the following physicians during your GP clinic.

BLUE RED GREEN Nasab Choudhury Nunez Prosper Khan Pierre Yogananda P. Kemawikasit Pinnamaneni Rangsiyakul

The following covering physicians will precept in the Pediatric Clinic on the following days: Tuesday PM, Wednesday AM Constance Pimentel, MD (Nephrology) Wednesday PM, Friday AM Magda Mendez, MD (Residency Program Director) Thursday PM Katherine Szema, MD (Allergy)

3 Resident Weekly Topics A series of weekly topics will be discussed for 5-10 minutes with your preceptor. The schedule is posted on the bulletin board outside Room 568. Pertinent journal articles will be emailed to you prior to the session.

Walk-In Patients Walk-in patients are primarily placed on attendings’ schedules. Each PGY-2 and PGY-3 has 1 appt slot for walk-in patients designated as the PCS slot.

Patient Flow 1. Patient registration begins at the front desk where the financial clerk check in patients. The clerk reviews patient information (insurance, phone number, consent forms) and places the Patient Flow Sheet in the appropriate color team bin for the PCA. 2. The PCA brings the patient and Patient Flow Sheet to the examination room where vitals are performed (height, weight, BP, Pulse, RR head circumference, temperature). Hearing and vision and done for patients ages 3 and above on an annual basis. 3. The EDAR (Electronic Daily Activity Report) can be accessed with your Groupwise password and ID to review your patient list for your clinic. Patients will be highlighted in red when they have checked in to be seen. Walk-in patients will be added to the EDAR as they are registered. 4. The Patient Flow sheet is given to the doctor. Subsequent patient flow sheets are placed outside the room in the plastic bin. The next patient will be in the front of the bin. 5. The doctor circles any necessary immunizations or screening tests (hearing/vision/urinalysis) that the patient requires on the Patient Flow Sheet. The doctor gives the Patient Flow Sheet to the nurse who will prepare the vaccines and also informs the PCA regarding any additional screening tests that are required. 6. Please make sure your patients are undressed in a gown when you examine them. 7. The doctor performs the examination and informs the PCA regarding necessary appointments: #1 = New #2 = Revisit #3 = First Newborn visit #4 = Dietician #5 = Lactation consultant #222 = PCS #911 = ER or inpatient follow up #888 = Reminder template card (Please see Item #9 below) 8. Internal Lincoln referrals are done online. Choose order entry, #45 Referrals, and follow the prompts. Print out the referral sheet and give it to the PCA to schedule any appointments. 9. If patients require an appointment > 6 months, please check off “Reminder Template” on the Patient Flow Sheet, and enter the month that you would like to see the patient. A postcard will be mailed to the patient to remind them to call the clinic 1 month before the requested visit. 10. Complete all your notes by the end of your clinic session and meet with your preceptor to review your EDAR sheet, DNKAs, and notes. Enter all your patients into your ACGME patient log.

Clinic Schedule and Room Assignments Daily schedules and room assignments are posted on the sticky bulletin boards outside the Staff Lounge, nurses stations (Rooms 587 & 555), and across from Room 562.

4 Cycle Time Week For 2-3 days of each month, cycle times (length of time for the patient’s whole visit from check-in to check-out) are calculated. Each person encountering the patient will document their name in addition to the time in and time out on the Patient Cycle Time Sheet when they have seen the patient. This gives us an overall picture of the patient visit to keep the cycle time of the patients within 60 minutes.

Reminder cards (#888) If you do not need to see your patient for more than 4-6 months, please have the PCA enter your patient on the Unity computer system for a reminder card (Resource Code 888). Patients will be mailed a postcard 1 month before the anticipated month of the visit to call to schedule an appointment.

DNKAs (Did Not Keep Appointments) Follow up call or Letter You must order a DNKA follow up call or letter for each patient that failed to keep their scheduled appointment. It is important that you review your EDAR list to order the DNKA notes and to determine whether the patient should be called for an urgent or sooner appointment (abnormal lab, vaccines, infants < 1 year) or if they can be scheduled for the next available appointment. Based on your instructions on DNKA order, the clerk will either recall the patient sooner or send a letter to the patient to call for a return appointment to the clinic.

AGCME Documentation All residents must document their patients in the ACGME computer log with pertinent information, including age, diagnosis and encounter date.

Medical Students Education is important for all physicians. As part of your training, you may be supervising medical students from St. George’s University School of Medicine or Weill Cornell Medical College. They will each be assigned to a color team or subspecialty clinic and are responsible for seeing patients on their own and presenting their patients to you and/or the attending physician. They will either write on pre-printed forms or type their notes onto a word document. Each attending physician is responsible for evaluating one write-up per session for each medical student. These evaluations must be turned in to Dr. Sitnitskaya (Coordinator of medical students) upon completion.

Absences/Tardiness from Clinic Resident absences (changing call assignments, vacations, job interviews) from clinic must be submitted in writing to the Residency Program Director (Dr. Mendez) with a copy to Dr. Szema. The chief residents may not approve any absences from clinic. You will be excused from clinic only when requests are approved by Dr. Mendez and NOT by the chief residents.

Part of being a good physician is professionalism. Therefore, tardiness is unacceptable. Residents who are 15 minutes late will receive a tardy slip beginning in August 2007. After the 3rd tardy slip in clinic, a written censure will be placed on the resident’s evaluation and submitted to their personal file.

5 Heads Up! Reading Program We are involved with the national non-profit organizations, Reach Out and Read, and Reading is Fundamental to promote early literacy for our patients by giving new books to children ages 2 weeks to 5 years of age, and advising parents about the importance of reading aloud to their to children. At each well child check up or health maintenance visit, a child should receive an age appropriate book. Bonus books are given for older children depending on our book supply. Books are located in the grey cabinets near Room 568 as well as in the middle corridor file room. Guidelines are written regarding which age-appropriate book to give to your patients. For other visits, we have bookmarks and a few extra books available for distribution. The reading room, located near the waiting room, also has extra books for older patients for distribution. The Heads Up! coordinator from the Children Development Center at Weill Cornell Medical College comes to Lincoln on Tuesdays and Thursdays to restock our books.

Attending Precepting Room 568 Pediatric reference books are found in the cabinets in Room 568. Patient brochures including TIPP safety sheets, VIS (vaccine information statements), MAF (Medication Administration Forms), and other patient information are filed here. In addition, handouts for the resident weekly topics are located in the bottom file cabinet and filed by week of discussion.

Mailboxes/Notices Mailboxes for residents and general pediatricians are also located outside Room 568. Please check your mailbox every time you are in clinic. You may have messages or school forms from your patients located in the mailboxes. The Resident Weekly Topics and any notices are posted outside Room 568. The daily OPD schedules are posted in each corridor on the sticky bulletin boards outside the Staff Lounge, and nurses stations (Room 587, Room 555), and across from Room 562.

School/WIC/Camp/Job Forms All patient forms will be placed in your clinic mailbox for your completion and signature. Once completed, please give the form to Rosa Guadalupe or your clerk so they can file the form in the patient form bin for patient pick-up.

OPD Rotation

Residents will be assigned to 4 week OPD block rotations during their training and will be assigned to general pediatrics or one of the subspecialty clinics.

Procedure Resident All OPD residents will be assigned on certain days as the procedure resident during the OPD rotation. You may be paged for insertion of IV catheters, foley catheters for VCUGs, or to accompany patients who are sedated for various procedures or studies (i.e. CT scan, MRI). Your backup for procedures will be the chief residents on service (Beeper#27401). An attending pediatrician will be supervising you as your preceptor.

Case Presentations/Lectures Dr. Nunez will arrange case presentations approximately 1-2 Thursday mornings (9:00-9:45 a.m.) per rotation to discuss various topics with the OPD residents and attendings.

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