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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

24

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

26

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.

42

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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