Guide to YKHC Medical Practices - User contributions [en]

HROB Stickers--Problems/Plans

2026-04-21T01:08:02Z

LiamG:

Last updated 4/20/2026

'''2 VESSEL UMBILICAL CORD'''

''' ''' See Guideline for '''Management of isolated soft ultrasound markers for aneuploidy in the second trimester'''

'''ADRENO-GENITAL SYNDROME, previous child and same FOB'''

 At 10 weeks, draw MaternaT 21 to determine fetal sex.

 When results of MaternaT 21 are complete, send Maternal Fetal Medicine/Perinatology referral for a plan of management.

 DO NOT start high dose dexamethasone.

'''ADVANCE MATERNAL AGE, age 35-39'''

 Recommend MaternaT 21 at 10-12 weeks before the patient’s appointment in Anchorage at 20 weeks

Offer 2nd trimester MSAFP screen

 Recommend referral to Maternal Fetal Medicine/Perinatology for DAFUS and Genetic Counseling.

'''ADVANCE MATERNAL AGE, age 40 plus'''

 Recommend MaternaT 21 at 10-12 weeks before the patient’s appointment in Anchorage at 20 weeks

Offer 2nd trimester MSAFP screen

 Recommend referral to Maternal Fetal Medicine/Perinatology for DAFUS and Genetic Counseling.

 NST-AFI weekly starting at 36 weeks

 Recommend delivery by EDD

'''ALLERGY TO PENICILLIN'''

''' ''' If GBS positive, GBS culture will automatically reflex in lab for sensitivity to clindamycin and erythromycin.

'''AMNIOTIC BAND'''

''' ''' Refer to Maternal Fetal Medicine/Perinatology

'''ANEMIA, Hg <11'''

 Follow Anemia in pregnancy guideline

'''ASYMPTOMATIC BACTURIA'''

 Test of cure (TOC) at next appointment

 Urine culture every visit

 Treat any level of bacteriuria

'''cardiac anomalies in fetus, current pregnancy'''

If suspected anomaly found during screening ultrasound in Bethel, contact Maternal Fetal Medicine/Perinatology for a plan of care.

 Document plan of care in patient note and problem list

 Return to HROB meeting after the ANMC visit to discuss and plan for subsequent care.

'''Chronic Hepatitis B Virus (HBV) Infection'''

''' ''' HbsAg positive

 Draw LFTs, HB core IgM, HBeAg, HBeAb, HBsAb, HB DNA PCR

 If HBV DNA detected with a specific titer over 10IU, refer to Hepatology for possible anti-viral therapy.

 If HBV DNA not detected or detected <10IU, do not sent referral.

 '''ALL neonates born to mother with a positive HBsAg WILL receive HBIG and HBV vaccine at birth with parental consent.'''

'''CHRONIC HYPERTENSION'''

 Consult HROB or OB/GYN at 1st prenatal visit or at diagnosis

 Baseline testing: Urine protein/creatinine ratio, comprehensive metabolic panel.

 Consider EKG/Echocardiogram if longstanding hypertension or multiple medications. HROB meeting will decide if these are necessary.

Consider Stopping medication and rechecking blood pressure in 1 week.

Change Medication to labetalol or amlodipine

 Aspirin 162mg daily from 12 weeks until delivery

 Ultrasound for growth weeks 24, 28, 32, 36

 Start antenatal testing at 34 weeks, BPP weekly

Consult obstetrician at 37 weeks for delivery plan.

 Repeat labs for suspected superimposed Preeclampsia, if found, contact HROB or OB/GYN for plan of care. Discuss at every prenatal visit with HROB or OB/GYN.

'''CONGENITAL ADRENAL HYPERPLASIA, previous child'''

''' ''' At 10 weeks, draw MaternaT 21 to determine fetal sex.

 When results of MaternaT 21 are complete, send MFM referral for a plan of management.

 DO NOT start high dose dexamethasone.

'''DIABETES, PRE-PREGNANCY'''

 Aspirin 162mg daily from 12 weeks until delivery

Consult Obstetrician for medication

 Recommend insulin starting with NPH.

 Baseline testing: Protein/creatinine ratio, comprehensive metabolic panel, TSH.

 Consider EKG/Echocardiogram if longstanding disease, severe/brittle disease or co-morbid conditions. HROB meeting will decide if these are necessary.

 Optometry referral

 Recommend 1st Trimester screening for aneuploidy, using MaternaT 21

 Refer to Maternal Fetal Medicine/Perinatology for DAFUS, Fetal Echo and consultation

 Transfer of Care to Anchorage depends on patient adherence to plan of care and glucose control. Could be any time from 30 weeks to 35 weeks.

'''DILATED FETAL RENAL PELVIS (UTD)'''

 See Guideline for '''Management of isolated soft ultrasound markers for aneuploidy in the second trimester'''

'''ELEVATED MSAFP'''

Verify information sent to LabCorp for calculating results

Obtain ultrasound for dating if not already done.

Resubmit for recalculation if necessary

If AFP MOM <3.0, repeat AFP. If MOM still >2.5, or initial result is >3.0, refer to Maternal Fetal Medicine/Perinatology for DAFUS and genetic counseling.

 In third trimester, watch for: IUGR, preeclampsia, preterm labor, vaginal bleeding. Consult HROB or OB/GYN if these occur.

 Ultrasound at 32 weeks or as directed by the Maternal Fetal Medicine/Perinatology

'''FETAL GROWTH RESTRICTION, Suspected'''

''' ''' Obtain an ultrasound for fetal Growth

 If US shows EFW<10%,

Obtain cord Doppler

Send images to Maternal Fetal Medicine/Perinatology

Follow recommended plan of care from Maternal Fetal Medicine/Perinatology

 If ultrasound shows EFW>10%, contact HROB or OB/GYN for plan of management.

'''GENITAL HERPES'''

 Inspection of vulva and vagina at 36 weeks and in labor

 Encourage valacyclovir 500mg BID for prophylaxis at Be in Bethel visit or 4 weeks before planned delivery

'''GENETIC TESTING IN EARLY PREGNANCY LOSS (EPL)'''

Not all EPL need to have genetic testing.

The provider and the patient will weigh the risks and benefits of doing testing before proceeding.

Generally, testing during the patient’s 1st EPL is not recommended.

If the decision is made to test, written consent MUST be obtained using the YKHC AND LabCorp consent for genetic testing.

Once a specimen is obtained by spontaneous passage or surgery, place a 1cm specimen in sterile saline (THIS CANNOT BE IN FORMALIN) and label the cup with a patient label.

Using the Miscellaneous lab test order in PowerChart:

order Karyotype on Fetal Tissue LabCorp test number 052052.

And/or

order SNP/Microarray POC LabCorp test number 510101

'''Gestational Diabetes'''

Goal: Fasting <95, 2 hour postprandial <120 or 1 hour postprandial <140

 Close monitoring until controlled (weekly visits or contact).

Weekly discussion between monitoring provider and diabetes department

Growth US at 36 weeks

 If poor control (>25% of values above goal)

consider medical therapy (insulin(preferred) or oral medication)

stay in Bethel after 32 weeks

 If the patient is not providing data through finger stick glucose monitoring, offer Continuous glucose monitor.

 If the patient is not providing adequate data from any method of testing, transfer to Anchorage at 35 weeks or sooner.



'''GESTATIONAL DIABETES, POOR CONTROL'''

''' ''' Consult HROB or OB/GYN at every visit for patients in poor control (>25% of values above goal) to update the plan of care.

''' ''' Transfer to Anchorage at 32 weeks

'''GESTATIONAL DIABETES, ON MEDICATION'''

Insulin is preferred medication. Only use oral medication if the patient refuses insulin.

Goal: Fasting <95, 2 hour postprandial <120 or 1 hour postprandial <140

 Close monitoring (weekly visits or contact).

At least weekly discussion between reviewing provider, diabetes department and Maternal Fetal Medicine/Perinatology as needed.

Adjust medication at least weekly until goal achieved.

Weekly BPP after 32 weeks. (stay in Bethel)

Transfer to Anchorage at 32-35 weeks depending on patient participation with the plan of care and glucose control.

'''GESTATIONAL HYPERTENSION/PREECLAMPSIA in current pregnancy'''

''' ''' Prenatal visits twice a week

 Weekly Labs CBC, CMP, protein/Creatinine ratio. 24-hour urine as recommended by HROB or OB/GYN physician.

 NST 2x/week, AFI weekly

 US OB follow-up for growth every 3 weeks

 If Growth restriction suspected, contact HROB or OB/GYN for a plan.

 Consult with HROB or OB/GYN at EVERY VISIT

 Place order refer to OB Induction for delivery at 37 weeks. Place this order as soon as possible but at lease 1 week in advance of the induction date. If the induction needs to happen in less than 1 week, contact the OB charge nurse and the inpatient physician to coordinate the induction.

'''Gestational pruritus'''

 Do not start Ursodiol

 Repeat Bile Acids and LFT every 1-2 weeks.

'''GESTATIONAL PRURITUS WITH LAB ABNORMALITIES OR SEVERE PRURITUS'''

Lab abnormalities: Cholic acid > 3.0, elevated AST, ALT, bilirubin or alkaline phosphatase > 300.

Severe itching is excoriations, scratching during appointment, itching that alters sleep

Start ursodiol 600mg po BID. Treat as Cholestasis.

NST weekly after 32 weeks.

Induce at 39 weeks.



'''GRAND MULTIPARA (5 or more deliveries)'''

 Active management of 3rd Stage recommended

 Discuss Birth Control Plans at 36 weeks

 Sign Sterilization consent at 20 week visit, if considering sterilization

'''GROUP B STREP BACTERIURIA in current pregnancy'''

''' Any''' level of GBS in the urine at any time of the pregnancy initiates this plan

'''Do not''' do screen with vaginal/rectal swab at 36 weeks.

Begin prophylaxis in labor per guideline.

'''GROUP B STEP, PREVIOUS BABY WITH INVASIVE DISEASE'''

 Screen for bacteriuria per the routine.

 '''Do Not''' screen with vaginal/rectal swab at 36 weeks.

Begin prophylaxis in labor per guideline.

'''GROUP B STEP, PREVIOUS PREGNANCY WITH POSITIVE CULTURE AT TERM, BUT NO NEONATAL INFECTION'''

''' ''' No treatment is indicated

 Screen at 36 weeks per routine protocol

'''HBsAg POSITIVE, NEW FINDING'''

 Draw LFTs, HB core IgM, HBeAg, HBeAb, HBsAb, HB DNA PCR

 Refer to ANMC hepatology

'''HIGH RISK FOR PRETERM BIRTH'''

 Reason:

 Discuss with OB/GYN as soon as possible after the 1st prenatal visit.

If recommended, start progesterone 200mg per vagina qhs 16 – 36 weeks

 Urine culture every visit

 Serial cervical length every 2 weeks from 16- 24 weeks

 If cervical length less than 30mm, see sticker for short cervix of the “Guideline Preterm Labor: Screening and Prevention”

 Treat BV if symptomatic (screening for BV is not indicated)

'''HISTORY OF DEPRESSION/POST PARTUM DEPRESSION'''

 Screen every visit for depression

 Contact ACT or Behavioral Health for score >9

 Consider SSRI postpartum

'''HISTORY OF DOMESTIC VIOLENCE'''

 Discuss at every visit.

 Monitor for signs or symptoms of abuse

 Offer counseling or referral for services.

'''HISTORY OF INTRAHEPATIC CHOLESTATIS'''

 Draw baseline total bile acids and liver enzymes at first visit

 Monitor for symptoms at every visit

 If severe clinical symptoms, redraw labs above and begin Ursodiol 600 mg BID.

 See guideline

'''HISTORY OF IUGR OR SMALL FOR GESTATIONAL AGE (SGA) <20% FETUS'''

''' ''' Growth scans at 24, 28, 32 and 36 weeks

'''HISTORY OF A LARGE FOR GESTATIONAL AGE (LGA) >90% FETUS OR >4000GM'''

 Screen for Gestational Diabetes per protocol

 Ultrasound at 36 weeks for growth

'''HISTORY OF MOLAR PREGNANCY'''

''' ''' Make sure first trimester US has history of Molar pregnancy as a diagnosis

 Review the US with HROB physician

 Refer patient to HROB meeting

 Send Placenta for pathology after delivery.

'''HISTORY OF POSTPARTUM HEMORRHAGE'''

 Second IV in labor

 Standard: T&S in labor and assessment for risk of postpartum hemorrhage

 Active Management of 3rd stage of labor If PPH risk score is 3 prior to induction of labor, transfer care to Anchorage prior to induction. Contact OB unit to help with calculating the score if needed.

'''HISTORY OF GESTATIONAL HYPERTENSION/PREECLAMPSIA with or without SEVERE FEATURES/ECLAMPSIA'''

 Aspirin 162mg daily from 12 until delivery.

 Baseline labs: Protein/Creatinine ratio, CBC, CMP.

 Monitor for signs or symptoms of preeclampsia and repeat labs as needed

'''HISTORY OF SEIZURE DISORDER'''

 Begin Folic Acid 4mg daily ASAP

 Draw Drug level for current medication

 Consult HROB or OB/GYN for possible medication change

 Detailed Anatomic Fetal Ultrasound(DAFUS) at 18-22 weeks in Anchorage

 Monitor symptoms and drug levels as needed

 Monitor drug levels Postpartum as physiology changes

Consider adding vitamin K 10mg daily from 36 weeks to delivery

Do not give Tdap vaccine.

'''HISTORY OF SHOULDER DYSTOCIA'''

US for growth at 36 weeks.

Transfer to ANMC at 36 weeks for delivery.

'''HISTORY OF SKELETAL DYSPLASIA OR DWARFISM'''

 If this occurs in any pregnancy, refer for genetic counseling.

 If counseling states there is a recurrence risk, refer to ANMC Maternal Fetal Medicine/Perinatology at 1st Prenatal Visit.

 Refer all patients for DAFUS and Maternal Fetal Medicine/Perinatology consultation

 Follow plan from ANMC Maternal Fetal Medicine/Perinatology note

'''HISTORY OF SUBSTANCE ABUSE'''

 Discuss at EVERY visit

 Monitor for signs or symptoms of abuse

 Behavioral Health referral

 If opioid, refer to Suboxone clinician

'''HISTORY OF STILLBIRTH'''

''' ''' At first prenatal, attempt to locate the post stillbirth workup in the chart and document the results in your note for HROB conference.

 Add Bile Acids and LFT to the 1st OB visit labs.

 Ultrasound for growth at 24, 28, 32 and 36 weeks.

 Visits every 2 weeks in Bethel after 28 weeks.

 Fetal Kick counts after 28 weeks

 Further planning after HROB meeting based on other diagnoses and risk factors. See ACOG Obstetric Care Consensus Number 10 (2020) Management of Stillbirth

 BPP weekly after 32 weeks.

 Offer induction at 38 weeks.

'''HIV disease NEW'''

''' See Guideline'''

Contact EIS (907-7292907 or Tiger Text role “ANMC Discharge Scheduler HIV/EIS Clinic”) ASAP for notification and/or medication start

 Get initial HIV labs based on recommendations from EIS

 Follow HIV in pregnancy Guideline

 CD4 count and viral load at 24 and 36 weeks

 Refer to Maternal Fetal Medicine/Perinatology

 See guideline for decision of where to deliver

'''HIV disease previously known'''

''' See Guideline'''

Continue HAART

 Contact EIS (907-7292907 or Tiger Text role “ANMC Discharge Scheduler HIV/EIS Clinic”) for notification and/or medication change

 CD4 count and viral load at first prenatal, 24 and 36 weeks

 Refer to Maternal Fetal Medicine/Perinatology

 See guideline for decision where to deliver

'''HYPERTHYROID prior to pregnancy'''

''' ''' Discuss with HROB or OB/GYN at first visit.

Draw TSH, Free T4 at first visit and at least each Trimester.

Redraw TSH and Free T4 4-6 weeks after a dosage change.

 Contact Maternal Fetal Medicine/Perinatology to determine need to change Methimazole, to PTU for first trimester or stop all medications.

 If on PTU, continue at present dose.

 Monitor for signs and symptoms of hyperthyroid disease at every visit. (goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

'''HYPERTHYROID new diagnosis'''

''' ''' Discuss with HROB or OB/GYN at diagnosis or if severe disease suspected.

Draw TSH, Free T4 at first visit and at least each Trimester.

Redraw TSH and Free T4 4-6 weeks after a dosage change.

 Observe carefully for signs and symptoms of Thyroid storm. (severe hypertension, goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

If tachycardic, start Atenolol 25mg daily

 Begin PTU at 50mg po TID, draw labs weekly until stable.

 Monitor for signs and symptoms of hyperthyroid disease at every visit. (goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

'''HYPOTHYROID prior to pregnancy'''

 Order TSH, Free T4

 Do not treat subclinical disease

 If previous thyroidectomy or ablation, increase levothyroxine dose by 25% in first trimester and measure TSH and Free T4 every 4-6 weeks until results are stable.

 For all others, measure TSH, Free T4 each trimester.

'''HYPOTHYROID new diagnosis'''

 Begin levothyroxine ASAP at 100mcg daily

 Check TSH Free T4 monthly until labs normalized

 Check TSH Free T4 every trimester thereafter

 Re-evaluate postpartum

'''INTRAHEPATIC CHOLESTASIS (IHCP) – Severe itching and abnormal Labs'''

 Start ursodiol 600 mg BID. You may increase dose up to 900mg TID for continued severe pruritus.

 Start weekly BPP at 32 weeks

 Redraw Total Bile Acids (TBA) and LFTs weekly after 32 weeks

 May return home with weekly visits

 Consult HROB meeting or OB/GYN

 Correct TBA by subtracting the urodeoxycholic acid (ursodiol) from the TBA on the results.

 Severe IHCP if corrected TBA >40, must be induced at 37 weeks.

 If corrected TBA > 100, induce at 35-36 weeks in Anchorage.

 Mild IHCP, TBA < 40, induce at 38 weeks.

'''IUGR see Fetal Growth Restriction'''

'''LTBI'''

''' ''' If prior tuberculosis diagnosis with completed treatment, diagnosis of LTBI.

No PPD or Quantiferon

 Ask about symptoms: hemoptysis, fever, night sweats, weight loss, or cough.

 If all symptoms are negative, no reactivation of TB and no treatment or diagnostic testing needed.

'''MIGRAINE HEADACHES'''

''' ''' Discontinue triptan medication

 Low dose tricyclics OK after 1st trimester

 Tylenol.

 If above fails, refer to Neurology.

 Avoid opiates.

'''OBESITY'''

 If BMI >40, refer to HROB meeting for consultation.

 If BMI >40 and patient 36 weeks gestation or later, Consult HROB on call and on call CRNA on call for consultation regarding suitability for delivery in Bethel.

 For all women with BMI> 35, obtain US for growth at 28, 32 and 36 weeks and start BPP weekly at 32 weeks.

'''POSITIVE ANTIBODY SCREEN'''

 Confirm antibody identification.

 If antibody is Kell, Duffy (Fy), c, C, D, e or E, contact OB/GYN or discuss at HROB ASAP

 Any other antibody, contact OB/GYN for plan of management. Obtain Unity cell free DNA screening for T21, T18, T13, sex chromosomes and the antigen identified above (Kell, Duffy (Fy), c, C, D, e or E). The testing kits are available at the Team Room C nursing station.

 If fetal antigen testing is negative, no further testing is needed.

 If fetal antigen testing is positive, refer to Maternal Fetal Medicine/Perinatology for plan of care to monitor for isoimmunization.

 Contact the blood bank at 32 weeks to discuss the availability of antigen negative blood at the delivery.

'''POSITIVE HIV SCREEN'''

 Confirm HIV status with reflex testing.

 Once HIV disease confirmed, see HIV Disease, New

'''PLACENTAL ABNORMALITIES'''

LOW LYING: <2.5cm from internal os of the cervix

 Repeat transvaginal ultrasound monthly until resolved.

 If not resolved by 32 weeks, consult Maternal Fetal Medicine/Perinatology for further plan of management

CIRCUMVALLATE

 At risk for growth restriction. Growth US at 32 weeks to assess for growth restriction.

SUCCENTURATE LOBE

 Make sure ultrasound has screened for vasa previa

 At delivery, ensure entire placenta is removed during 3rd stage.

VELAMENTOUS CORD INSERTION

''' ''' At risk for growth restriction. Growth US at 32 weeks to assess for growth restriction.

'''PLACENTA PREVIA'''

''' ''' Placenta previa diagnosed at second trimester ultrasound

 Repeat ultrasound at 24 weeks.

 If still a previa,

 Pelvic rest: no sex, no exams

 Transfer to Anchorage until previa resolves.

 Before 24 weeks, no need to change activity unless actively bleeding

'''PREDIABETES'''

 Refer patient to Diabetes and prescribe supplies for finger stick testing

 Review testing results weekly at HROB rounds with diabetes team

 Screen for GDM as per routine care

'''PREVIOUS CESAREAN'''

 If considering repeat cesarean in Bethel, appointment with OB/GYN ASAP

Refer to HROB meeting for discussion

Repeat Cesareans done in Bethel unless there is a medical reason for the transfer.

Document patient’s choice of location and route of delivery, in note and as comment in diagnosis.

Provide trial of labor after cesarean (TOLAC) education and first prenatal visit.

Complete TOLAC consent ASAP

'''Rh negative'''

See Guideline.

Repeat Type and Screen with Rhogam work up at 28 weeks.

If RH negative, Give Rhogam at 28 weeks.

At delivery, follow OB guideline for Rh negative patients.

'''RUBELLA NON-IMMUNE'''

''' ''' Repeat MMR vaccine postpartum if the patient has fewer than 3 lifetime MMR vaccines

'''SHORT CERVIX ON SCREENING'''

''' History of Preterm Birth'''

Cervical length less than 25mm

 Consult with Maternal Fetal Medicine/Perinatology physician to discuss cerclage

 Cervical length 26 to 29mm

 Weekly cervical length ultrasound

 Cervical length 30mm, continue every other week cervical length measurements until 24 weeks.

 '''No History of Preterm Birth'''

''' ''' Cervical length 20mm or less

 Vaginal progesterone 200mg qhs

 Repeat cervical length in 1-2 weeks

 Cervical length 10mm or less

 Consult Maternal Fetal Medicine/Perinatology for possible cerclage

'''SUBOXONE TREATMENT'''

 Make appointments with Dr Compton or another MAT/Women’s Health (WH) provider

 UDS as needed (does not need to be every week), Tramadol and/or gabapentin levels depending on patient’s drug use history

 Transfer to Anchorage at 36 weeks or sooner for delivery

'''TWIN GESTATION (Diamniotic-Dichorionic)'''

Add Folic Acid 1mg daily

Aspirin 162mg daily from 12 weeks until delivery

'''18 Weeks ANMC'''

 TV ultrasound for cervical length

 Early DAFUS,

 Counseling

'''22 Weeks ANMC'''

''' ''' Full DAFUS

'''24 Weeks YKHC'''

 Prenatal visit

 1 hr. GST, CBC

'''26 Weeks YKHC'''

 Prenatal visit

 Ultrasound for fetal growth and TV ultrasound for cervical length

'''28 Weeks YKHC'''

''' ''' Prenatal visit

'''30 Weeks YKHC'''

''' ''' Prenatal visit

Ultrasound for fetal growth and TV ultrasound for cervical length

<nowiki>**</nowiki> BE IN BETHEL due to high risk pregnancy **

'''31 Weeks YKHC'''

 Prenatal visit

'''32 Weeks YKHC'''

''' ''' ** Transfer to ANMC until delivery**

'''TWIN GESTATION MONOAMNIOTIC-DICHORIONIC OR MONOAMNIOTIC-MONOCHORIONIC'''

Add Folic Acid 1mg daily

Aspirin 162mg daily from 12 weeks until delivery

'''16 weeks –''' Appointment in Anchorage to evaluate for twin-twin transfusion syndrome

 All future appointments in Anchorage

'''UTERINE SHELF'''

''' ''' Repeat ultrasound in 4 weeks.

 These rarely are a problem

'''UTI IN PREGNANCY'''

 Urine Culture every visit

Prophylaxis after 2nd UTI or 1st pyelonephritis: recommend Nitrofurantoin 100mg po qhs.

'''TOLAC in Bethel, Planned'''

 Discuss Case at HROB meeting

 At BIB, provider will contact the HROB on call, blood bank lead, OB charge nurse.

 On admission in labor: Admitting physician will notify CRNA on call, HROB on call.

 Complete TOLAC Consent at earliest prenatal visit possible ''' '''

'''VITAMIN D DEFICIENCY'''

 SELECT ONLY ONE SENTENCE FOR NOTE

25-OH Vitamin D > 20ng/ml Continue cholecalciferol 1000 IU daily (standard for all patients)

 25-OH Vitamin D > 12ng/ml and <20ng/ml increase cholecalciferol to 3000 IU daily

25-OH Vitamin D < 12ng/ml

If < 32 weeks, increase cholecalciferol to 3000 IU daily

If > 32 weeks give ergocalciferol 50,000 IU weekly for 12 weeks.

[[:category:Women's Health]]

Meetings

2026-02-14T01:27:46Z

LiamG: /* Generic Monthly Calendar */

==Generic Monthly Calendar==
{|class="wikitable"
!style="width:200px; text-align:center;color:blue"|MONDAY
!style="width:200px; text-align:center;color:blue"|TUESDAY
!style="width:200px; text-align:center;color:blue"|WEDNESDAY
!style="width:200px; text-align:center;color:blue"|THURSDAY
!style="width:200px; text-align:center;color:blue"|FRIDAY
|- style="vertical-align:top;"

|1ST
 Piniutet (Addiction Committee) Meeting
|1ST
 Grand Rounds

Medical Staff Executive Committee (MSEC)
|1ST
 General Medical Staff Meeting (GMS, day after MSEC so sometimes 2nd Wednesday)
|1ST

|1ST
 High Risk OB (HROB)
|- style="vertical-align:top;"
|2ND
 Piniutet (Addiction Committee) Meeting

|2ND
 Grand Rounds 
|2ND
|2ND

|2ND
 High Risk OB (HROB)
|- style="vertical-align:top;"
|3RD
 Piniutet (Addiction Committee) Meeting
|3RD
 Grand Rounds
|3RD
 Performance Improvement (PI) Committee
|3RD
 Provider RAST Committee

|3RD
 High Risk OB (HROB)
|- style="vertical-align:top;"
|4TH
 Piniutet (Addiction Committee) Meeting
|4TH
 Grand Rounds

Antimicrobial Stewardship (AMS) Committee
|4TH
 Pharmacy & Therapeutics (P&T) Committee
|4TH
 
|4TH
 High Risk OB (HROB)

|- style="vertical-align:top;"
|Last
 
|Last
|Last
|Last

Outpatient Medical Staff Meeting
|Last

|}
Yugtun ''Piniutet'' ("strength") was endorsed by patients to name the Addiction Medicine program at YKHC.

==Meeting Locations==
*BB (''Blueberry (across from ED just past FastTrack'')
*BBA (''Blueberry (side A-front)'')
*BBB (''Blueberry (side B-back)'')

==Case Review Processes and Meetings==

From least detailed to most detailed discussion. Generally, cases are not referred to multiple reviews (e.g. if a case is going to be discussed at Trauma Review it will not be discussed at M&M). PI is the only case referral process that can result in disciplinary action. Concerns regarding individual providers may also be raised to the department heads or to the Chief of Staff.

===Critical Case Review (CCR)===
What it is: CCR is a process by which providers receive an involved discussion of a critical or complicated case by their peers. Cases are reviewed by permanent staff not involved in the case and discussed quarterly. Although cases are autogenerated based on outcomes (intubations, transfers, etc.) any case which a provider would like reviewed in an investigative but non-punitive format can be subject to CCR.

How cases are referred: Automatically by meeting criteria, then filtered by department heads. Cases can also be referred for CCR by providers by emailing the department head. As CCR is the least involved discussion any case which goes to C&C, PI or M&M does not need to be referred for CCR.

How often: Quarterly.

===Trauma Review===
What it is: Multidisciplinary review of major trauma cases. Pre-arrival care, hospital care and subsequent management at tertiary referral center is reviewed with a focus highlighting key points in the management of trauma and the potential for system improvement.

How cases are referred: Automatically by meeting criteria. Select major trauma cases resulting in significant morbidity or mortality. Cases are presented by Trauma Director with collaboration from ED Nurse Manager and ED Director.

How often: Quarterly.

===Performance Improvement (PI)===
What it is: PI is an as-needed case review by members of the Medical Staff Executive Committee, with a focus on correcting suboptimal provider medical care and documentation. After a case is referred, the heads of PI Committee will delegate the case to be reviewed by a member of MSEC not directly involved in the case. Participating in these reviews is a condition of being on MSEC and is non-optional. MSEC members discuss these reviews and determine potential for provider improvement. Providers involved in the case are not present for these reviews and receive a letter from PI committee following MSEC review.

How cases are referred: By providers, by emailing the PI Med Staff Committee. Members of MSEC not involved in the case present.

How often: As needed, up to monthly.

===Morbidity and Mortality (M&M)===
What it is: M&M is an hour-long presentation on a single case, typically with a suboptimal outcome which demonstrates key management points in regards to a disease process and highlights potential for system improvement. M&M can look critically at both provider management and systems processes but is non-punitive as information is for education benefit.

How cases are referred: By providers, by emailing the Inpatient Service Chief. The person requesting the case typically presents. Multiple presenters may discuss a single case.

How often: Monthly

Chronic Cough/Bronchiectasis – Pediatrics

2026-02-07T07:22:58Z

LiamG: /* Resources/References */

'''Pathophysiology:''' Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions.
 '''Risk Factors:'''
*Prematurity
*Immunocompromise
*Early recurrent respiratory infections
*Previous injury
*Environmental effects (lack of piped water, household crowding, woodstove use)
'''Demographics:''' Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000.
 '''Signs/Symptoms:''' Chronic wet cough, respiratory exacerbations with fever, crackles, wheezing
 '''Diagnosis:''' Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) to CT scan confirmed Bronchiectasis
 '''Management:'''
*Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations
*Improve other factors contributing: attention to nutrition, detect complications, pollutants
*Systemic care: regular review, multi-disciplinary care, education, enhance self care and management
*Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year
*Special attention in adolescents to transferring to adult care.

'''Critical Times for Affected Patients:''' exacerbations – antibiotic treatment important, prophylaxis if frequent exacerbations, transition to adulthood critical – poorly managed bronchiectasis can lead to early COPD and death

===Resources/References===
* [[Media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] (PowerPoint Presentation by Rosalyn Singleton, MD)
* Munro, et al. [https://www.researchgate.net/profile/Catherine_Byrnes/publication/228632714_Burden_of_Bronchiectasis_in_Indigenous_Peoples-How_Can_it_be_Improved/links/02bfe51326836e5853000000/Burden-of-Bronchiectasis-in-Indigenous-Peoples-How-Can-it-be-Improved.pdf Burden of Bronchiectasis in Indigenous Peoples- How Can it be Improved?]. ''Current Pediatric Reviews.'' 2009, 5, 00-00.
* Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014.
* Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4
*Lewis, T. et al. [https://journal.chestnet.org/article/S0012-3692(15)32159-0/abstract Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children]. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
*Healthy Homes Baseline Characteristics: Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, Skarada J, Kovesi T, McDonald D, Hennessy TW, Ritter T. [https://onlinelibrary.wiley.com/doi/abs/10.1111/ina.12315 Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions]. ''Indoor Air'' 2017 Mar;27(2):478-486. DOI: 10.1111/ina.12315 Epub 2016 Jul 18
*Healthy Homes Results: Singleton R, Salkoski AJ, Bulkow L, et al. [https://www.tandfonline.com/doi/full/10.1080/22423982.2017.1422669 Impact of Home Remediation and Household Education on Indoor Air Quality, Respiratory Visits, and Symptoms in Alaska Native Children]. ''Int J Circumpolar Health'' 2018;77(1) DOI: 10.1080/22423982.2017.1422669
*Kinghorn B, Singleton R, Mccallum GB, Bulkow L, Grimwood K, Hermann L, Chang AB, Redding G. Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children. Pediatric Pulmonology 2018;1-8. https://doi.org/10.1002/ppul.24174
*Sibanda D, Singleton R, Clark J, et al. Adult outcomes of childhood bronchiectasis. Int J Circumpolar Health. 2020;79(1):1731059. https://www.ncbi.nlm.nih.gov/pubmed/32090714
* [[Media:Bronchiectasis peds.pdf|YKHC Clinical Guideline for Bronchiectasis]]
* [[Media:REHCFlyer.pdf|Free Indoor Air Toolkit Program - 2026 Flyer]]

[[:category:YKHC Guidelines|YKHC Clinical Guidelines]]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

File:REHCFlyer.pdf

2026-02-07T07:19:45Z

LiamG:

Chronic Cough/Bronchiectasis – Pediatrics

2026-02-07T07:17:04Z

LiamG: /* Resources/References */

'''Pathophysiology:''' Recurrent pneumonia and lower respiratory tract infections cause airway damage that leads to "ectasia" and loss of elasticity of bronchi. Loss of muco-ciliary function leads to difficulty clearing secretions.
 '''Risk Factors:'''
*Prematurity
*Immunocompromise
*Early recurrent respiratory infections
*Previous injury
*Environmental effects (lack of piped water, household crowding, woodstove use)
'''Demographics:''' Alaska YK Delta: 1 in 63 children, Central Australia: 1 in 68, U.S.: 1 in 250,000.
 '''Signs/Symptoms:''' Chronic wet cough, respiratory exacerbations with fever, crackles, wheezing
 '''Diagnosis:''' Progression of disease from protracted bronchitis to chronic suppurative lung disease (3 episodes at least 3 months each) to CT scan confirmed Bronchiectasis
 '''Management:'''
*Reduce infection-inflammation: treat early and exacerbations 'aggressively' with antibiotics, airway hygiene clearance, vaccinations
*Improve other factors contributing: attention to nutrition, detect complications, pollutants
*Systemic care: regular review, multi-disciplinary care, education, enhance self care and management
*Collaboration with Seattle Children's Hospital Pulmonologists who generally see patients in a Bethel Field Clinic 3-4 times a year
*Special attention in adolescents to transferring to adult care.

'''Critical Times for Affected Patients:''' exacerbations – antibiotic treatment important, prophylaxis if frequent exacerbations, transition to adulthood critical – poorly managed bronchiectasis can lead to early COPD and death

===Resources/References===
* [[media:Bronchiectasis.pdf|Bronchiectasis: Prevention and Management 2016]] (PowerPoint Presentation by Rosalyn Singleton, MD)
* Munro, et al. [https://www.researchgate.net/profile/Catherine_Byrnes/publication/228632714_Burden_of_Bronchiectasis_in_Indigenous_Peoples-How_Can_it_be_Improved/links/02bfe51326836e5853000000/Burden-of-Bronchiectasis-in-Indigenous-Peoples-How-Can-it-be-Improved.pdf Burden of Bronchiectasis in Indigenous Peoples- How Can it be Improved?]. ''Current Pediatric Reviews.'' 2009, 5, 00-00.
* Singleton RJ et al. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ppul.22763 Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis]. ''Pediatr Pulmonol'' 2014.
* Redding et al. [https://www.sciencedirect.com/science/article/pii/S0012369215510817?via%3Dihub Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis]. CHEST 2014:146;762-4
*Lewis, T. et al. [https://journal.chestnet.org/article/S0012-3692(15)32159-0/abstract Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children]. CHEST. 125(5):1665-1673, May 2004. doi.org/10.1378/chest.125.5.1665
*Healthy Homes Baseline Characteristics: Singleton R, Salkoski AJ, Bulkow L, Fish C, Dobson J, Albertson L, Skarada J, Kovesi T, McDonald D, Hennessy TW, Ritter T. [https://onlinelibrary.wiley.com/doi/abs/10.1111/ina.12315 Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions]. ''Indoor Air'' 2017 Mar;27(2):478-486. DOI: 10.1111/ina.12315 Epub 2016 Jul 18
*Healthy Homes Results: Singleton R, Salkoski AJ, Bulkow L, et al. [https://www.tandfonline.com/doi/full/10.1080/22423982.2017.1422669 Impact of Home Remediation and Household Education on Indoor Air Quality, Respiratory Visits, and Symptoms in Alaska Native Children]. ''Int J Circumpolar Health'' 2018;77(1) DOI: 10.1080/22423982.2017.1422669
*Kinghorn B, Singleton R, Mccallum GB, Bulkow L, Grimwood K, Hermann L, Chang AB, Redding G. Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children. Pediatric Pulmonology 2018;1-8. https://doi.org/10.1002/ppul.24174
*Sibanda D, Singleton R, Clark J, et al. Adult outcomes of childhood bronchiectasis. Int J Circumpolar Health. 2020;79(1):1731059. https://www.ncbi.nlm.nih.gov/pubmed/32090714
* [[media:Bronchiectasis_peds.pdf|YKHC Clinical Guideline for Bronchiectasis]]
* [[media:REHCFlyer.pdf|Free Indoor Air Toolkit Program]]

[[:category:YKHC Guidelines|YKHC Clinical Guidelines]]
 [[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

File:Specialty Calendar.pdf

2026-02-03T19:05:05Z

LiamG: LiamG uploaded a new version of File:Specialty Calendar.pdf

Regularly updated schedule field clinics at YKHC

Category:YKHC Guidelines

2026-02-03T01:47:22Z

LiamG:

<pre style="color: green">
If you are having difficulty finding a specific guideline, Please use Ctrl+F. "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. If you are in a document or in a web browser, pressing the Ctrl key + the F key will bring up a search box in the top right corner of the screen.
</pre>

'''LOCAL GUIDELINE COLLECTIONS'''
 [[Media:Clinical Resource Book.pdf|YKHC Clinical Guidelines (Clinical Resource Book)]]
 [https://anmc.org/medical-professionals/clinical-guidelines/ ANMC Clinical Guidelines]

'''CLINICAL GUIDELINES (Arranged by system)'''

==General==
* [[Media:Use of Consultants.pdf|Consultations]]; [[:Category:Consults#Internal (Bethel) Consult Services|supplement]]
* [[Media:Guideline guideline.pdf|Guideline Guideline]]
* [[Media:Orders change process.pdf|Process to Update the EHR to Match Guidelines]]

==Critical Care & Emergency Medicine==
* [[Media:Acetaminophen overdose.pdf|Acetaminophen Overdose (Adult and Pediatric)]]; [[Acetaminophen Overdose|supplement]]
* [[Media:MI.pdf|Acute Coronary Syndrome (ACS/MI)]]; [[Myocardial Infarction – Acute|supplement]]
* [[Media:Burns Guideline.pdf|Burns (Adult and Pediatric)]]; [[Burn Evaluation and Treatment|supplement]]
* [[Media:VillageCode.pdf|Cardiac Arrest in Village]]; [[Village Code|supplement]]
* [[Media:Stroke.pdf|Cerebrovascular Accident (Stroke)]]; [[Ischemic Stroke – Acute|supplement]]
* [[Media:Adult Critical Care Guide.pdf|Critical Care Medications Guide (Adult)]]; [[Adult Critical Care|supplement]]
* [[Media:Pediatric critical care guide.pdf|Critical Care Medications Guide (Weight-Based – Pediatric)]]
* [[Media:Death.pdf|Death Protocol]]; [[Death Protocol|supplement]]
* [[Media:Frostbite.pdf|Frostbite (Adult and Pediatric)]]; [[Frostbite|supplement]]
* [[Media:Head injury adult.pdf|Head Injury (Adult)]]
* [[Media:Head injury peds.pdf|Head Injury/Concussion (<18 years)]]; [[Head Injury / Concussion Under 18 Years|supplement]]
* [[Media:HFNC.pdf|High-Flow Nasal Cannula (HFNC) (Pediatric)]]; [[High-Flow Nasal Cannula (HFNC) — Pediatric|supplement]]
* [[Media:Hypothermia.pdf|Hypothermia]]; [[Hypothermia|supplement]]
* [[Media:Intubation adult and peds.pdf|Intubation (Adult and Pediatric)]]; [[Intubation – Adult and Peds|supplement]]
* [[Media:ET CO2.pdf|Intubated Pediatric Patients: ET CO2 Monitoring]]
* [[Media:MTP.pdf|Massive Transfusion Protocol (≥14 years)]]
* [[Media:Medevac village to Bethel.pdf|Medevac Activation: Village to YKHC]]; [[:Category:Medevacs and Transport#Village to Bethel Medevacs|supplement]]
* [[Media:Medevac Bethel to Anchorage.pdf|Medevac Activation: YKHC to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:MedevacTrauma.pdf|Medevac/Transfer Process for Trauma]]; [[Medevac for Trauma|supplement]]
* [[Media:Activating emergency military transport.pdf|Military Transport for Emergencies (RCC)]]; [[:Category:Medevacs and Transport|supplement]]
* [[Media:Peds medevac.pdf|Pediatric Medevacs: Bethel to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:Procedural Sedation.pdf|Procedural Sedation & Analgesia Outside the OR (PSAOOR)]]; [[Procedural Sedation|supplement]]
* [[Media:Respiratory distress.pdf|Respiratory Distress & Bronchiolitis Management (<5 years)]]; supplement
* [[Media:Seizure evaluation peds.pdf|Seizure Evaluation (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Sepsis adult.pdf|Sepsis (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis meds adult.pdf|Sepsis Medications (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis peds.pdf|Sepsis (Pediatric)]]; [[Sepsis – Pediatric|supplement]]
* [[Media:Spinal cord injury.pdf|Spinal Cord Injury Management]]
* [[Media:Status Tx Adult.pdf|Status Epilepticus Treatment (Adult)]]
* [[Media:Seizure treatment peds.pdf|Status Epilepticus Treatment (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Strangulation.pdf|Strangulation]]; [[Strangulation|supplement]]
* [[Media:Trauma outside Bethel.pdf|Trauma Outside Bethel]]
* [[Media:Villages without health aides.pdf|Villages without Health Aides]]

==Abuse/Assault==
* [[Media:Adult sexual assault.pdf|Sexual Assault (≥18 Years)]]; [[SART|supplement]]
* [[Media:Suspected pediatric child abuse.pdf|Suspected Physical Abuse Procedure (Pediatric)]]; [[SART|supplement]]
* [[Media:Suspected pediatric sexual abuse.pdf|Suspected Sexual Abuse Procedure (Pediatric)]]; [[SART|supplement]]

==Endocrine==
* [[Media:Type 2 diabetes.pdf|Diabetes, Type 2]]; [[Type 2 Diabetes|supplements]]
* [[Media:Endocrine links page.pdf|Pediatric Endocrine Protocols (DKA, Endocrine Emergencies, and Follow-Up)]]

==Gastrointestinal==
* [[Media:CSID.pdf|Congenital Sucrase-Isomaltase Deficiency Resource (CSID)]]; [[Congenital Sucrase-Isomaltase Deficiency (CSID)|supplement]]
* [[Media:H pylori dyspepsia.pdf|Dyspepsia/H. pylori (Adult and Pediatric)]]; [[Dyspepsia – H. Pylori|supplement]]

==Hematologic==
* [[Media:AdultAnemia.pdf|Anemia in Adults]]; [[Anemia in Adults|supplement]]
* [[Media:IV Iron.pdf|Iron Infusion for Chronic Iron-Deficiency Anemia (Adult and Pediatrics)]]; [[IV Iron|supplement]]

==Infectious Disease==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Botulism.pdf|Botulism]]; [[Botulism|supplement]]
* [[Media:Bronchiectasis peds.pdf|Bronchiectasis/Chronic Cough (<18 years)]]; [[Chronic Cough/Bronchiectasis – Pediatrics|supplement]]
* [[Media:Croup stridor.pdf|Croup/Stridor (6 months - 3 years)]]; [[Croup/Stridor: Evaluation & Treatment|supplement]]
* [[Media:Fever less than 90 days.pdf|Fever (0-90 days)]]; [[Fever – Infants 0-90 days|supplement]]
* [[Media:UnderimmFever.pdf|Fever in Underimmunized Children]]; [[Fever in Underimmunized Children|supplement]]
* [[Hepatitis C]]
* [[Media:Influenza.pdf|Influenza (Adult and Pediatric)]]; [[Influenza|supplement]]
* [[Media:Cervical lymphadenitis peds.pdf|Lymphadenitis, Acute Cervical (Pediatric)]]; [[Acute Cervical Lymphadenitis Evaluation & Treatment – Pediatrics|supplement]]
* [[Media:Dex in meningitis from ANMC.pdf|Meningitis: Use of Dexamethasone]]
* [[Media:MIS-C.pdf|Multisystem Inflammatory Syndrome (MIS-C)]]
* [[Media:AOM peds.pdf|Otitis Media, Acute (3 months - 12 years)]]; [[Otitis Media 3 months–12 years|supplement]]
* [[Media:Peritonsillar abscess guideline.pdf|Peritonsillar Abscess (Adult and Pediatric)]]; [[Peritonsillar Abscess|supplement]]
* [[Media:GAS Guideline.pdf|Pharyngitis (Adult and Pediatric) (Group A Strep)]]; [[Pharyngitis|supplement]]
* [[Media:Pneumonia adult.pdf|Pneumonia (Adult)]]; [[Pneumonia – Adult|supplement]]
* [[Media:Pneumonia peds.pdf|Pneumonia Treatment (3 months - 18 years)]]; [[Pneumonia – Pediatric More Than 3 Months|supplement]]
* [[Media:Pertussis.pdf|Pertussis]]; [[Pertussis|supplement]]
* [[Media:Rabies.pdf|Rabies Prevention]]; [[Rabies|supplement]]
* [[Media:STI guideline.pdf|Sexually Transmitted Infections (STI)]]; [[Sexually Transmitted Infections|supplement]]
* [[Media:Joint and bone infections.pdf|Suspected Septic Arthritis and Osteomyelitis]]
* [[Media:Sinusitis peds.pdf|Sinusitis (4-18 years)]]; [[Sinusitis More Than 5 Years|supplement]]
* [[Media:SSTI.pdf|Skin and Soft Tissue Infection (Adult and Pediatric)]]; [[Skin and Soft Tissue Infection|supplement]]
* [[Media:Active TB.pdf|Tuberculosis: Active Pulmonary (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:LTBI.pdf|Tuberculosis: Latent/LTBI (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Peds TB.pdf|Tuberculosis: Evaluation and Treatment (<14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Induced sputum peds.pdf|Tuberculosis: Induced Sputum Collection]]; [[Pediatric Induced Sputum Collection|supplement]]
* [[Media:UTI adult.pdf|Urinary Tract Infection (UTI in Adults)]]; [[UTI – Adult|supplement]]
* [[Media:UTI peds.pdf|Urinary Tract Infection (UTI from 3 months to 5 years)]]; [[UTI – Children 3 Months–5 Years|supplement]]
* [[Media:Varicella.pdf|Varicella (Chickenpox), Suspected]]; [[Varicella|supplement]]

==Neonatal/Pediatric Growth & Development==
* [[Media:PedsClinicAdmit.pdf|Admissions from Clinic (Pediatric Direct Admit)]]; [[Admissions from Clinic (Pediatric)|supplement]]
* [[Media:Caffeine Guideline.pdf|Caffeine Protocol, Post-NICU Discharge]]
* [[Media:FTT.pdf|Failure to Thrive in Children <24 Months]]
* [[Media:Hip infant.pdf|Hip Exam and Surveillance in Infants]]; [[Pediatric Hip Exam and Surveillance Protocol|supplement]]
* [[Media:Jaundice neonatal.pdf|Jaundice in a Baby <4 Weeks]]; [[Jaundice – Neonatal Evaluation & Treatment|supplement]]
* [[Media:Late preterm.pdf|Late Preterm and Low Birth Weight Newborns]]; [[Late Preterm|supplement]]
* [[Media:MPEWS flow.pdf|mPEWS Protocol for Pediatric Patients]]
* [[Media:Neonatal Abstinence Syndrome.pdf|Neonatal Abstinence Syndrome (NAS)]]; [[Neonatal Abstinence Syndrome|supplement]]<nowiki/>hiv
* [[Media:NCPAP.pdf|Neonatal Nasal CPAP Set-Up Guide]]
* [[Media:Newborn sepsis.pdf|Newborn Early Onset Sepsis/GBS]]; [[Newborn GBS & Infection Evaluation and Treatment|supplement]]
* [[Media:Glucose neonatal.pdf|Neonatal Glucose Screening]]; [[Neonatal Glucose Screening Evaluation and Treatment|supplement]]
* [[Media:Neonatal resuscitation summary.pdf|Neonatal Resuscitation Summary]]
* [[Media:NeoPuff set up.pdf|Neopuff™ Set-Up Guide]]
* [[Media:Surfactant Clinical Resource.pdf|Surfactant (Curosurf®) Administration Protocol]]; [[Curosurf Administration|supplement]]
* [[Media:HIEprotocolPAMC.pdf|Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy (HIE)- PAMC NICU Protocol]]
* [[Media:Village delivery (peds).pdf|Village Deliveries]]; [[Pediatric Village Delivery Orientation|supplement]]

==Obstetrics==
* [[Media:Anemia in pregnancy.pdf|Anemia in Pregnancy]]; [[Anemia in Pregnancy|supplement]]
* [[Media:Aneuploidy.pdf|Aneuploidy]]
* [[Media:Gestational diabetes.pdf|Diabetes, Gestational]]; [[Gestational Diabetes|supplement]]
* [[Media:Ectopic pregnancy.pdf|Ectopic Pregnancy Treatment]]; [[Ectopic Pregnancy – Treatment|supplement]]
* [[Media:First trimester vaginal bleeding.pdf|First Trimester Vaginal Bleeding]]; [[First Trimester Vaginal Bleeding: Ectopic Pregnancy Diagnosis & Treatment of Non-Viable Early Pregnancy|supplement]]
* [[Media:GBS maternal.pdf|Group B Streptococcus (GBS) Maternal]]; [[Group B Streptococcus (GBS) – Maternal|supplement]]
* [[Media:HIV prenatal screening and care.pdf|HIV Screening and Prenatal Care]]; [[HIV Prenatal Screening and Care|supplement]]
* [[Media:Chronic hypertension in pregnancy.pdf|Hypertension in Pregnancy, Chronic]]; [[Chronic Hypertension in Pregnancy|supplement]]
* [[Media:Gestational hypertension.pdf|Hypertension, Gestational]]; [[Gestational Hypertension|supplement]]
* [[Media:Severe HTN in pregnancy guideline.pdf|Hypertension in Pregnant and Postpartum Patients, Severe]]; [[Gestational Hypertension|supplement]]
* [[Media:Induction of labor.pdf|Induction of Labor]]; [[Induction of Labor|supplement]]
* [[Media:IHCP.pdf|Intrahepatic Cholestasis of Pregnancy (IHCP)]]; [[Intrahepatic Cholestatis of Pregnancy (IHCP)|supplement]]
* [[Media:IUGR.pdf|Intrauterine Growth Restriction (IUGR)]]; [[Intrauterine Growth Restriction (IUGR)|supplement]]
* [[Media:Village labor.pdf|Labor Patient in a Village]]; [[OB RMT#Labor in the Village|supplement]]
* [[Media:Molar pregnancy.pdf|Molar Pregnancy]]; [[Molar Pregnancy|supplement]]
* [[Media:Oligohydramnios.pdf|Oligohydramnios]]; [[Oligohydramnios|supplement]]
* [[Media:Post dates pregnancy.pdf|Post Dates Pregnancy]]; [[Post Dates Pregnancy|supplement]]
* [[Media:PPH.pdf|Postpartum Hemorrhage]]; [[Postpartum Hemorrhage (PPH)|supplement]]
* [[Media:Prenatal care.pdf|Prenatal Care]]; [[Prenatal Information|supplement]]
* [[Media:Preterm labor.pdf|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]]; [[Preterm Labor – Screening and Prevention|supplement]]
* [[Media:PPROM.pdf|Preterm Premature Rupture of Membranes (PPROM)]]; [[Preterm Premature Rupture of Membranes|supplement]]
* [[Media:Anti D immune globulin.pdf|Rhogam®]]; [[Anti-D Immune Globulin|supplement]]
* [[Media:TOLAC.pdf|Trial of Labor After Caesarian (TOLAC/VBAC)]]; [[Vaginal Birth After Cesarian|supplement]]

==Preventative Health Care & Outpatient Protocols==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Aspirin.pdf|Aspirin for Adults >40 without Known Cardiovascular Disease]]; [[Aspirin|supplement]]
* [[Media:Breast cancer screening.pdf|Breast Cancer Screening]]; [[Breast Cancer Screening|supplement]]
* [[Media:Cervical Cancer Screening.pdf|Cervical Cancer Screening with hrHPV]]; [[Cervical Cancer Screening|supplement]]
* [[Media:Colorectal Cancer Screening.pdf|Colorectal Cancer Screening]]; [[Colorectal Cancer Screening|supplement]]
* [[Media:Chronic pain.pdf|Chronic Pain Eligibility and Follow Up]]; [[:Category:Chronic Pain|supplement]]
* [[Media:Hyperlipidemia.pdf|Hyperlipidemia]]
* [[Media:Htn.pdf|Hypertension]]
* [[Media:Lead.pdf|Lead Evaluation (Pediatric)]]; [[Lead Evaluation – Pediatrics|supplement]]
* [[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]; [[Nirsevimab|supplement]]
* [[Media:Osteoporosis Screening and Treatment.pdf|Osteoporosis Screening and Treatment]]; [[Osteoporosis|supplement]]
* [[Media:Pre anesthesia management.pdf|Pre-Anesthesia Testing]]; [[Pre-Anesthesia Testing|supplement]]
* [[Media:NICU grad checklist.pdf|Primary Care for Ex-Premies - Checklist]]
* [[Media:Primary prevention CVD.pdf|Primary Prevention of Cardiovascular Disease]]
* [[Media:Return to sports guideline.pdf|Sports Clearance for Pediatric Patients with History of COVID-19 (return to play after COVID)]]; [[Sports Clearance for Pediatric Patients with History of COVID-19|supplement]]
* [[Media:Wound care supplies.pdf|Wound Care Supplies]]

==Psychiatry==
* [[Media:Alcohol hangover withdrawal.pdf|Alcohol Hangover/Withdrawal]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:ADHD.pdf|Attention Deficit Hyperactivity Disorder (Pediatrics)]]; [[Attention Deficit Hyperactivity Disorder in Children|supplement]]
* [[Media:Escalating patients.pdf|Care of an Agitated/Aggressive/Escalating Patient on Inpatient or DES]]; [[Escalating Patients|supplement]]
* [[Media:Intoxicated ED patient.pdf|Intoxicated Patient]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:Title 47.pdf|Involuntary Psychiatric Admissions (Title 47)]]; [[Title 47 Hold|supplement]]
* [[Media:Psychiatricadmission.pdf|Psychiatric Admissions (General)]]

==Documentation==
* [[Media:Checklist for care conferences.pdf|Care Conference Checklist]]
* [[Media:DME documentation requirements.pdf|DME Documentation Requirements]]
* [[Media:Incontinence documentation requirements.pdf|Incontinence Supplies Documentation Requirements]]
* [[Media:Nutritional supplement documentation requirements.pdf|Nutritional Supplements Documentation Requirements]]

File:Clinical Resource Book.pdf

2026-02-03T01:43:12Z

LiamG: LiamG uploaded a new version of File:Clinical Resource Book.pdf

File:Peds TB.pdf

2026-02-03T01:42:36Z

LiamG: LiamG uploaded a new version of File:Peds TB.pdf

File:Suspected pediatric child abuse.pdf

2026-02-03T01:42:00Z

LiamG: LiamG uploaded a new version of File:Suspected pediatric child abuse.pdf

File:Nutritional supplement documentation requirements.pdf

2026-02-03T01:41:29Z

LiamG: LiamG uploaded a new version of File:Nutritional supplement documentation requirements.pdf

File:Late preterm.pdf

2026-02-03T01:41:07Z

LiamG: LiamG uploaded a new version of File:Late preterm.pdf

File:Joint and bone infections.pdf

2026-02-03T01:40:38Z

LiamG: LiamG uploaded a new version of File:Joint and bone infections.pdf

File:Dex in meningitis from ANMC.pdf

2026-02-03T01:40:02Z

LiamG: LiamG uploaded a new version of File:Dex in meningitis from ANMC.pdf

File:CSID.pdf

2026-02-03T01:39:26Z

LiamG: LiamG uploaded a new version of File:CSID.pdf

File:Use of Consultants.pdf

2026-02-03T01:38:43Z

LiamG: LiamG uploaded a new version of File:Use of Consultants.pdf

File:Caffeine Guideline.pdf

2026-02-03T01:38:14Z

LiamG: LiamG uploaded a new version of File:Caffeine Guideline.pdf

File:Amoxicillin allergy trials.pdf

2026-02-03T01:37:42Z

LiamG: LiamG uploaded a new version of File:Amoxicillin allergy trials.pdf

File:Endocrine emergencies.pdf

2026-02-03T01:23:06Z

LiamG: LiamG uploaded a new version of File:Endocrine emergencies.pdf

== Summary ==
Peds endocrine emergencies document

File:Pediatric non-emergency endocrine recommendations.pdf

2026-02-03T01:22:51Z

LiamG: LiamG uploaded a new version of File:Pediatric non-emergency endocrine recommendations.pdf

HROB Stickers--Problems/Plans

2026-01-29T03:27:45Z

LiamG:

Last updated 1/21/2026

'''2 VESSEL UMBILICAL CORD'''

''' ''' See Guideline for '''Management of isolated soft ultrasound markers for aneuploidy in the second trimester'''

'''ADRENO-GENITAL SYNDROME, previous child and same FOB'''

 At 10 weeks, draw MaternaT 21 to determine fetal sex.

 When results of MaternaT 21 are complete, send Maternal Fetal Medicine/Perinatology referral for a plan of management.

 DO NOT start high dose dexamethasone.

'''ADVANCE MATERNAL AGE, age 35-39'''

 Recommend MaternaT 21 at 10-12 weeks before the patient’s appointment in Anchorage at 20 weeks

 Offer 2nd trimester MSAFP screen

 Recommend referral to Maternal Fetal Medicine/Perinatology for DAFUS and Genetic Counseling.

'''ADVANCE MATERNAL AGE, age 40 plus'''

 Recommend MaternaT 21 at 10-12 weeks before the patient’s appointment in Anchorage at 20 weeks

 Offer 2nd trimester MSAFP screen

 Recommend referral to Maternal Fetal Medicine/Perinatology for DAFUS and Genetic Counseling.

 NST-AFI weekly starting at 36 weeks

 Recommend delivery by EDD

'''ALLERGY TO PENICILLIN'''

''' ''' If GBS positive, GBS culture will automatically reflex in lab for sensitivity to clindamycin and erythromycin.

'''AMNIOTIC BAND'''

''' ''' Refer to Maternal Fetal Medicine/Perinatology

'''ANEMIA, Hg <11'''

 Follow Anemia in pregnancy guideline

'''ASYMPTOMATIC BACTURIA'''

 Test of cure (TOC) at next appointment

 Urine culture every visit

 Treat any level of bacteriuria

'''cardiac anomalies in fetus, current pregnancy'''

 If suspected anomaly found during screening ultrasound in Bethel, contact Maternal Fetal Medicine/Perinatology for a plan of care.

 Document plan of care in patient note and problem list

 Return to HROB meeting after the ANMC visit to discuss and plan for subsequent care.

'''Chronic Hepatitis B Virus (HBV) Infection'''

''' ''' HbsAg positive

 Draw LFTs, HB core IgM, HBeAg, HBeAb, HBsAb, HB DNA PCR

 If HBV DNA detected with a specific titer over 10IU, refer to Hepatology for possible anti-viral therapy.

 If HBV DNA not detected or detected <10IU, do not sent referral.

 '''ALL neonates born to mother with a positive HBsAg WILL receive HBIG and HBV vaccine at birth with parental consent.'''

'''CHRONIC HYPERTENSION'''

 Consult HROB or OB/GYN at 1st prenatal visit or at diagnosis

 Baseline testing: Urine protein/creatinine ratio, comprehensive metabolic panel.

 Consider EKG/Echocardiogram if longstanding hypertension or multiple medications. HROB meeting will decide if these are necessary.

 Consider Stopping medication and rechecking blood pressure in 1 week.

 Change Medication to labetalol or amlodipine

 Aspirin 162mg daily from 12 weeks until delivery

 Ultrasound for growth weeks 24, 28, 32, 36

 Start antenatal testing at 34 weeks, BPP weekly

 Consult obstetrician at 37 weeks for delivery plan.

 Repeat labs for suspected superimposed Preeclampsia, if found, contact HROB or OB/GYN for plan of care. Discuss at every prenatal visit with HROB or OB/GYN.

'''CONGENITAL ADRENAL HYPERPLASIA, previous child'''

''' ''' At 10 weeks, draw MaternaT 21 to determine fetal sex.

 When results of MaternaT 21 are complete, send MFM referral for a plan of management.

 DO NOT start high dose dexamethasone.

'''DIABETES, PRE-PREGNANCY'''

 Aspirin 162mg daily from 12 weeks until delivery

 Consult Obstetrician for medication

 Recommend insulin starting with NPH.

 Baseline testing: Protein/creatinine ratio, comprehensive metabolic panel, TSH.

 Consider EKG/Echocardiogram if longstanding disease, severe/brittle disease or co-morbid conditions. HROB meeting will decide if these are necessary.

 Optometry referral

 Recommend 1st Trimester screening for aneuploidy, using MaternaT 21

 Refer to Maternal Fetal Medicine/Perinatology for DAFUS, Fetal Echo and consultation

 Transfer of Care to Anchorage depends on patient adherence to plan of care and glucose control. Could be any time from 30 weeks to 35 weeks.

'''DILATED FETAL RENAL PELVIS (UTD)'''

 See Guideline for '''Management of isolated soft ultrasound markers for aneuploidy in the second trimester'''

'''ELEVATED MSAFP'''

 Verify information sent to LabCorp for calculating results

 Obtain ultrasound for dating if not already done.

 Resubmit for recalculation if necessary

 If AFP MOM <3.0, repeat AFP. If MOM still >2.5, or initial result is >3.0, refer to Maternal Fetal Medicine/Perinatology for DAFUS and genetic counseling.

 In third trimester, watch for: IUGR, preeclampsia, preterm labor, vaginal bleeding. Consult HROB or OB/GYN if these occur.

 Ultrasound at 32 weeks or as directed by the Maternal Fetal Medicine/Perinatology

'''FETAL GROWTH RESTRICTION, Suspected'''

''' ''' Obtain an ultrasound for fetal Growth

 If US shows EFW<10%,

 Obtain cord Doppler

 Send images to Maternal Fetal Medicine/Perinatology

 Follow recommended plan of care from Maternal Fetal Medicine/Perinatology

 If ultrasound shows EFW>10%, contact HROB or OB/GYN for plan of management.

'''GENITAL HERPES'''

 Inspection of vulva and vagina at 36 weeks and in labor

 Encourage valacyclovir 500mg BID for prophylaxis at Be in Bethel visit or 4 weeks before planned delivery

'''Gestational Diabetes'''

 Goal: Fasting <95, 2 hour postprandial <120 or 1 hour postprandial <140

 Close monitoring until controlled (weekly visits or contact).

 Weekly discussion between monitoring provider and diabetes department

 Growth US at 36 weeks

 If poor control (>25% of values above goal)

 consider medical therapy (insulin(preferred) or oral medication)

 stay in Bethel after 32 weeks

 If the patient is not providing data through finger stick glucose monitoring, offer Continuous glucose monitor.

 If the patient is not providing adequate data from any method of testing, transfer to Anchorage at 35 weeks or sooner.



'''GESTATIONAL DIABETES, POOR CONTROL'''

''' ''' Consult HROB or OB/GYN at every visit for patients in poor control (>25% of values above goal) to update the plan of care.

''' ''' Transfer to Anchorage at 32 weeks

'''GESTATIONAL DIABETES, ON MEDICATION'''

 Insulin is preferred medication. Only use oral medication if the patient refuses insulin.

 Goal: Fasting <95, 2 hour postprandial <120 or 1 hour postprandial <140

 Close monitoring (weekly visits or contact).

 At least weekly discussion between reviewing provider, diabetes department and Maternal Fetal Medicine/Perinatology as needed.

 Adjust medication at least weekly until goal achieved.

 Weekly BPP after 32 weeks. (stay in Bethel)

 Transfer to Anchorage at 32-35 weeks depending on patient participation with the plan of care and glucose control.

'''GESTATIONAL HYPERTENSION/PREECLAMPSIA in current pregnancy'''

''' ''' Prenatal visits twice a week

 Weekly Labs CBC, CMP, protein/Creatinine ratio. 24-hour urine as recommended by HROB or OB/GYN physician.

 NST 2x/week, AFI weekly

 US OB follow-up for growth every 3 weeks

 If Growth restriction suspected, contact HROB or OB/GYN for a plan.

 Consult with HROB or OB/GYN at EVERY VISIT

 Place order refer to OB Induction for delivery at 37 weeks. Place this order as soon as possible but at lease 1 week in advance of the induction date. If the induction needs to happen in less than 1 week, contact the OB charge nurse and the inpatient physician to coordinate the induction.

'''Gestational pruritus'''

 Do not start Ursodiol

 Repeat Bile Acids and LFT every 1-2 weeks.

'''GESTATIONAL PRURITUS WITH LAB ABNORMALITIES OR SEVERE PRURITUS'''

 Lab abnormalities: Cholic acid > 3.0, elevated AST, ALT, bilirubin or alkaline phosphatase > 300.

 Severe itching is excoriations, scratching during appointment, itching that alters sleep

 Start ursodiol 600mg po BID. Treat as Cholestasis.

 NST weekly after 32 weeks.

 Induce at 39 weeks.



'''GRAND MULTIPARA (5 or more deliveries)'''

 Active management of 3rd Stage recommended

 Discuss Birth Control Plans at 36 weeks

 Sign Sterilization consent at 20 week visit, if considering sterilization

'''GROUP B STREP BACTERIURIA in current pregnancy'''

''' Any''' level of GBS in the urine at any time of the pregnancy initiates this plan

 '''Do not''' do screen with vaginal/rectal swab at 36 weeks.

 Begin prophylaxis in labor per guideline.

'''GROUP B STEP, PREVIOUS BABY WITH INVASIVE DISEASE'''

 Screen for bacteriuria per the routine.

 '''Do Not''' screen with vaginal/rectal swab at 36 weeks.

 Begin prophylaxis in labor per guideline.

'''GROUP B STEP, PREVIOUS PREGNANCY WITH POSITIVE CULTURE AT TERM, BUT NO NEONATAL INFECTION'''

''' ''' No treatment is indicated

 Screen at 36 weeks per routine protocol

'''HBsAg POSITIVE, NEW FINDING'''

 Draw LFTs, HB core IgM, HBeAg, HBeAb, HBsAb, HB DNA PCR

 Refer to ANMC hepatology

'''HIGH RISK FOR PRETERM BIRTH'''

 Reason:

 Discuss with OB/GYN as soon as possible after the 1st prenatal visit.

If recommended, start progesterone 200mg per vagina qhs 16 – 36 weeks

 Urine culture every visit

 Serial cervical length every 2 weeks from 16- 24 weeks

 If cervical length less than 30mm, see sticker for short cervix of the “Guideline Preterm Labor: Screening and Prevention”

 Treat BV if symptomatic (screening for BV is not indicated)

'''HISTORY OF DEPRESSION/POST PARTUM DEPRESSION'''

 Screen every visit for depression

 Contact ACT or Behavioral Health for score >9

 Consider SSRI postpartum

'''HISTORY OF DOMESTIC VIOLENCE'''

 Discuss at every visit.

 Monitor for signs or symptoms of abuse

 Offer counseling or referral for services.

'''HISTORY OF INTRAHEPATIC CHOLESTATIS'''

 Draw baseline total bile acids and liver enzymes at first visit

 Monitor for symptoms at every visit

 If severe clinical symptoms, redraw labs above and begin Ursodiol 600 mg BID.

 See guideline

'''HISTORY OF IUGR OR SMALL FOR GESTATIONAL AGE (SGA) <20% FETUS'''

''' ''' Growth scans at 24, 28, 32 and 36 weeks

'''HISTORY OF A LARGE FOR GESTATIONAL AGE (LGA) >90% FETUS OR >4000GM'''

 Screen for Gestational Diabetes per protocol

 Ultrasound at 36 weeks for growth

'''HISTORY OF MOLAR PREGNANCY'''

''' ''' Make sure first trimester US has history of Molar pregnancy as a diagnosis

 Review the US with HROB physician

 Refer patient to HROB meeting

 Send Placenta for pathology after delivery.

'''HISTORY OF POSTPARTUM HEMORRHAGE'''

 Second IV in labor

 Standard: T&S in labor and assessment for risk of postpartum hemorrhage

 Active Management of 3rd stage of labor

 If PPH risk score is 3 prior to induction of labor, transfer care to Anchorage prior to induction. Contact OB unit to help with calculating the score if needed.

'''HISTORY OF GESTATIONAL HYPERTENSION/PREECLAMPSIA with or without SEVERE FEATURES/ECLAMPSIA'''

 Aspirin 162mg daily from 12 until delivery.

 Baseline labs: Protein/Creatinine ratio, CBC, CMP.

 Monitor for signs or symptoms of preeclampsia and repeat labs as needed

'''HISTORY OF SEIZURE DISORDER'''

 Begin Folic Acid 4mg daily ASAP

 Draw Drug level for current medication

 Consult HROB or OB/GYN for possible medication change

 Detailed Anatomic Fetal Ultrasound(DAFUS) at 18-22 weeks in Anchorage

 Monitor symptoms and drug levels as needed

 Monitor drug levels Postpartum as physiology changes

 Consider adding vitamin K 10mg daily from 36 weeks to delivery

 Do not give Tdap vaccine.

'''HISTORY OF SHOULDER DYSTOCIA'''

 US for growth at 36 weeks.

 Transfer to ANMC at 36 weeks for delivery.

'''HISTORY OF SKELETAL DYSPLASIA OR DWARFISM'''

 If this occurs in any pregnancy, refer for genetic counseling.

 If counseling states there is a recurrence risk, refer to ANMC Maternal Fetal Medicine/Perinatology at 1st Prenatal Visit.

 Refer all patients for DAFUS and Maternal Fetal Medicine/Perinatology consultation

 Follow plan from ANMC Maternal Fetal Medicine/Perinatology note

'''HISTORY OF SUBSTANCE ABUSE'''

 Discuss at EVERY visit

 Monitor for signs or symptoms of abuse

 Behavioral Health referral

 If opioid, refer to Suboxone clinician

'''HISTORY OF STILLBIRTH'''

''' ''' At first prenatal, attempt to locate the post stillbirth workup in the chart and document the results in your note for HROB conference.

 Add Bile Acids and LFT to the 1st OB visit labs.

 Ultrasound for growth at 24, 28, 32 and 36 weeks.

 Visits every 2 weeks in Bethel after 28 weeks.

 Fetal Kick counts after 28 weeks

 Further planning after HROB meeting based on other diagnoses and risk factors. See ACOG Obstetric Care Consensus Number 10 (2020) Management of Stillbirth

 BPP weekly after 32 weeks.

 Offer induction at 38 weeks.

'''HIV disease NEW'''

''' See Guideline'''

 Contact EIS (907-7292907 or Tiger Text role “ANMC Discharge Scheduler HIV/EIS Clinic”) ASAP for notification and/or medication start

 Get initial HIV labs based on recommendations from EIS

 Follow HIV in pregnancy Guideline

 CD4 count and viral load at 24 and 36 weeks

 Refer to Maternal Fetal Medicine/Perinatology

 See guideline for decision of where to deliver

'''HIV disease previously known'''

''' See Guideline'''

 Continue HAART

 Contact EIS (907-7292907 or Tiger Text role “ANMC Discharge Scheduler HIV/EIS Clinic”) for notification and/or medication change

 CD4 count and viral load at first prenatal, 24 and 36 weeks

 Refer to Maternal Fetal Medicine/Perinatology

 See guideline for decision where to deliver

'''HYPERTHYROID prior to pregnancy'''

''' ''' Discuss with HROB or OB/GYN at first visit.

 Draw TSH, Free T4 at first visit and at least each Trimester.

 Redraw TSH and Free T4 4-6 weeks after a dosage change.

 Contact Maternal Fetal Medicine/Perinatology to determine need to change Methimazole, to PTU for first trimester or stop all medications.

 If on PTU, continue at present dose.

 Monitor for signs and symptoms of hyperthyroid disease at every visit. (goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

'''HYPERTHYROID new diagnosis'''

''' ''' Discuss with HROB or OB/GYN at diagnosis or if severe disease suspected.

 Draw TSH, Free T4 at first visit and at least each Trimester.

 Redraw TSH and Free T4 4-6 weeks after a dosage change.

 Observe carefully for signs and symptoms of Thyroid storm. (severe hypertension, goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

 If tachycardic, start Atenolol 25mg daily

 Begin PTU at 50mg po TID, draw labs weekly until stable.

 Monitor for signs and symptoms of hyperthyroid disease at every visit. (goiter, tremor, palpitations, anxiety, weight loss despite a normal or increased appetite, increased frequency of bowel movements, and shortness of breath)

'''HYPOTHYROID prior to pregnancy'''

 Order TSH, Free T4

 Do not treat subclinical disease

 If previous thyroidectomy or ablation, increase levothyroxine dose by 25% in first trimester and measure TSH and Free T4 every 4-6 weeks until results are stable.

 For all others, measure TSH, Free T4 each trimester.

'''HYPOTHYROID new diagnosis'''

 Begin levothyroxine ASAP at 100mcg daily

 Check TSH Free T4 monthly until labs normalized

 Check TSH Free T4 every trimester thereafter

 Re-evaluate postpartum

'''INTRAHEPATIC CHOLESTASIS (IHCP) – Severe itching and abnormal Labs'''

 Start ursodiol 600 mg BID. You may increase dose up to 900mg TID for continued severe pruritus.

 Start weekly BPP at 32 weeks

 Redraw Total Bile Acids (TBA) and LFTs weekly after 32 weeks

 May return home with weekly visits

 Consult HROB meeting or OB/GYN

 Correct TBA by subtracting the urodeoxycholic acid (ursodiol) from the TBA on the results.

 Severe IHCP if corrected TBA >40, must be induced at 37 weeks.

 If corrected TBA > 100, induce at 35-36 weeks in Anchorage.

 Mild IHCP, TBA < 40, induce at 38 weeks.

'''IUGR see Fetal Growth Restriction'''

'''LTBI'''

''' ''' If prior tuberculosis diagnosis with completed treatment, diagnosis of LTBI.

 No PPD or Quantiferon

 Ask about symptoms: hemoptysis, fever, night sweats, weight loss, or cough.

 If all symptoms are negative, no reactivation of TB and no treatment or diagnostic testing needed.

'''MIGRAINE HEADACHES'''

''' ''' Discontinue triptan medication

 Low dose tricyclics OK after 1st trimester

 Tylenol.

 If above fails, refer to Neurology.

 Avoid opiates.

'''OBESITY'''

 If BMI >40, refer to HROB meeting for consultation.

 If BMI >40 and patient 36 weeks gestation or later, Consult HROB on call and on call CRNA on call for consultation regarding suitability for delivery in Bethel.

 For all women with BMI> 35, obtain US for growth at 28, 32 and 36 weeks and start BPP weekly at 32 weeks.

'''POSITIVE ANTIBODY SCREEN'''

 Confirm antibody identification.

 If antibody is Kell, Duffy (Fy), c, C, D, e or E, contact OB/GYN or discuss at HROB ASAP

 Any other antibody, contact OB/GYN for plan of management. Obtain Unity cell free DNA screening for T21, T18, T13, sex chromosomes and the antigen identified above (Kell, Duffy (Fy), c, C, D, e or E). The testing kits are available at the Team Room C nursing station.

 If fetal antigen testing is negative, no further testing is needed.

 If fetal antigen testing is positive, refer to Maternal Fetal Medicine/Perinatology for plan of care to monitor for isoimmunization.

 Contact the blood bank at 32 weeks to discuss the availability of antigen negative blood at the delivery.

'''POSITIVE HIV SCREEN'''

 Confirm HIV status with reflex testing.

 Once HIV disease confirmed, see HIV Disease, New

'''PLACENTAL ABNORMALITIES'''

LOW LYING: <2.5cm from internal os of the cervix

 Repeat transvaginal ultrasound monthly until resolved.

 If not resolved by 32 weeks, consult Maternal Fetal Medicine/Perinatology for further plan of management

CIRCUMVALLATE

 At risk for growth restriction. Growth US at 32 weeks to assess for growth restriction.

SUCCENTURATE LOBE

 Make sure ultrasound has screened for vasa previa

 At delivery, ensure entire placenta is removed during 3rd stage.

VELAMENTOUS CORD INSERTION

''' ''' At risk for growth restriction. Growth US at 32 weeks to assess for growth restriction.

'''PLACENTA PREVIA'''

''' ''' Placenta previa diagnosed at second trimester ultrasound

 Repeat ultrasound at 24 weeks.

 If still a previa,

 Pelvic rest: no sex, no exams

 Transfer to Anchorage until previa resolves.

 Before 24 weeks, no need to change activity unless actively bleeding

'''PREDIABETES'''

 Refer patient to Diabetes and prescribe supplies for finger stick testing

 Review testing results weekly at HROB rounds with diabetes team

 Screen for GDM as per routine care

'''PREVIOUS CESAREAN'''

 If considering repeat cesarean in Bethel, appointment with OB/GYN ASAP

 Refer to HROB meeting for discussion

 Repeat Cesareans done in Bethel unless there is a medical reason for the transfer.

 Document patient’s choice of location and route of delivery, in note and as comment in diagnosis.

 Provide trial of labor after cesarean (TOLAC) education and first prenatal visit.

 Complete TOLAC consent ASAP

'''Rh negative'''

 See Guideline.

 Repeat Type and Screen with Rhogam work up at 28 weeks.

 If RH negative, Give Rhogam at 28 weeks.

 At delivery, follow OB guideline for Rh negative patients.

'''RUBELLA NON-IMMUNE'''

''' ''' Repeat MMR vaccine postpartum if the patient has fewer than 3 lifetime MMR vaccines

'''SHORT CERVIX ON SCREENING'''

''' History of Preterm Birth'''

 Cervical length less than 25mm

 Consult with Maternal Fetal Medicine/Perinatology physician to discuss cerclage

 Cervical length 26 to 29mm

 Weekly cervical length ultrasound

 Cervical length 30mm, continue every other week cervical length measurements until 24 weeks.

 '''No History of Preterm Birth'''

''' ''' Cervical length 20mm or less

 Vaginal progesterone 200mg qhs

 Repeat cervical length in 1-2 weeks

 Cervical length 10mm or less

 Consult Maternal Fetal Medicine/Perinatology for possible cerclage

'''SUBOXONE TREATMENT'''

 Make appointments with Dr Compton or another MAT/Women’s Health (WH) provider

 UDS as needed (does not need to be every week), Tramadol and/or gabapentin levels depending on patient’s drug use history

 Transfer to Anchorage at 36 weeks or sooner for delivery

'''TWIN GESTATION (Diamniotic-Dichorionic)'''

 Add Folic Acid 1mg daily

 Aspirin 162mg daily from 12 weeks until delivery

'''18 Weeks ANMC'''

 TV ultrasound for cervical length

 Early DAFUS,

 Counseling

'''22 Weeks ANMC'''

''' ''' Full DAFUS

'''24 Weeks YKHC'''

 Prenatal visit

 1 hr. GST, CBC

'''26 Weeks YKHC'''

 Prenatal visit

 Ultrasound for fetal growth and TV ultrasound for cervical length

'''28 Weeks YKHC'''

''' ''' Prenatal visit

'''30 Weeks YKHC'''

''' ''' Prenatal visit

 Ultrasound for fetal growth and TV ultrasound for cervical length

 ** BE IN BETHEL due to high risk pregnancy **

'''31 Weeks YKHC'''

 Prenatal visit

'''32 Weeks YKHC'''

''' ''' ** Transfer to ANMC until delivery**

'''TWIN GESTATION MONOAMNIOTIC-DICHORIONIC OR MONOAMNIOTIC-MONOCHORIONIC'''

 Add Folic Acid 1mg daily

 Aspirin 162mg daily from 12 weeks until delivery

'''16 weeks –''' Appointment in Anchorage to evaluate for twin-twin transfusion syndrome

 All future appointments in Anchorage

'''UTERINE SHELF'''

''' ''' Repeat ultrasound in 4 weeks.

 These rarely are a problem

'''UTI IN PREGNANCY'''

 Urine Culture every visit

 Prophylaxis after 2nd UTI or 1st pyelonephritis: recommend Nitrofurantoin 100mg po qhs.

'''TOLAC in Bethel, Planned'''

 Discuss Case at HROB meeting

 At BIB, provider will contact the HROB on call, blood bank lead, OB charge nurse.

 On admission in labor: Admitting physician will notify CRNA on call, HROB on call.

 Complete TOLAC Consent at earliest prenatal visit possible ''' '''

'''VITAMIN D DEFICIENCY'''

 SELECT ONLY ONE SENTENCE FOR NOTE

25-OH Vitamin D > 20ng/ml Continue cholecalciferol 1000 IU daily (standard for all patients)

 25-OH Vitamin D > 12ng/ml and <20ng/ml increase cholecalciferol to 3000 IU daily

 25-OH Vitamin D < 12ng/ml

 If < 32 weeks, increase cholecalciferol to 3000 IU daily

 If > 32 weeks give ergocalciferol 50,000 IU weekly for 12 weeks.

[[:category:Women's Health]]

File:YKHC Formulary.pdf

2026-01-29T01:28:43Z

LiamG: LiamG uploaded a new version of File:YKHC Formulary.pdf

YKHC Formulary, Hospital Formulary, formulary

File:SRC Formulary.pdf

2026-01-29T01:27:25Z

LiamG: LiamG uploaded a new version of File:SRC Formulary.pdf

SRC clinics formulary

File:Village Formulary.pdf

2026-01-29T01:26:15Z

LiamG: LiamG uploaded a new version of File:Village Formulary.pdf

Village Formulary, village clinics

File:Specialty Calendar.pdf

2025-12-19T19:01:01Z

LiamG: LiamG uploaded a new version of File:Specialty Calendar.pdf

Regularly updated schedule field clinics at YKHC

Category:YKHC Guidelines

2025-12-04T06:24:55Z

LiamG: /* Critical Care & Emergency Medicine */

<pre style="color: green">
If you are having difficulty finding a specific guideline, Please use Ctrl+F. "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. If you are in a document or in a web browser, pressing the Ctrl key + the F key will bring up a search box in the top right corner of the screen.
</pre>

'''LOCAL GUIDELINE COLLECTIONS'''
 [[Media:Clinical Resource Book.pdf|YKHC Clinical Guidelines (Clinical Resource Book)]]
 [https://anmc.org/medical-professionals/clinical-guidelines/ ANMC Clinical Guidelines]

'''CLINICAL GUIDELINES (Arranged by system)'''

==General==
* [[Media:Use of Consultants.pdf|Consultations]]; [[:Category:Consults#Internal (Bethel) Consult Services|supplement]]
* [[Media:Guideline guideline.pdf|Guideline Guideline]]
* [[Media:Orders change process.pdf|Process to Update the EHR to Match Guidelines]]

==Critical Care & Emergency Medicine==
* [[Media:Acetaminophen overdose.pdf|Acetaminophen Overdose (Adult and Pediatric)]]; [[Acetaminophen Overdose|supplement]]
* [[Media:MI.pdf|Acute Coronary Syndrome (ACS/MI)]]; [[Myocardial Infarction – Acute|supplement]]
* [[Media:Burns Guideline.pdf|Burns (Adult and Pediatric)]]; [[Burn Evaluation and Treatment|supplement]]
* [[Media:VillageCode.pdf|Cardiac Arrest in Village]]; [[Village Code|supplement]]
* [[Media:Stroke.pdf|Cerebrovascular Accident (Stroke)]]; [[Ischemic Stroke – Acute|supplement]]
* [[Media:Adult Critical Care Guide.pdf|Critical Care Medications Guide (Adult)]]; [[Adult Critical Care|supplement]]
* [[Media:Pediatric critical care guide.pdf|Critical Care Medications Guide (Weight-Based – Pediatric)]]
* [[Media:Death.pdf|Death Protocol]]; [[Death Protocol|supplement]]
* [[Media:Frostbite.pdf|Frostbite (Adult and Pediatric)]]; [[Frostbite|supplement]]
* [[Media:Head injury adult.pdf|Head Injury (Adult)]]
* [[Media:Head injury peds.pdf|Head Injury/Concussion (<18 years)]]; [[Head Injury / Concussion Under 18 Years|supplement]]
* [[Media:HFNC.pdf|High-Flow Nasal Cannula (HFNC) (Pediatric)]]; [[High-Flow Nasal Cannula (HFNC) — Pediatric|supplement]]
* [[Media:Hypothermia.pdf|Hypothermia]]; [[Hypothermia|supplement]]
* [[Media:Intubation adult and peds.pdf|Intubation (Adult and Pediatric)]]; [[Intubation – Adult and Peds|supplement]]
* [[Media:ET CO2.pdf|Intubated Pediatric Patients: ET CO2 Monitoring]]
* [[Media:MTP.pdf|Massive Transfusion Protocol (≥14 years)]]
* [[Media:Medevac village to Bethel.pdf|Medevac Activation: Village to YKHC]]; [[:Category:Medevacs and Transport#Village to Bethel Medevacs|supplement]]
* [[Media:Medevac Bethel to Anchorage.pdf|Medevac Activation: YKHC to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:MedevacTrauma.pdf|Medevac/Transfer Process for Trauma]]; [[Medevac for Trauma|supplement]]
* [[Media:Activating emergency military transport.pdf|Military Transport for Emergencies (RCC)]]; [[:Category:Medevacs and Transport|supplement]]
* [[Media:Peds medevac.pdf|Pediatric Medevacs: Bethel to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:Procedural Sedation.pdf|Procedural Sedation & Analgesia Outside the OR (PSAOOR)]]; [[Procedural Sedation|supplement]]
* [[Media:Respiratory distress.pdf|Respiratory Distress & Bronchiolitis Management (<5 years)]]; supplement
* [[Media:Seizure evaluation peds.pdf|Seizure Evaluation (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Sepsis adult.pdf|Sepsis (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis meds adult.pdf|Sepsis Medications (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis peds.pdf|Sepsis (Pediatric)]]; [[Sepsis – Pediatric|supplement]]
* [[Media:Spinal cord injury.pdf|Spinal Cord Injury Management]]
* [[Media:Status Tx Adult.pdf|Status Epilepticus Treatment (Adult)]]
* [[Media:Seizure treatment peds.pdf|Status Epilepticus Treatment (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Strangulation.pdf|Strangulation]]; [[Strangulation|supplement]]
* [[Media:Trauma outside Bethel.pdf|Trauma Outside Bethel]]
* [[Media:Villages without health aides.pdf|Villages without Health Aides]]

==Abuse/Assault==
* [[Media:Adult sexual assault.pdf|Sexual Assault (≥18 Years)]]; [[SART|supplement]]
* [[Media:Suspected pediatric child abuse.pdf|Suspected Physical Abuse Procedure (Pediatric)]]; [[SART|supplement]]
* [[Media:Suspected pediatric sexual abuse.pdf|Suspected Sexual Abuse Procedure (Pediatric)]]; [[SART|supplement]]

==Endocrine==
* [[Media:Type 2 diabetes.pdf|Diabetes, Type 2]]; [[Type 2 Diabetes|supplements]]
* [[Media:Endocrine links page.pdf|Pediatric Endocrine Protocols (DKA, Endocrine Emergencies, and Follow-Up)]]

==Gastrointestinal==
* [[Media:CSID.pdf|Congenital Sucrase-Isomaltase Deficiency Resource]]; [[Congenital Sucrase-Isomaltase Deficiency (CSID)|supplement]]
* [[Media:H pylori dyspepsia.pdf|Dyspepsia/H. pylori (Adult and Pediatric)]]; [[Dyspepsia – H. Pylori|supplement]]

==Hematologic==
* [[Media:AdultAnemia.pdf|Anemia in Adults]]; [[Anemia in Adults|supplement]]
* [[Media:IV Iron.pdf|Iron Infusion for Chronic Iron-Deficiency Anemia (Adult and Pediatrics)]]; [[IV Iron|supplement]]

==Infectious Disease==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Botulism.pdf|Botulism]]; [[Botulism|supplement]]
* [[Media:Bronchiectasis peds.pdf|Bronchiectasis/Chronic Cough (<18 years)]]; [[Chronic Cough/Bronchiectasis – Pediatrics|supplement]]
* [[Media:EUA Molnupiravir.pdf|COVID: Molnupiravir, Emergency Use]]
* [[Media:EUA Paxlovid.pdf|COVID: Paxlovid]]
* [[Media:Croup stridor.pdf|Croup/Stridor (6 months - 3 years)]]; [[Croup/Stridor: Evaluation & Treatment|supplement]]
* [[Media:Fever less than 90 days.pdf|Fever (0-90 days)]]; [[Fever – Infants 0-90 days|supplement]]
* [[Media:UnderimmFever.pdf|Fever in Underimmunized Children]]; [[Fever in Underimmunized Children|supplement]]
* [[Hepatitis C]]
* [[Media:Influenza.pdf|Influenza (Adult and Pediatric)]]; [[Influenza|supplement]]
* [[Media:Cervical lymphadenitis peds.pdf|Lymphadenitis, Acute Cervical (Pediatric)]]; [[Acute Cervical Lymphadenitis Evaluation & Treatment – Pediatrics|supplement]]
* [[Media:Dex in meningitis from ANMC.pdf|Meningitis: Use of Dexamethasone]]
* [[Media:MIS-C.pdf|Multisystem Inflammatory Syndrome (MIS-C)]]
* [[Media:AOM peds.pdf|Otitis Media, Acute (3 months - 12 years)]]; [[Otitis Media 3 months–12 years|supplement]]
* [[Media:Peritonsillar abscess guideline.pdf|Peritonsillar Abscess (Adult and Pediatric)]]; [[Peritonsillar Abscess|supplement]]
* [[Media:GAS Guideline.pdf|Pharyngitis (Adult and Pediatric) (Group A Strep)]]; [[Pharyngitis|supplement]]
* [[Media:Pneumonia adult.pdf|Pneumonia (Adult)]]; [[Pneumonia – Adult|supplement]]
* [[Media:Pneumonia peds.pdf|Pneumonia Treatment (3 months - 18 years)]]; [[Pneumonia – Pediatric More Than 3 Months|supplement]]
* [[Media:Pertussis.pdf|Pertussis]]; [[Pertussis|supplement]]
* [[Media:Rabies.pdf|Rabies Prevention]]; [[Rabies|supplement]]
* [[Media:STI guideline.pdf|Sexually Transmitted Infections (STI)]]; [[Sexually Transmitted Infections|supplement]]
* [[Media:Joint and bone infections.pdf|Suspected Septic Arthritis and Osteomyelitis]]
* [[Media:Sinusitis peds.pdf|Sinusitis (4-18 years)]]; [[Sinusitis More Than 5 Years|supplement]]
* [[Media:SSTI.pdf|Skin and Soft Tissue Infection (Adult and Pediatric)]]; [[Skin and Soft Tissue Infection|supplement]]
* [[Media:Active TB.pdf|Tuberculosis: Active Pulmonary (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:LTBI.pdf|Tuberculosis: Latent/LTBI (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Peds TB.pdf|Tuberculosis: Evaluation and Treatment (<14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Induced sputum peds.pdf|Tuberculosis: Induced Sputum Collection]]; [[Pediatric Induced Sputum Collection|supplement]]
* [[Media:UTI adult.pdf|Urinary Tract Infection (UTI in Adults)]]; [[UTI – Adult|supplement]]
* [[Media:UTI peds.pdf|Urinary Tract Infection (UTI from 3 months to 5 years)]]; [[UTI – Children 3 Months–5 Years|supplement]]
* [[Media:Varicella.pdf|Varicella (Chickenpox), Suspected]]; [[Varicella|supplement]]

==Neonatal/Pediatric Growth & Development==
* [[Media:PedsClinicAdmit.pdf|Admissions from Clinic (Pediatric Direct Admit)]]; [[Admissions from Clinic (Pediatric)|supplement]]
* [[Media:Caffeine Guideline.pdf|Caffeine Protocol, Post-NICU Discharge]]
* [[Media:FTT.pdf|Failure to Thrive in Children <24 Months]]
* [[Media:Hip infant.pdf|Hip Exam and Surveillance in Infants]]; [[Pediatric Hip Exam and Surveillance Protocol|supplement]]
* [[Media:Jaundice neonatal.pdf|Jaundice in a Baby <4 Weeks]]; [[Jaundice – Neonatal Evaluation & Treatment|supplement]]
* [[Media:Late preterm.pdf|Late Preterm and Low Birth Weight Newborns]]; [[Late Preterm|supplement]]
* [[Media:MPEWS flow.pdf|mPEWS Protocol for Pediatric Patients]]
* [[Media:Neonatal Abstinence Syndrome.pdf|Neonatal Abstinence Syndrome (NAS)]]; [[Neonatal Abstinence Syndrome|supplement]]<nowiki/>hiv
* [[Media:NCPAP.pdf|Neonatal Nasal CPAP Set-Up Guide]]
* [[Media:Newborn sepsis.pdf|Newborn Early Onset Sepsis/GBS]]; [[Newborn GBS & Infection Evaluation and Treatment|supplement]]
* [[Media:Glucose neonatal.pdf|Neonatal Glucose Screening]]; [[Neonatal Glucose Screening Evaluation and Treatment|supplement]]
* [[Media:Neonatal resuscitation summary.pdf|Neonatal Resuscitation Summary]]
* [[Media:NeoPuff set up.pdf|Neopuff™ Set-Up Guide]]
* [[Media:Surfactant Clinical Resource.pdf|Surfactant (Curosurf®) Administration Protocol]]; [[Curosurf Administration|supplement]]
* [[Media:HIEprotocolPAMC.pdf|Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy (HIE)- PAMC NICU Protocol]]
* [[Media:Village delivery (peds).pdf|Village Deliveries]]; [[Pediatric Village Delivery Orientation|supplement]]

==Obstetrics==
* [[Media:Anemia in pregnancy.pdf|Anemia in Pregnancy]]; [[Anemia in Pregnancy|supplement]]
* [[Media:Aneuploidy.pdf|Aneuploidy]]
* [[Media:Gestational diabetes.pdf|Diabetes, Gestational]]; [[Gestational Diabetes|supplement]]
* [[Media:Ectopic pregnancy.pdf|Ectopic Pregnancy Treatment]]; [[Ectopic Pregnancy – Treatment|supplement]]
* [[Media:First trimester vaginal bleeding.pdf|First Trimester Vaginal Bleeding]]; [[First Trimester Vaginal Bleeding: Ectopic Pregnancy Diagnosis & Treatment of Non-Viable Early Pregnancy|supplement]]
* [[Media:GBS maternal.pdf|Group B Streptococcus (GBS) Maternal]]; [[Group B Streptococcus (GBS) – Maternal|supplement]]
* [[Media:HIV prenatal screening and care.pdf|HIV Screening and Prenatal Care]]; [[HIV Prenatal Screening and Care|supplement]]
* [[Media:Chronic hypertension in pregnancy.pdf|Hypertension in Pregnancy, Chronic]]; [[Chronic Hypertension in Pregnancy|supplement]]
* [[Media:Gestational hypertension.pdf|Hypertension, Gestational]]; [[Gestational Hypertension|supplement]]
* [[Media:Severe HTN in pregnancy guideline.pdf|Hypertension in Pregnant and Postpartum Patients, Severe]]; [[Gestational Hypertension|supplement]]
* [[Media:Induction of labor.pdf|Induction of Labor]]; [[Induction of Labor|supplement]]
* [[Media:IHCP.pdf|Intrahepatic Cholestasis of Pregnancy (IHCP)]]; [[Intrahepatic Cholestatis of Pregnancy (IHCP)|supplement]]
* [[Media:IUGR.pdf|Intrauterine Growth Restriction (IUGR)]]; [[Intrauterine Growth Restriction (IUGR)|supplement]]
* [[Media:Village labor.pdf|Labor Patient in a Village]]; [[OB RMT#Labor in the Village|supplement]]
* [[Media:Molar pregnancy.pdf|Molar Pregnancy]]; [[Molar Pregnancy|supplement]]
* [[Media:Oligohydramnios.pdf|Oligohydramnios]]; [[Oligohydramnios|supplement]]
* [[Media:Post dates pregnancy.pdf|Post Dates Pregnancy]]; [[Post Dates Pregnancy|supplement]]
* [[Media:PPH.pdf|Postpartum Hemorrhage]]; [[Postpartum Hemorrhage (PPH)|supplement]]
* [[Media:Prenatal care.pdf|Prenatal Care]]; [[Prenatal Information|supplement]]
* [[Media:Preterm labor.pdf|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]]; [[Preterm Labor – Screening and Prevention|supplement]]
* [[Media:PPROM.pdf|Preterm Premature Rupture of Membranes (PPROM)]]; [[Preterm Premature Rupture of Membranes|supplement]]
* [[Media:Anti D immune globulin.pdf|Rhogam®]]; [[Anti-D Immune Globulin|supplement]]
* [[Media:TOLAC.pdf|Trial of Labor After Caesarian (TOLAC/VBAC)]]; [[Vaginal Birth After Cesarian|supplement]]

==Preventative Health Care & Outpatient Protocols==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Aspirin.pdf|Aspirin for Adults >40 without Known Cardiovascular Disease]]; [[Aspirin|supplement]]
* [[Media:Breast cancer screening.pdf|Breast Cancer Screening]]; [[Breast Cancer Screening|supplement]]
* [[Media:Cervical Cancer Screening.pdf|Cervical Cancer Screening with hrHPV]]; [[Cervical Cancer Screening|supplement]]
* [[Media:Colorectal Cancer Screening.pdf|Colorectal Cancer Screening]]; [[Colorectal Cancer Screening|supplement]]
* [[Media:Chronic pain.pdf|Chronic Pain Eligibility and Follow Up]]; [[:Category:Chronic Pain|supplement]]
* [[Media:Hyperlipidemia.pdf|Hyperlipidemia]]
* [[Media:Htn.pdf|Hypertension]]
* [[Media:Lead.pdf|Lead Evaluation (Pediatric)]]; [[Lead Evaluation – Pediatrics|supplement]]
* [[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]; [[Nirsevimab|supplement]]
* [[Media:Osteoporosis Screening and Treatment.pdf|Osteoporosis Screening and Treatment]]; [[Osteoporosis|supplement]]
* [[Media:Pre anesthesia management.pdf|Pre-Anesthesia Testing]]; [[Pre-Anesthesia Testing|supplement]]
* [[Media:NICU grad checklist.pdf|Primary Care for Ex-Premies - Checklist]]
* [[Media:Primary prevention CVD.pdf|Primary Prevention of Cardiovascular Disease]]
* [[Media:Return to sports guideline.pdf|Sports Clearance for Pediatric Patients with History of COVID-19 (return to play after COVID)]]; [[Sports Clearance for Pediatric Patients with History of COVID-19|supplement]]
* [[Media:Wound care supplies.pdf|Wound Care Supplies]]

==Psychiatry==
* [[Media:Alcohol hangover withdrawal.pdf|Alcohol Hangover/Withdrawal]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:ADHD.pdf|Attention Deficit Hyperactivity Disorder (Pediatrics)]]; [[Attention Deficit Hyperactivity Disorder in Children|supplement]]
* [[Media:Escalating patients.pdf|Care of an Agitated/Aggressive/Escalating Patient on Inpatient or DES]]; [[Escalating Patients|supplement]]
* [[Media:Intoxicated ED patient.pdf|Intoxicated Patient]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:Title 47.pdf|Involuntary Psychiatric Admissions (Title 47)]]; [[Title 47 Hold|supplement]]
* [[Media:Psychiatricadmission.pdf|Psychiatric Admissions (General)]]

==Documentation==
* [[Media:Checklist for care conferences.pdf|Care Conference Checklist]]
* [[Media:DME documentation requirements.pdf|DME Documentation Requirements]]
* [[Media:Incontinence documentation requirements.pdf|Incontinence Supplies Documentation Requirements]]
* [[Media:Nutritional supplement documentation requirements.pdf|Nutritional Supplements Documentation Requirements]]

Category:YKHC Guidelines

2025-11-18T22:40:47Z

LiamG: /* Abuse/Assault */

<pre style="color: green">
If you are having difficulty finding a specific guideline, Please use Ctrl+F. "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. If you are in a document or in a web browser, pressing the Ctrl key + the F key will bring up a search box in the top right corner of the screen.
</pre>

'''LOCAL GUIDELINE COLLECTIONS'''
 [[Media:Clinical Resource Book.pdf|YKHC Clinical Guidelines (Clinical Resource Book)]]
 [https://anmc.org/medical-professionals/clinical-guidelines/ ANMC Clinical Guidelines]

'''CLINICAL GUIDELINES (Arranged by system)'''

==General==
* [[Media:Use of Consultants.pdf|Consultations]]; [[:Category:Consults#Internal (Bethel) Consult Services|supplement]]
* [[Media:Guideline guideline.pdf|Guideline Guideline]]
* [[Media:Orders change process.pdf|Process to Update the EHR to Match Guidelines]]

==Critical Care & Emergency Medicine==
* [[Media:Acetaminophen overdose.pdf|Acetaminophen Overdose (Adult and Pediatric)]]; [[Acetaminophen Overdose|supplement]]
* [[Media:MI.pdf|Acute Coronary Syndrome (ACS/MI)]]; [[Myocardial Infarction – Acute|supplement]]
* [[Media:Burns Guideline.pdf|Burns (Adult and Pediatric)]]; [[Burn Evaluation and Treatment|supplement]]
* [[Media:VillageCode.pdf|Cardiac Arrest in Village]]; [[Village Code|supplement]]
* [[Media:Stroke.pdf|Cerebrovascular Accident]]; [[Ischemic Stroke – Acute|supplement]]
* [[Media:Adult Critical Care Guide.pdf|Critical Care Medications Guide (Adult)]]; [[Adult Critical Care|supplement]]
* [[Media:Pediatric critical care guide.pdf|Critical Care Medications Guide (Weight-Based – Pediatric)]]
* [[Media:Death.pdf|Death Protocol]]; [[Death Protocol|supplement]]
* [[Media:Frostbite.pdf|Frostbite (Adult and Pediatric)]]; [[Frostbite|supplement]]
* [[Media:Head injury adult.pdf|Head Injury (Adult)]]
* [[Media:Head injury peds.pdf|Head Injury/Concussion (<18 years)]]; [[Head Injury / Concussion Under 18 Years|supplement]]
* [[Media:HFNC.pdf|High-Flow Nasal Cannula (HFNC) (Pediatric)]]; [[High-Flow Nasal Cannula (HFNC) — Pediatric|supplement]]
* [[Media:Hypothermia.pdf|Hypothermia]]; [[Hypothermia|supplement]]
* [[Media:Intubation adult and peds.pdf|Intubation (Adult and Pediatric)]]; [[Intubation – Adult and Peds|supplement]]
* [[Media:ET CO2.pdf|Intubated Pediatric Patients: ET CO2 Monitoring]]
* [[Media:MTP.pdf|Massive Transfusion Protocol (≥14 years)]]
* [[Media:Medevac village to Bethel.pdf|Medevac Activation: Village to YKHC]]; [[:Category:Medevacs and Transport#Village to Bethel Medevacs|supplement]]
* [[Media:Medevac Bethel to Anchorage.pdf|Medevac Activation: YKHC to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:MedevacTrauma.pdf|Medevac/Transfer Process for Trauma]]; [[Medevac for Trauma|supplement]]
* [[Media:Activating emergency military transport.pdf|Military Transport for Emergencies (RCC)]]; [[:Category:Medevacs and Transport|supplement]]
* [[Media:Peds medevac.pdf|Pediatric Medevacs: Bethel to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:Procedural Sedation.pdf|Procedural Sedation & Analgesia Outside the OR (PSAOOR)]]; [[Procedural Sedation|supplement]]
* [[Media:Respiratory distress.pdf|Respiratory Distress & Bronchiolitis Management (<5 years)]]; supplement
* [[Media:Seizure evaluation peds.pdf|Seizure Evaluation (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Sepsis adult.pdf|Sepsis (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis meds adult.pdf|Sepsis Medications (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis peds.pdf|Sepsis (Pediatric)]]; [[Sepsis – Pediatric|supplement]]
* [[Media:Spinal cord injury.pdf|Spinal Cord Injury Management]]
* [[Media:Status Tx Adult.pdf|Status Epilepticus Treatment (Adult)]]
* [[Media:Seizure treatment peds.pdf|Status Epilepticus Treatment (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Strangulation.pdf|Strangulation]]; [[Strangulation|supplement]]
* [[Media:Trauma outside Bethel.pdf|Trauma Outside Bethel]]
* [[Media:Villages without health aides.pdf|Villages without Health Aides]]

==Abuse/Assault==
* [[Media:Adult sexual assault.pdf|Sexual Assault (≥18 Years)]]; [[SART|supplement]]
* [[Media:Suspected pediatric child abuse.pdf|Suspected Physical Abuse Procedure (Pediatric)]]; [[SART|supplement]]
* [[Media:Suspected pediatric sexual abuse.pdf|Suspected Sexual Abuse Procedure (Pediatric)]]; [[SART|supplement]]

==Endocrine==
* [[Media:Type 2 diabetes.pdf|Diabetes, Type 2]]; [[Type 2 Diabetes|supplements]]
* [[Media:Endocrine links page.pdf|Pediatric Endocrine Protocols (DKA, Endocrine Emergencies, and Follow-Up)]]

==Gastrointestinal==
* [[Media:CSID.pdf|Congenital Sucrase-Isomaltase Deficiency Resource]]; [[Congenital Sucrase-Isomaltase Deficiency (CSID)|supplement]]
* [[Media:H pylori dyspepsia.pdf|Dyspepsia/H. pylori (Adult and Pediatric)]]; [[Dyspepsia – H. Pylori|supplement]]

==Hematologic==
* [[Media:AdultAnemia.pdf|Anemia in Adults]]; [[Anemia in Adults|supplement]]
* [[Media:IV Iron.pdf|Iron Infusion for Chronic Iron-Deficiency Anemia (Adult and Pediatrics)]]; [[IV Iron|supplement]]

==Infectious Disease==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Botulism.pdf|Botulism]]; [[Botulism|supplement]]
* [[Media:Bronchiectasis peds.pdf|Bronchiectasis/Chronic Cough (<18 years)]]; [[Chronic Cough/Bronchiectasis – Pediatrics|supplement]]
* [[Media:EUA Molnupiravir.pdf|COVID: Molnupiravir, Emergency Use]]
* [[Media:EUA Paxlovid.pdf|COVID: Paxlovid]]
* [[Media:Croup stridor.pdf|Croup/Stridor (6 months - 3 years)]]; [[Croup/Stridor: Evaluation & Treatment|supplement]]
* [[Media:Fever less than 90 days.pdf|Fever (0-90 days)]]; [[Fever – Infants 0-90 days|supplement]]
* [[Media:UnderimmFever.pdf|Fever in Underimmunized Children]]; [[Fever in Underimmunized Children|supplement]]
* [[Hepatitis C]]
* [[Media:Influenza.pdf|Influenza (Adult and Pediatric)]]; [[Influenza|supplement]]
* [[Media:Cervical lymphadenitis peds.pdf|Lymphadenitis, Acute Cervical (Pediatric)]]; [[Acute Cervical Lymphadenitis Evaluation & Treatment – Pediatrics|supplement]]
* [[Media:Dex in meningitis from ANMC.pdf|Meningitis: Use of Dexamethasone]]
* [[Media:MIS-C.pdf|Multisystem Inflammatory Syndrome (MIS-C)]]
* [[Media:AOM peds.pdf|Otitis Media, Acute (3 months - 12 years)]]; [[Otitis Media 3 months–12 years|supplement]]
* [[Media:Peritonsillar abscess guideline.pdf|Peritonsillar Abscess (Adult and Pediatric)]]; [[Peritonsillar Abscess|supplement]]
* [[Media:GAS Guideline.pdf|Pharyngitis (Adult and Pediatric) (Group A Strep)]]; [[Pharyngitis|supplement]]
* [[Media:Pneumonia adult.pdf|Pneumonia (Adult)]]; [[Pneumonia – Adult|supplement]]
* [[Media:Pneumonia peds.pdf|Pneumonia Treatment (3 months - 18 years)]]; [[Pneumonia – Pediatric More Than 3 Months|supplement]]
* [[Media:Pertussis.pdf|Pertussis]]; [[Pertussis|supplement]]
* [[Media:Rabies.pdf|Rabies Prevention]]; [[Rabies|supplement]]
* [[Media:STI guideline.pdf|Sexually Transmitted Infections (STI)]]; [[Sexually Transmitted Infections|supplement]]
* [[Media:Joint and bone infections.pdf|Suspected Septic Arthritis and Osteomyelitis]]
* [[Media:Sinusitis peds.pdf|Sinusitis (4-18 years)]]; [[Sinusitis More Than 5 Years|supplement]]
* [[Media:SSTI.pdf|Skin and Soft Tissue Infection (Adult and Pediatric)]]; [[Skin and Soft Tissue Infection|supplement]]
* [[Media:Active TB.pdf|Tuberculosis: Active Pulmonary (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:LTBI.pdf|Tuberculosis: Latent/LTBI (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Peds TB.pdf|Tuberculosis: Evaluation and Treatment (<14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Induced sputum peds.pdf|Tuberculosis: Induced Sputum Collection]]; [[Pediatric Induced Sputum Collection|supplement]]
* [[Media:UTI adult.pdf|Urinary Tract Infection (UTI in Adults)]]; [[UTI – Adult|supplement]]
* [[Media:UTI peds.pdf|Urinary Tract Infection (UTI from 3 months to 5 years)]]; [[UTI – Children 3 Months–5 Years|supplement]]
* [[Media:Varicella.pdf|Varicella (Chickenpox), Suspected]]; [[Varicella|supplement]]

==Neonatal/Pediatric Growth & Development==
* [[Media:PedsClinicAdmit.pdf|Admissions from Clinic (Pediatric Direct Admit)]]; [[Admissions from Clinic (Pediatric)|supplement]]
* [[Media:Caffeine Guideline.pdf|Caffeine Protocol, Post-NICU Discharge]]
* [[Media:FTT.pdf|Failure to Thrive in Children <24 Months]]
* [[Media:Hip infant.pdf|Hip Exam and Surveillance in Infants]]; [[Pediatric Hip Exam and Surveillance Protocol|supplement]]
* [[Media:Jaundice neonatal.pdf|Jaundice in a Baby <4 Weeks]]; [[Jaundice – Neonatal Evaluation & Treatment|supplement]]
* [[Media:Late preterm.pdf|Late Preterm and Low Birth Weight Newborns]]; [[Late Preterm|supplement]]
* [[Media:MPEWS flow.pdf|mPEWS Protocol for Pediatric Patients]]
* [[Media:Neonatal Abstinence Syndrome.pdf|Neonatal Abstinence Syndrome (NAS)]]; [[Neonatal Abstinence Syndrome|supplement]]<nowiki/>hiv
* [[Media:NCPAP.pdf|Neonatal Nasal CPAP Set-Up Guide]]
* [[Media:Newborn sepsis.pdf|Newborn Early Onset Sepsis/GBS]]; [[Newborn GBS & Infection Evaluation and Treatment|supplement]]
* [[Media:Glucose neonatal.pdf|Neonatal Glucose Screening]]; [[Neonatal Glucose Screening Evaluation and Treatment|supplement]]
* [[Media:Neonatal resuscitation summary.pdf|Neonatal Resuscitation Summary]]
* [[Media:NeoPuff set up.pdf|Neopuff™ Set-Up Guide]]
* [[Media:Surfactant Clinical Resource.pdf|Surfactant (Curosurf®) Administration Protocol]]; [[Curosurf Administration|supplement]]
* [[Media:HIEprotocolPAMC.pdf|Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy (HIE)- PAMC NICU Protocol]]
* [[Media:Village delivery (peds).pdf|Village Deliveries]]; [[Pediatric Village Delivery Orientation|supplement]]

==Obstetrics==
* [[Media:Anemia in pregnancy.pdf|Anemia in Pregnancy]]; [[Anemia in Pregnancy|supplement]]
* [[Media:Aneuploidy.pdf|Aneuploidy]]
* [[Media:Gestational diabetes.pdf|Diabetes, Gestational]]; [[Gestational Diabetes|supplement]]
* [[Media:Ectopic pregnancy.pdf|Ectopic Pregnancy Treatment]]; [[Ectopic Pregnancy – Treatment|supplement]]
* [[Media:First trimester vaginal bleeding.pdf|First Trimester Vaginal Bleeding]]; [[First Trimester Vaginal Bleeding: Ectopic Pregnancy Diagnosis & Treatment of Non-Viable Early Pregnancy|supplement]]
* [[Media:GBS maternal.pdf|Group B Streptococcus (GBS) Maternal]]; [[Group B Streptococcus (GBS) – Maternal|supplement]]
* [[Media:HIV prenatal screening and care.pdf|HIV Screening and Prenatal Care]]; [[HIV Prenatal Screening and Care|supplement]]
* [[Media:Chronic hypertension in pregnancy.pdf|Hypertension in Pregnancy, Chronic]]; [[Chronic Hypertension in Pregnancy|supplement]]
* [[Media:Gestational hypertension.pdf|Hypertension, Gestational]]; [[Gestational Hypertension|supplement]]
* [[Media:Severe HTN in pregnancy guideline.pdf|Hypertension in Pregnant and Postpartum Patients, Severe]]; [[Gestational Hypertension|supplement]]
* [[Media:Induction of labor.pdf|Induction of Labor]]; [[Induction of Labor|supplement]]
* [[Media:IHCP.pdf|Intrahepatic Cholestasis of Pregnancy (IHCP)]]; [[Intrahepatic Cholestatis of Pregnancy (IHCP)|supplement]]
* [[Media:IUGR.pdf|Intrauterine Growth Restriction (IUGR)]]; [[Intrauterine Growth Restriction (IUGR)|supplement]]
* [[Media:Village labor.pdf|Labor Patient in a Village]]; [[OB RMT#Labor in the Village|supplement]]
* [[Media:Molar pregnancy.pdf|Molar Pregnancy]]; [[Molar Pregnancy|supplement]]
* [[Media:Oligohydramnios.pdf|Oligohydramnios]]; [[Oligohydramnios|supplement]]
* [[Media:Post dates pregnancy.pdf|Post Dates Pregnancy]]; [[Post Dates Pregnancy|supplement]]
* [[Media:PPH.pdf|Postpartum Hemorrhage]]; [[Postpartum Hemorrhage (PPH)|supplement]]
* [[Media:Prenatal care.pdf|Prenatal Care]]; [[Prenatal Information|supplement]]
* [[Media:Preterm labor.pdf|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]]; [[Preterm Labor – Screening and Prevention|supplement]]
* [[Media:PPROM.pdf|Preterm Premature Rupture of Membranes (PPROM)]]; [[Preterm Premature Rupture of Membranes|supplement]]
* [[Media:Anti D immune globulin.pdf|Rhogam®]]; [[Anti-D Immune Globulin|supplement]]
* [[Media:TOLAC.pdf|Trial of Labor After Caesarian (TOLAC/VBAC)]]; [[Vaginal Birth After Cesarian|supplement]]

==Preventative Health Care & Outpatient Protocols==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Aspirin.pdf|Aspirin for Adults >40 without Known Cardiovascular Disease]]; [[Aspirin|supplement]]
* [[Media:Breast cancer screening.pdf|Breast Cancer Screening]]; [[Breast Cancer Screening|supplement]]
* [[Media:Cervical Cancer Screening.pdf|Cervical Cancer Screening with hrHPV]]; [[Cervical Cancer Screening|supplement]]
* [[Media:Colorectal Cancer Screening.pdf|Colorectal Cancer Screening]]; [[Colorectal Cancer Screening|supplement]]
* [[Media:Chronic pain.pdf|Chronic Pain Eligibility and Follow Up]]; [[:Category:Chronic Pain|supplement]]
* [[Media:Hyperlipidemia.pdf|Hyperlipidemia]]
* [[Media:Htn.pdf|Hypertension]]
* [[Media:Lead.pdf|Lead Evaluation (Pediatric)]]; [[Lead Evaluation – Pediatrics|supplement]]
* [[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]; [[Nirsevimab|supplement]]
* [[Media:Osteoporosis Screening and Treatment.pdf|Osteoporosis Screening and Treatment]]; [[Osteoporosis|supplement]]
* [[Media:Pre anesthesia management.pdf|Pre-Anesthesia Testing]]; [[Pre-Anesthesia Testing|supplement]]
* [[Media:NICU grad checklist.pdf|Primary Care for Ex-Premies - Checklist]]
* [[Media:Primary prevention CVD.pdf|Primary Prevention of Cardiovascular Disease]]
* [[Media:Return to sports guideline.pdf|Sports Clearance for Pediatric Patients with History of COVID-19 (return to play after COVID)]]; [[Sports Clearance for Pediatric Patients with History of COVID-19|supplement]]
* [[Media:Wound care supplies.pdf|Wound Care Supplies]]

==Psychiatry==
* [[Media:Alcohol hangover withdrawal.pdf|Alcohol Hangover/Withdrawal]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:ADHD.pdf|Attention Deficit Hyperactivity Disorder (Pediatrics)]]; [[Attention Deficit Hyperactivity Disorder in Children|supplement]]
* [[Media:Escalating patients.pdf|Care of an Agitated/Aggressive/Escalating Patient on Inpatient or DES]]; [[Escalating Patients|supplement]]
* [[Media:Intoxicated ED patient.pdf|Intoxicated Patient]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:Title 47.pdf|Involuntary Psychiatric Admissions (Title 47)]]; [[Title 47 Hold|supplement]]
* [[Media:Psychiatricadmission.pdf|Psychiatric Admissions (General)]]

==Documentation==
* [[Media:Checklist for care conferences.pdf|Care Conference Checklist]]
* [[Media:DME documentation requirements.pdf|DME Documentation Requirements]]
* [[Media:Incontinence documentation requirements.pdf|Incontinence Supplies Documentation Requirements]]
* [[Media:Nutritional supplement documentation requirements.pdf|Nutritional Supplements Documentation Requirements]]

File:Orders change process.pdf

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Hypertension in Pregnancy

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LiamG: Created page with " '''References''' Quality Improvement Toolkit"

'''References'''
[[File:CMQCC 2024.pdf|left|thumb|Quality Improvement Toolkit]]

File:CMQCC 2024.pdf

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LiamG:

California Maternal Quality Care Collaborative Toolkit

Bethel A to Z

2025-11-15T14:25:47Z

LiamG:

[[File:Welcome_to_bethel_alaska_sign.png|350x350px]][[File:Bethel_star.png|250x250px]][[File:Bethel_aerial_map.png|500x500px]]
===Airlines===

Alaska Air is the only carrier that connects Bethel with the rest of the world. There are 2-3 flights daily to/from Anchorage.

Grant, Yute, Fox, Ravn, and other charter companies fly to the villages of the YK Delta.

For frequent flyer programs: see https://www.alaskaair.com/ and https://www.flygrant.com/

Alaska Airlines also has the [https://www.alaskaair.com/atmosrewards/content/club-49 Club49 program] with baggage and cargo benefits for Alaska residents.

There are small charters that will fly you for sightseeing tours or to drop you off at a remote location for a hunting, fishing, or camping trip. https://www.renfrosalaskanadventures.com/ and https://www.pbadventures.com/

===Alaska Court System===

If you register to vote in Bethel, your name will go into the pool of candidates for jury duty. The courthouse is located next to the city building. For more information: http://courts.alaska.gov/courtdir/4be.htm

===Alcohol===

Bethel is a damp community. You can have alcohol here, but there is no liquor store. You can mail order alcohol from stores in Anchorage, but there is a limit on the quantity. There are two restaurants that serve beer and wine (Fili's Pizza and Uncommon Pizza).

Most of the surrounding villages are dry. Alcohol in any form is illegal, but there are people who consume it. A few villages are damp and a few are wet—they have liquor stores.

===Amazon Prime===

An inexpensive and easy way to get specialty items and supplies to Bethel. Packages do not arrive in two days, but will ship for free. You may not be able to have large or bulky item shipped, and you may have to finagle your shipping address (see Shipping below).

===Banks===
There are three banks in Bethel:
*Global Credit Union (formerly Alaska USA Federal Credit Union): 800-525-9094
*First National Bank: 543-2601
*Wells Fargo Bank: 543-3875

Do not forget to get an ATM card. The bank will have the necessary forms for you to complete. We have ATM machines at the AC store, the movie theatre, Swanson’s grocery store. The ATM’s may charge a $2-3 fee for non-sponsoring Bank users. In addition, there is an ATM at the Anchorage airport, which comes in handy for those last minute cash advances needed before vacations.

You can request YKHC Payroll directly deposit your paycheck into your local bank account. This is convenient and highly recommended.

===Barge Services===
During the summer months in Bethel (June-September) there are barges that come up the Kuskokwim to deliver goods from Seattle and Anchorage to Bethel. Many organized Bethel residents order food and other goods from Northland Barge Company and have them shipped up here during the summer months. You can also order building materials, cars, boats and anything else you can pay for and save a lot of money on both the original cost of the item as well as the shipping costs.

Northland Services: 1-800-426-3113

===Berry Picking===
A favorite summer activity. The tundra is a bounty of berries: blueberries, blackberries, salmonberries, and cranberries. Rarely, wild raspberries can be found upriver. Ask around for clues to good spots or explore on your own.

===Bethel Actors Guild===
Are you really a closet actor/actress? Does the smell of grease paint excite you? All personality types are needed for this group of great local talent seeking to present live performances in Bethel. Find the Bethel Actors Guild on Facebook.

===Bethel, City of===
Please see https://www.cityofbethel.org/ for information about local government, businesses, and other services offered.

===Bingo===
If these five letters make your heart pound, a Bingo game can be found almost every night here in Bethel (VFW, etc.). It would be worth attending an evening with a local for the benefit of seeing how a significant number of our patients spend their evenings. Maybe you will even win some money to buy a toy such as a boat or a snow machine!

===Boating===
It is a lot of fun to have a boat in Bethel in the summertime for picnics during the late summer evenings on a nearby sandbar or the bluffs upriver. You can visit Jung’s Store in Napakiak to check out the sales and native crafts, or take a camping trip up the Gweek or the Kwethluk River.

Boats, motors, and trailers are expensive new, but can be affordable if bought used...especially if you go in on buying a boat with someone else. Look for ads hanging up in AC or the Cultural Center, or “Bethel Bargains” on Facebook. Ask around to see if anyone wants a “partner” or has a boat for sale. Advice on what kind of boat and motor to get is free and easily obtained. In addition, you can probably get as many different opinions on this subject as you like.

New boats can be purchased at Back Creek Marine or the Prop Shop. You can also buy a boat from a dealer outside of Bethel and have it shipped on the barge.

Bethel has a “small boat harbor” with floating docks and you can rent a slip for your boat. Call the Bethel Port Commissioner at 543-2310 for more information. You can also keep the boat at your house and launch it from a boat trailer at the two ramps in the small boat harbor. A final option is to anchor the boat on the shore of the small boat harbor, just watch the tides and keep it bailed out! However you use the small boat harbor there is an annual usage fee of around $20 per boat paid to the Bethel Port. They give you a decal to stick on your boat. Registering your boat with the Coast Guard is not required, but not a bad idea if the boat is stolen or you are late returning or in need of rescue.

Life preservers (technical name is Personal Floatation Device or PFD) are necessary. The local stores will sell them, but YKHC Injury Prevention has them available at cost and can provide instruction on fit and use. PFDs are required for all boat passengers and children must be wearing them at all times. It is a good idea, to have your children wear their PFD anytime they are near or in the water.

===Boyscouts===
There is a Boy Scout troop in Bethel. Ask around for contact information.

===Cama'i Dance Festival===
An annual dance festival event in the spring (March or April) sponsored by the SouthWest Alaska Arts Group. More info at https://www.swaagak.org.

===Cell Services/Phones===
GCI is an Alaskan company that provides service to the bush. The service is not as fast as what you get in the lower 48, but it works. There is a GCI store located in the AC building, and it is open Monday through Saturday. Verizon works in Bethel, but there is no Verizon store. Verizon does not work in the villages, so if you are planning trips to the villages you will want to check into GCI’s service. People with AT&T can also get their phones to work in Bethel. If you have cell service with a company other than the three noted, your phone will not work.

===Chamber of Commerce===
543-2911 or http://www.chamberofbethel.org/

===Churches===
There are many different denominations represented in Bethel: Russian Orthodox, Baptist, Catholic, Lutheran, Evangelical, and Latter Day Saints to name a few.

===Civil Air Patrol===
If you are a pilot, this is a great way to build up your “hours” inexpensively and to make contact with other pilots in town. CAP owns and operates two planes including a deHavilland Beaver, the ultimate Bush plane. Even though you may not fly, have you considered being an observer or ground support in this vital service of search and rescue? If interested call 543-2359.

===Coffee===
Alba’s Coffee Shop is open 24 hours a day and is located in the green building across from the AC store. There is also a drive through Coffee Express in the Arctic Chiropractic parking lot.

===Community College===
The University of Alaska Fairbanks Kuskokwim Campus is located in the center of town near the city offices, radio station and courthouse. More information at https://www.uaf.edu/bethel/.

===Crafts===
People sell their Native crafts at Saturday Market. Many different crafts (earrings, fur hats and mittens, mukluks, ivory carvings, ulus) are made and sold.

Crafts are also sold at the Moravian Bookstore and at Lucy’s Cache (upper floor of Yute Air).

Another way to find crafts is during a village trip. Village stores may carry a small selection and there may be crafts for sale by individuals. Ask the Health Aides if you have an interest in a particular craft.

===Dancing===
Weekend dances are advertised at local facilities. Fiddle dances are popular and usually held at the National Guard Armory.

===Daycare===
AVCP (Association of Village Council Presidents) offers Head Start https://www.avcp.org/services/head-start/ or call 543-3188.

You can also find someone by posting on Facebook. There is no licensed day care facility in Bethel.

===Delta Illusions===
This is the dance team in Bethel, open to both boys and girls. Please contact Pam Conrad for membership, times, cost. They usually bring in several high quality teachers throughout the year for classes.

===Dental===
The YKDRH Dental Clinic is available to hospital employees and their families and community members. If there is a long wait for appointment, you can walk in at 8 am on weekdays if you have an emergency.

The [https://bethelfamilyclinic.org Bethel Family Clinic] also offers dental services.

===Ducks Unlimited===
A yearly banquet and auction held in April to support stewardship of waterfowl. It is the main dress up event of the Bethel Cultural Scene. The perfect place for a Tux and Bunny Boots! A welcomed break during the waning winter months.

===Electricity===
--see Utilities

===Employment Service===
The State of Alaska Job Service is located in the BNC Complex, first floor.

===Facebook===
Facebook is one of the main forms of communication in Bethel. You will read all about the local gossip, as well as where the garage sales are. People sell a variety of things on the Bethel Bargains page. You can also find information on your child’s school activities and where to catch the best fish. YKHC has a Facebook page.

Consider becoming a member of 'Bethel Bargains', 'It’s Going on in Bethel', 'Bethel 911 Alerts', 'Bethel with Kids', and 'Bethel, AK Housing Wanted'.

===Fish===
Of course, Salmon is the fish everyone talks about in Bethel. There are five different kinds that “run” up the Kuskokwim, starting in June. First Kings (Chinook), then Reds (Sockeye) in late June and early July, followed Coho (Silver) in August. The Chum (Dogfish) will run with all the other salmon species.

In the even years, there is a small run of Pink or Humpy Salmon, but in numbers hardly worth mentioning. You can also catch whitefish, blackfish, and pike.

Anyone can subsistence fish with a gill net if you have lived in Bethel for at least a year, but if you are going to rod and reel in Alaska, you need to purchase a recreational fishing license. These can be purchased online at https://www.adfg.alaska.gov/index.cfm?adfg=license.main.

There are many different ways of preparing and eating fish. The UAF campus offers classes on canning fish.

===Fly and Reel Fishing===
Go world-class fly and reel fishing within a two to three hour boat ride up the Kwethluk, Kasigluk, or Kisaralik rivers. You can fly to Quinhagak for the day and fish the world famous Kanektok. You can catch fish from the runway or pay someone to take you upriver by boat. Please be respectful of the locals desire to keep human waste out of their river and drinking water supply.

===Fire Department/EMS===
Bethel does have a fire department and EMS, and you can call 911 in an emergency. If you are interested in volunteering, you can call or stop by the fire department.

===Freight===
You can ship and receive large items using freight airlines. Alaska Air, Everett’s, Northern Air Cargo (NAC), and Ryan Air can ship your items. If purchasing something in Anchorage, the store may deliver the item to the freight company, or you may have to find a way to get it there. Certain items like gunpowder or CO2 need to be shipped Hazmat.

Each company will give you a quote if you have the weight and the dimensions of your item. It is recommended to shop around because not all freight costs the same.

===Fun Run / Walk / Ski / Bike===
There are many miles to walk, run, or bike in Bethel, but there are no dedicated trails. The boardwalk though Pinky’s Park in City-Sub is the closest you will get to a dedicated trail. You can walk miles in the tundra. There is a Bethel half-marathon each summer around the solstice. Look at the community boards in AC and Cultural Center for events.

===Gardening===
Yes! There is gardening in Bethel. Many people are able to grow successful vegetable and flower gardens around town. Soil amendment is a big plus and picking cool weather crops that have relatively short growing seasons is another plus. There is a Community Garden where space is available near the Youth Center in City-Sub. Meyer Farm sells vegetable boxes throughout the year—check Facebook for what is available.

===Gas===
All prices are about the same… expensive. Gasoline is sold at: “Tank Farm” (a man less gas station on Standard Oil Road that takes only credit or debit cards), Delta Western on 3rd Avenue, QFC 2 (7-11 type store near Blueberry Subdivision), and Vitus Terminals (towards Brown Slough)

===Girl Scouts===
There is a Girl Scout troop in Bethel. Ask around for contact information.

===Hangar Lake===
A nice place for Sunday walks and watching the floatplanes take off and land. Veer left over Brown Slough Bridge and keep going to the end of the road.

===Hunting/Sport Fishing===
For more information on Alaska state regulations, call the Department of Fish and Game 543-2979 or stop by their office on Main Street. Their website will provide information on regulations. https://www.adfg.alaska.gov/index.cfm?adfg=home.main

===Ice===
Ice is one of the negative things about winter in Bethel. The roads and parking lots can be very slick, and many people have fallen and broken bones. Consider purchasing ice cleats for your shoes/boots or boots with cleats built in. Businesses frown on wearing cleats inside, so a removable pair is more practical. YKHC sells these for $2 to try and keep people safe.

===Ice Classic===
The [https://iceclassic.org Kuskokwim Ice Classic] give you the opportunity to try to guess when the Kuskokwim River ice will “break up”. The movement of a wooden tripod traveling 100 feet downriver, which trips a clock, determines the official break up. This typically happens in late May and is celebrated with live music and free hot dogs down at the seawall. The winnings are generous, usually around $12,000.

===Ice Fishing===
A winter sport! Be sure to listen to KYUK, call the State Troopers or D.O.T. to check ice thickness for safety. Popular locations are down river at the mouth of the Johnson River or up river to the mouth of the Gweek.

===Ice Highway===
During the winter, the river is like a giant highway for travelers with dog sleds, snowmobiles, cars, trucks, and even taxicabs. Certain areas are plowed by the Alaska Department of Transportation to maintain a road. Sometimes the road stretches all the way to Aniak, over a hundred miles upriver. Please be aware that you will be traveling on a river, which is affected by the tide, and can have areas of open water. Always ask if the river is safe before venturing out.

===“Just Desserts”===
A local talent show, where many desserts are sold to raise money for community cultural events. Come and be amazed at the talent hiding in your neighborhood!

===Knitting===
Knitting is a favorite pastime in Bethel. Lisa’s Party Store on East Avenue, Swanson’s, and AC sell yarn.

===Kuskokwim University Campus (KuC)===
Work on college courses and expand your horizons and education. Courses are offered during the fall and spring semesters and they sponsor short community oriented workshops. Look for announcement throughout the year or online at https://www.uaf.edu/bethel/. If you have a class you would like to offer, you can also contact the campus office. Be on the lookout for special classes on how to make a qasqeq (traditional Yup’ik dress/shirt), fur mittens, hats, etc.

===Kuskokwim 300 Sled Dog Race===
The K300 is the premier middle distance sled dog race, and it usually takes place the 3rd Friday in January. There is the 300-mile race, as well as the Bogus Creek 150, and the Akiak Dash. Many volunteers are needed to help set up, work at headquarters, host mushers, and provide transportation. It is a great opportunity to be involved in the community and they sell nice swag.

Contact person – Race Manager at 543-3300 or https://www.k300.org/

===KYKD (100 FM)===
A Christian station, KYKD is a Christ ministries organization located out of Nenana, Alaska. Volunteers needed. Contact 543-KYKD.

===KYUK (640AM)===
KYUK is the oldest Native-owned media organization in the United States and the only station providing daily news in an indigenous language. It is the source of NPR News and All Things Considered and Alaska Public radio News. The website is a good place to read the local news (https://www.kyuk.org/).

Have you ever wanted to be a DJ on a PBS station? Well now’s your lucky chance! Volunteers are always needed in many areas from country/western to top 40. Call 543-3131 and ask for the volunteer coordinator. Always in need and deserving of monetary and volunteer support. NPR sponsored by the Medical Staff.

===Library===
The Kuskokwim Consortium Library is a part of the University of Alaska system, so books that are not in the library can be ordered. The kid’s selection is great. Ask about the book discussion group, children’s story hour, and friends of the Library group. Besides books, there are Videos available for two-day rental and Internet access available in 30-minute blocks free.

This is a great quiet place to sit in a sunny room and watch the ducks and muskrat on the pond. They are also part of the OVERDRIVE system that allows you to check out electronic books on your e-reader for free using your library card.

https://www.uaf.edu/bethellibrary/ or 543-4516

===License (car)===
Division of Motor Vehicles (DMV) 543-2771. Currently open most weekdays, but call first. Service is intermittent so if you need to obtain a driver’s license, the only alternative is to go to Anchorage.

You will need proof of a physical address when applying for your Alaska driver’s license. A rental agreement, mortgage statement, or utility bill with your physical address will work. You will also have to take a written test (and pass) before you will be issued your license. There are books available so you can study.

You can also register your automobiles or boat at the DMV. By law, you need to have current license plate tags (but many people do not).

The DMV is located in City Hall. http://doa.alaska.gov/dmv/

===Lions Club===
A service organization, with emphasis on eye care, and youth in the community. Meetings are held the 1st and 3rd Thursday of each month. They also host a monthly food drive for those in need. Contact: 543-4300 or https://www.facebook.com/BethelAKLions

===Lodging===
Bethel has several hotels and some Bed and Breakfasts; check with local residents for recommendations.

===Medical Services===
Yukon Kuskokwim Delta Regional Hospital 543-6300

State of Alaska Public Health Nursing Bethel Health Center, a State of Alaska Facility. For Immunizations, Well Child Care, and Women’s Health Issues and Family Planning. 543-2456.

Bethel Family Clinic - The Bethel Family Clinic is located on Main Street. You can be seen for primary care or behavioral health concerns. Staffed by Nurse Practitioners or Physician Assistants.
The only pharmacy in Bethel is at YKHC, so any prescriptions written by a non-YKHC provider need to be obtained via mail order.

LifeMed - commonly used medevac service to transport critical patients (or people who are unable to travel on a commercial flight) to Anchorage for higher level medical care. They offer a membership that all residence should apply for that covers the cost of a medevac that insurance does not cover (for many insurances that cover 80% of medical bills, 20% of an over $20,000 bill can be significant). see: https://www.lifemedalaska.com/membership to apply.

===Meeting Space===
Cultural Center, local churches and non-profits usually have meeting space for rent. You can also rent space at the Lion’s Club and the Longhouse Hotel.

===Movie Theatre===
Bethel has a two-screen movie theatre that has several showing throughout the week. Check out their Facebook page at Suurvik Cinema at Kipsuvik for movies and show times.

===Mud===
There is plenty of it here, especially during spring break-up. It is composed of fine alluvial silt, which, when dry, creates a fine ubiquitous dust. Politeness dictates you remove your shoes in the Arctic entryway prior to entering anyone’s home to cut down on the amount carried into the house.

===Museums===
The Cultural Center museum re-opened in 2025. Fish and Wildlife has a nice display also.

===Northern Lights (Aurora Borealis)===
Keep an eye out for these in the winter during the late evening or early morning. Not as common an event here as in other parts of Alaska. Best viewing is north of town out past the dump or at Hangar Lake to avoid the city lights.

===Playgrounds===
There are many little playgrounds tucked away around town. Some are skimpy and in disrepair and some are fancy and all have something unique to offer.

Pinky’s Park hosts softball games and other activities, Other playgrounds are at Ayalpik Apartments (Senior Citizen Housing) located in “housing,” ME School (next to high school in “housing”), across from the Kuskokwim University Campus, near small boat harbor, on Ptarmigan Road, and next to AVCP housing authority.

===Preschools===
There are a few preschool programs in Bethel: Involved Parent’s Preschool, Baptist Church Preschool, and Busy Bees

===Parks and Recreation===
Pool and Recreation center – see [https://www.ykfitness.org Yukon Kuskokwim Fitness Center].

YKHC has a fitness center in the Kangiq Building. Contact HR about membership information at 907-543-6060.

===Post Office===
The Bethel Post Office is the mail-processing center for the YK Delta. There is no home delivery of the mail, and because they do not deliver the mail, you do not have to pay for the rental of your box. When you apply for a box, you will need proof of a physical address in Bethel.

If you do not want to rent a box, you can have your mail and packages sent to General Delivery and will need to show you ID to pick up your mail.

You can pay to send packages next day; however, they will not arrive next day. A priority package sent out typically arrives at its destination in three to four business days. Likewise, when someone sends you a package, if send priority, will arrive in three to four business days.

[https://alaska-icargo.ibsplc.aero/icargoportal/portal/loginFlow Gold Streak] is an option to ship mail or packages out of Bethel the same day, and is a service provided by Alaska Air.

When placing internet orders, do not rely on the delivery date provided by the company. Certain items may arrive in three days, and others take two weeks. Most online stores honor their “free shipping on purchases over $XX”, but read the small print, because not all do.

===QFC # 2===
Located on Chief Eddie Hoffman Highway—like a 7-Eleven with gasoline. Open until midnight.

===Quyana===
The Yugtun word for “thank you.”

===Real Estate===
You can rent an apartment or house, or you can purchase a home in Bethel. Housing can be difficult to find, so patience and perseverance are needed. Bethel, AK Housing Wanted on Facebook is a good place to start. People will post apartments and homes for rent or sale and you can post that you are in search of (ISO) housing.

Trulia and Zillow list Bethel homes for sale. There are realtors in Bethel that can help you find a home as well. Ask around for names and numbers.

===Restaurants===
There are many restaurants in town (and they are smoke free!) offering Chinese, Italian, and American cuisine. Your best bet is to talk to someone who has been in Bethel for a while for recommendations.

You can also visit http://www.eatbethel.com/ to see menus. Some restaurants allow for online ordering, and most deliver free.

===Schools===
There are two school districts in the YK Delta, the Lower Kuskokwim (which includes Bethel) and the Lower Yukon. Information can be found at https://www.lksd.org/ and https://lysd.org/

In Bethel, there are two elementary schools and one middle/high school. Mikelnguut Elitnaurvait (known as M.E.) is for kids in grades kindergarten through second grade. Gladys Jung is for third through sixth, and Bethel Regional High School is for seventh through twelfth grade.

The Bethel schools offer many activities for school kids. They have the opportunity to participate in LEGO robotics (fourth through eighth grade), archery, cross-country, wrestling, basketball, volleyball, and swimming.
There is also Native Youth Olympics, in which kids participate in traditional Native Alaskan athletic contests (open to Native and non-Native!) https://creekwoodinn-alaska.com/the-outsiders-guide-to-alaskas-native-youth-olympics/

===Shipping===
You can send packages at the Post Office. There are no UPS or FedEx stores.

A few words on how to get packages to your house . . .
*Patience is necessary.
*Try to get things mailed via the US Postal Service. They will put an infamous yellow slip in your box, which you take to the counter, and then receive you package. If you have an oversized item, you will still get yellow slip, but it will have “BACK” written on it and will have to go to the loading dock in the back of the building.
*If the shipper will not ship to the post office, use your physical address and then put your box number (4036 Tunralik, #3370). Sometimes they say they will not ship to a P.O. box, but that is where the package ends up.
*If you purchase something that is shipped via UPS, it will be delivered to your doorstep. Bethel has a person who has a contract with UPS to deliver its packages. She is very reliable.
*Bethel also has a person with a contract to deliver packages from FedEx. Not as reliable, but you will still get your merchandise.
*If you judiciously monitor the tracking of your package, be aware that the internet may tell you the package has been delivered, but it is not in Bethel. Depending on the mode of delivery, some tracking states delivery when the package is in Anchorage waiting to be picked up by a third party.

===Shopping===
The two big stores in Bethel are “The AC” (Alaska Commercial) and Swanson’s. The selection of groceries and foods has improved over the past few years . . . you can find capers, couscous and other exotic foods if you cruise the aisles with an eagle eye. And AC even carries Ben and Jerry’s Ice Cream! Watch the sales in the weekly paper and hit both on shopping days. Prices are high.

Corina’s Caselot Groceries (across the Brown Slough bridge) is Bethel’s version of a mini Costco. They purchase bulk items in Anchorage and bring them back to Bethel. If you like shopping in bulk, you can save some money here and her selection is consistent and pretty darn good. Both AC and Swanson’s also have a bulk food aisle.

Anchorage is the ultimate shopping haven when you live in Bethel, and everyone is talking about Costco. Conveniently located near the Anchorage Airport, you can hit Costco on your way back to Bethel purchasing bulk foods at great prices. Fred Meyer (Discount Giant) and Long’s Drug Store have Bush Mail Service and you can order what you want and have it sent out. In fact, many businesses in Anchorage will take over-the-phone credit orders for merchandise and mail out COD.

There is always mail/internet order.

===Snow===
There is not a lot of snow in Bethel; however, there is a lot of drifting. If you need your driveway plowed, you may find someone on Facebook who does it, or you can post that you need assistance.

The snow is typically dry and wispy, not wet and packable for making snowmen or snow forts. Igloos and quinzhees have been built out of big drifts.

===Snow machine/Snow Go===
A snow machine is great way to get around in the winter. Like boats, snow machines can be bought used. The Prop Shop sells snow machines. Make sure you have warm winter clothes before going out and never go alone.

Get one and open up a new world of exploring and winter camping. Follow the K-300 dog race through its course or just use for tool errands. There is a lot of country to see!

=== SWAAG ===
The [https://www.swaagak.org/about SouthWest Alaska Arts Group] merged the Bethel Council on the Arts and Kuskokwim Art Guild in 2022 to coordinate arts activities in the community.

===Tax===
Although Alaska has no state sales tax, the City of Bethel does. You will pay 6% on all items purchased, including food. You will also likely be charged 6% tax on your online purchases.

===Taxi===
It has been reported that Bethel has the most cabs per capita in the country. There are two cab companies, Kusko Cab and Alaska Cab Company. The cabs charge a flat fee for a one-way trip and they will stop along the way to pick up other passengers. When you call for a cab, you will need to know your house number and which subdivision you are in. ''(e.g.: If you tell them 5717 Necrelaq Loop, they will not know where you are. You will need to say 5717 Kasayuli.)'' Kids under three ride free.
*Kusko Cab: 543-2169
*Alaska Cab: 543-2111

===Utilities===
Electric- AVEC: 543-2038

Oil –Top Fuel, Delta Western, Vitus, Crowley

An oil-fired furnace heats most houses in Bethel and many hot water heaters are oil heated too. Set up an account with the fuel companies and have them top off your tank if it is not full when you move in. Then, set up a delivery schedule with them ...try once a month. Check up with a dipstick (broom handle) now and then to make sure they do not forget... especially important around February.

Propane -North Star Gas: 543-4277 Some ovens and dryers run on propane. If so, the tank (big, cylindrical tank standing up outside somewhere) will need to be filled periodically. If you wait until your tanks are empty, North Star Gas will fill them up at your house. If they are not completely empty and you want them filled, you have to bring over to their office for filling. The way to tell when your tank is getting low is when you start smelling propane in your house . . . and they are empty when the King Salmon fillet for your twenty guests is stone cold when you take it out of the oven.

Telephone - GCI Alaska

[https://www.cityofbethel.org/242/Water-Sewer-Garbage-Utility Water/Sewer] - Utility Billing Office (City Offices) 543-3150. Unless you live in a house with large silver pipes running into an outside wall, you will have to have your water delivered to a holding tank located somewhere in your house. The sewer truck must evacuate your sewer tank, which may be buried on the property. You need to set up a schedule for water delivery and sewer evacuation when you sign up for service.
*How much water will I need? First, find out how big your water tank is. Sizes range from 300 gallons to 1500 gallons. It may be hit or miss at first as to how much water you will use as this depends on family size, shower time, laundry and toilet flushing preferences. You start by estimating that a family of four can get by with around 100 gallons a day and using conservative techniques can get down as low as 50 gallons a day. Then, see how it goes. You can always change your delivery schedule to fit your own needs. You are charged for the delivery, not the amount you use.
*How much water am I am using? One way to see how you are doing on water is to float a cork in your tank, attach it to a length of fishing line or string and tie a nail to the end. The cork floats in water and the nail hangs on the outside of the tank. You can watch the nail move up the tank as you use water....you can even mark with chalk on the tank how much water you should use a day so you can quickly assess your consumption.
*The water truck knows when your tank is full when the overflow pipe starts pouring out water during filling. A major potential problem exists in the wintertime if the overflow pipe gets plugged with ice. Some overflow pipes are wrapped with heat tape and should be turned on 24 hours before you expect water delivery when it is cold out. If you do not have the heat tape, pour boiling water on the pipe if it is frozen until the ice plug comes out.
*Sometimes the water or sewer truck may forget to come to your house. This is rare, but it has happened on occasion. Check your tank on water day to make sure you got your water.

If you smell a “sewer” type smell in your house after the sewer truck has evacuated your tank, this is probably due to the suction from the truck pulling the water out from the water traps in the sinks and toilets. The sewer gas is then able to escape from the tank back into your house. If this happens, just run the sinks for a few seconds and flush the toilets to fill the water seals again.

Garbage- There is no garbage pick-up in Bethel. You need to throw your trash into the dumpsters around town. You will pay for this privilege on the bill for your water and sewer services.

Recycling is voluntary. AVCP will pick up aluminum cans and #1 plastic bottles for recycling.

===Volunteer===
There are always a lot of great organizations or activities to be involved with. Ask around for volunteering opportunities. You never know whom you will meet or what skills you will gain.

===Voting===
[https://voterregistration.alaska.gov Register to vote!]

===Wood===
If you plan to heat with wood, or if you have a steam bath, you will need to find a wood supply. You can use pallets or collect driftwood and dead wood by boat or snow machine (upriver a bit).

Check Facebook for wood sales. A sled load (less than a chord) of uncut, un-split wood will cost $300-$600.

===Weather===
Bethel has two seasons: Winter and summer. Winter is long and lasts close to 7 months and summer can be rainy with lots of mosquitoes. In the winter, the weather can be very bipolar with temperatures ranging from minus 40 degrees or colder or up to 40 degrees above zero, and this fluctuation can happen in a few days. Summer generally sees temperatures from 50 degrees to 80 degrees but most often, it stays in the 60-degree range. Be prepared—you may need a hat and down coat in the summer.

Actually, the weather is not as bad as some say. It does change quickly, so having an extra layer of warmth is never a bad idea. The summer days are very enjoyable, and even the cold winter days offer pleasure and beauty.

The sun will come up in the winter, but not until around 11:00am. It will set around 4:00pm. You will see daylight a couple of hours before actual sunrise and twilight a couple of hours after sunset.

The sun does go down in the summer, but not for long. You will see sunrises at 5:00am and sunsets at 12:30am (yes, the sun goes down on a different day that it comes up!). Black out curtains are recommended to help you sleep in the summer.

===Wildlife===
Bethel is located in the Yukon Delta National Wildlife Refuge. The U.S. Fish and Wildlife Service office is on the highway just past the hospital. You can call at 543-3151 or visit their website for more information. https://www.fws.gov/refuge/yukon_delta/

Surprisingly, you will not see big game roaming the tundra in Bethel. You will have to travel by boat or snow machine to see moose. Bears are spotted, but not often. There are caribou herds, but the numbers are falling, and they too, are not seen very often.

Musk ox live on Nunivak Island and Nelson Island and there have been several sightings close to Bethel. There is a lottery every year for a tag to hunt musk ox.

Please do not harass the wildlife. Give them plenty of space, it is the right thing to do, and they can be dangerous.

Many different birds nest here in the YK Delta. You will see arctic turns, jaegers, plovers, shorebirds, osprey, and swans that are migratory. Eagles and ravens are seen year-round. For more information on birds: https://www.fws.gov/refuge/yukon_delta/wildlife_and_habitat/birdlist.html

===Wind===
A constant fact in Bethel, usually brisk and from the North. South and East winds will bring storms with them. It will be your continuous winter companion and will help you quickly understand the importance of a fur ruff on your parka.

===X===

While the Athabascan alphabet does include the letter “X” the Yupik alphabet does not.

===Yukon Kuskokwim Regional Aquatic Center===
Bethel’s new pool and recreation center was opened in November of 2014. It has a six-lane pool with a slide and kiddie pool. The gym center has treadmills, a stair machine, elliptical machines, bikes and top of the line weight equipment. Classes such as Spinning, Zumba, Yoga, Boot camp, and Judo are offered as well as swimming lessons. Contact the YK Fitness Center for more information. 543-0390 or http://www.ykfitness.org/

===Zoning===
It may not seem like Bethel has any zoning, but there are a few rules. Some areas are zoned general use and are wide open for any type of enterprise, others are more strictly residential. Some subdivisions allow up to two dogs, such as Blueberry and Hoffman, others allow dog yards of 10 or more, such as City Subdivision. For more information, contact City Hall at 543-2047 or https://www.cityofbethel.org/

Bethel A to Z

2025-11-15T14:08:20Z

LiamG:

[[File:Welcome_to_bethel_alaska_sign.png|350x350px]][[File:Bethel_star.png|250x250px]][[File:Bethel_aerial_map.png|500x500px]]
===Airlines===

Alaska Air is the only carrier that connects Bethel with the rest of the world. There are 2-3 flights daily to/from Anchorage.

Grant, Yute, Fox, Ravn, and other charter companies fly to the villages of the YK Delta.

For frequent flyer programs: see https://www.alaskaair.com/ and https://www.flygrant.com/

Alaska Airlines also has the Club49 program ([https://www.alaskaair.com/atmosrewards/content/club-49]). As an Alaska Resident, one can apply and will get two free checked bags up to 50 pounds flying to any destination outside of Alaska along with other benefits.

There are small charters that will fly you for sightseeing tours or to drop you off at a remote location for a hunting, fishing, or camping trip. https://www.renfrosalaskanadventures.com/ and https://www.pbadventures.com/

===Alaska Court System===

If you register to vote in Bethel, your name will go into the pool of candidates for jury duty. The courthouse is located next to the city building. For more information: http://courts.alaska.gov/courtdir/4be.htm

===Alcohol===

Bethel is a damp community. You can have alcohol here, but there is no liquor store. You can mail order alcohol from stores in Anchorage, but there is a limit on the quantity. There are two restaurants that serve beer and wine (Fili's Pizza and Uncommon Pizza).

Most of the surrounding villages are dry. Alcohol in any form is illegal, but there are people who consume it. A few villages are damp and a few are wet—they have liquor stores.

===Amazon Prime===

An inexpensive and easy way to get specialty items and supplies to Bethel. Packages do not arrive in two days, but will ship for free. You may not be able to have large or bulky item shipped, and you may have to finagle your shipping address (see Shipping below).

===Banks===
There are three banks in Bethel:
*Alaska USA Federal Credit Union: 543-2619
*First National Bank: 543-2601
*Wells Fargo Bank: 543-3875

Do not forget to get an ATM card. The bank will have the necessary forms for you to complete. We have ATM machines at the AC store, the movie theatre, Swanson’s grocery store. The ATM’s may charge a $2-3 fee for non-sponsoring Bank users. In addition, there is an ATM at the Anchorage airport, which comes in handy for those last minute cash advances needed before vacations.

You can request YKHC Payroll directly deposit your paycheck into your local bank account. This is convenient and highly recommended.

===Barge Services===
During the summer months in Bethel (June-September) there are barges that come up the Kuskokwim to deliver goods from Seattle and Anchorage to Bethel. Many organized Bethel residents order food and other goods from Northland Barge Company and have them shipped up here during the summer months. You can also order building materials, cars, boats and anything else you can pay for and save a lot of money on both the original cost of the item as well as the shipping costs.

Northland Services: 1-800-426-3113

===Berry Picking===
A favorite summer activity. The tundra is a bounty of berries: blueberries, blackberries, salmonberries, and cranberries. Rarely, wild raspberries can be found upriver. Ask around for clues to good spots or explore on your own.

===Bethel Actors Guild===
Are you really a closet actor/actress? Does the smell of grease paint excite you? All personality types are needed for this group of great local talent seeking to present live performances in Bethel. BAG produces approximately four shows a year and needs behind the scene help as well as actors.

===Bethel, City of===
Please see https://www.cityofbethel.org/ for information about local government, businesses, and other services offered.

===Bethel Council on the Arts===
Be involved in bringing culture to Western Alaska. Recent events have included concerts at the Cultural Center, art auctions, and dumpster painting. For information on projects, fund-raising, and event coordination, call 543-5222.

===Bingo===
If these five letters make your heart pound, a Bingo game can be found almost every night here in Bethel (VFW, etc.). It would be worth attending an evening with a local for the benefit of seeing how a significant number of our patients spend their evenings. Maybe you will even win some money to buy a toy such as a boat or a snow machine!

===Boating===
It is a lot of fun to have a boat in Bethel in the summertime for picnics during the late summer evenings on a nearby sandbar or the bluffs upriver. You can visit Jung’s Store in Napakiak to check out the sales and native crafts, or take a camping trip up the Gweek or the Kwethluk River.

Boats, motors, and trailers are expensive new, but can be affordable if bought used...especially if you go in on buying a boat with someone else. Look for ads hanging up in AC or the Cultural Center, or “Bethel Bargains” on Facebook. Ask around to see if anyone wants a “partner” or has a boat for sale. Advice on what kind of boat and motor to get is free and easily obtained. In addition, you can probably get as many different opinions on this subject as you like.

New boats can be purchased at Back Creek Marine or the Prop Shop. You can also buy a boat from a dealer outside of Bethel and have it shipped on the barge.

Bethel has a “small boat harbor” with floating docks and you can rent a slip for your boat. Call the Bethel Port Commissioner at 543-2310 for more information. You can also keep the boat at your house and launch it from a boat trailer at the two ramps in the small boat harbor. A final option is to anchor the boat on the shore of the small boat harbor, just watch the tides and keep it bailed out! However you use the small boat harbor there is an annual usage fee of around $20 per boat paid to the Bethel Port. They give you a decal to stick on your boat. Registering your boat with the Coast Guard is not required, but not a bad idea if the boat is stolen or you are late returning or in need of rescue.

Life preservers (technical name is Personal Floatation Device or PFD) are necessary. The local stores will sell them, but YKHC Injury Prevention has them available at cost and can provide instruction on fit and use. PFDs are required for all boat passengers and children must be wearing them at all times. It is a good idea, to have your children wear their PFD anytime they are near or in the water.

===Boyscouts===
There is a Boy Scout troop in Bethel. Ask around for contact information.

===Camai Dance Festival===
The Camai Dance Festival is held every March to celebrate traditional Yup’ik dancing and to welcome dancers from other cultures. Contact person is Linda Curda 543-5222.

===Cell Services/Phones===
GCI is an Alaskan company that provides service to the bush. The service is not as fast as what you get in the lower 48, but it works. There is a GCI store located in the AC building, and it is open Monday through Saturday. Verizon works in Bethel, but there is no Verizon store. Verizon does not work in the villages, so if you are planning trips to the villages you will want to check into GCI’s service. People with AT&T can also get their phones to work in Bethel. If you have cell service with a company other than the three noted, your phone will not work.

===Chamber of Commerce===
543-2911 or http://www.chamberofbethel.org/

===Churches===
There are many different denominations represented in Bethel: Russian Orthodox, Baptist, Catholic, Lutheran, Evangelical, and Latter Day Saints to name a few.

===Civil Air Patrol===
If you are a pilot, this is a great way to build up your “hours” inexpensively and to make contact with other pilots in town. CAP owns and operates two planes including a deHavilland Beaver, the ultimate Bush plane. Even though you may not fly, have you considered being an observer or ground support in this vital service of search and rescue? If interested call 543-2359.

===Coffee===
Alba’s Coffee Shop is open 24 hours a day and is located in the green Subway building across from the AC store. There is also a drive through Coffee Express in the Arctic Chiropractic parking lot. The Office of Environmental Health operates the Injury Prevention Store on the first floor of CHSB, which serves coffee as well as selling PFDs and winter gear.

===Community College===
see Kuskokwim University Campus

===Crafts===
People sell their Native crafts at Saturday Market. Many different crafts (earrings, fur hats and mittens, mukluks, ivory carvings, ulus) are made and sold.

Crafts are also sold at the Moravian Bookstore and at Lucy’s Cache (upper floor of Yuut Air).

Another way to find crafts is during a village trip. Village stores may carry a small selection and there may be crafts for sale by individuals. Ask the Health Aides if you have an interest in a particular craft.

===Dancing===
Weekend dances are advertised at local facilities. Fiddle dances are popular and usually held at the National Guard Armory. The Phillip Alcohol Treatment Center often sponsors sober dances with DJ’s playing dance tunes. The Youth Center occasionally holds dances for teens as well.

===Daycare===
AVCP (Association of Village Council Presidents) offers Head Start https://www.avcp.org/services/head-start/ or call 543-3188.

You can also find someone by posting on Facebook. There is no licensed day care facility in Bethel.

===Delta Illusions===
This is the dance team in Bethel, open to both boys and girls. Please contact Pam Conrad for membership, times, cost. They usually bring in several high quality teachers throughout the year for classes.

===Dental===
The YKDRH Dental Clinic is available to hospital employees and their families and community members. If there is a long wait for appointment, you can walk in at 8 am on weekdays if you have an emergency.

The Bethel Family Dental Clinic is located on 3rd Avenue. They take the Maritain Dental insurance that is offered by YKHC.

===Ducks Unlimited===
A yearly banquet and auction held in April to support stewardship of waterfowl. It is the main dress up event of the Bethel Cultural Scene. The perfect place for a Tux and Bunny Boots! A welcomed break during the waning winter months.

===Electricity===
--see Utilities

===Employment Service===
The State of Alaska Job Service is located in the BNC Complex, first floor.

===Facebook===
Facebook is one of the main forms of communication in Bethel. You will read all about the local gossip, as well as where the garage sales are. People sell a variety of things on the Bethel Bargains page. You can also find information on your child’s school activities and where to catch the best fish. YKHC has a Facebook page.

Consider becoming a member of 'Bethel Bargains', 'It’s Going on in Bethel', 'Bethel 911 Alerts', 'Bethel with Kids', and 'Bethel, AK Housing Wanted'.

===Fish===
Of course, Salmon is the fish everyone talks about in Bethel. There are five different kinds that “run” up the Kuskokwim, starting in June. First Kings (Chinook), then Reds (Sockeye) in late June and early July, followed Coho (Silver) in August. The Chum (Dogfish) will run with all the other salmon species.

In the even years, there is a small run of Pink or Humpy Salmon, but in numbers hardly worth mentioning. You can also catch whitefish, blackfish, and pike.

Anyone can subsistence fish with a gill net if you have lived in Bethel for at least a year, but if you are going to rod and reel in Alaska, you need to purchase a recreational fishing license. These can be purchased online at https://www.adfg.alaska.gov/index.cfm?adfg=license.main.

There are many different ways of preparing and eating fish. The UAF campus offers classes on canning fish.

===Fly and Reel Fishing===
Go world-class fly and reel fishing within a two to three hour boat ride up the Kwethluk, Kasigluk, or Kisaralik rivers. You can fly to Quinhagak for the day and fish the world famous Kanektok. You can catch fish from the runway or pay someone to take you upriver by boat. Please be respectful of the locals desire to keep human waste out of their river and drinking water supply.

===Fire Department/EMS===
Bethel does have a fire department and EMS, and you can call 911 in an emergency. If you are interested in volunteering, you can call or stop by the fire department.

===Freight===
You can ship and receive large items using freight airlines. Alaska Air, Everett’s, Northern Air Cargo (NAC), and Ryan Air can ship your items. If purchasing something in Anchorage, the store may deliver the item to the freight company, or you may have to find a way to get it there. Certain items like gunpowder or CO2 need to be shipped Hazmat.

Each company will give you a quote if you have the weight and the dimensions of your item. It is recommended to shop around because not all freight costs the same.

===Fun Run / Walk / Ski / Bike===
There are many miles to walk, run, or bike in Bethel, but there are no dedicated trails. The boardwalk though Pinky’s Park in City-Sub is the closest you will get to a dedicated trail. You can walk miles in the tundra. There is a Bethel half-marathon each summer around the solstice. Look at the community boards in AC and Cultural Center for events.

===Gardening===
Yes! There is gardening in Bethel. Many people are able to grow successful vegetable and flower gardens around town. Soil amendment is a big plus and picking cool weather crops that have relatively short growing seasons is another plus. There is a Community Garden where space is available near the Youth Center in City-Sub. Meyer Farm sells vegetable boxes throughout the year—check Facebook for what is available.

===Gas===
All prices are about the same… expensive. Gasoline is sold at: “Tank Farm” (a man less gas station on Standard Oil Road that takes only credit or debit cards), Delta Western on 3rd Avenue, QFC 2 (7-11 type store near Blueberry Subdivision), and North Star Gas (towards Brown Slough)

===Girl Scouts===
There is a Girl Scout troop in Bethel. Ask around for contact information.

===Hangar Lake===
A nice place for Sunday walks and watching the floatplanes take off and land. Veer left over Brown Slough Bridge and keep going to the end of the road.

===Hunting/Sport Fishing===
For more information on Alaska state regulations, call the Department of Fish and Game 543-2979 or stop by their office on Main Street. Their website will provide information on regulations. https://www.adfg.alaska.gov/index.cfm?adfg=home.main

===Ice===
Ice is one of the negative things about winter in Bethel. The roads and parking lots can be very slick, and many people have fallen and broken bones. Consider purchasing ice cleats for your shoes/boots or boots with cleats built in. Businesses frown on wearing cleats inside, so a removable pair is more practical. YKHC sells these for $2 to try and keep people safe.

===Ice Classic===
The Kuskokwim Ice Classic give you the opportunity to try to guess when the Kuskokwim River ice will “break up”. The movement of a wooden tripod traveling 100 feet downriver, which trips a clock, determines the official break up. This typically happens in late May and is celebrated with live music and free hot dogs down at the seawall. The winnings are generous, usually around $12,000.

===Ice Fishing===
A winter sport! Be sure to listen to KYUK, call the State Troopers or D.O.T. to check ice thickness for safety. Popular locations are down river at the mouth of the Johnson River or up river to the mouth of the Gweek.

===Ice Highway===
During the winter, the river is like a giant highway for travelers with dog sleds, snowmobiles, cars, trucks, and even taxicabs. Certain areas are plowed by the Alaska Department of Transportation to maintain a road. Sometimes the road stretches all the way to Aniak, over a hundred miles upriver. Please be aware that you will be traveling on a river, which is affected by the tide, and can have areas of open water. Always ask if the river is safe before venturing out.

===“Just Desserts”===
A local talent show, where many desserts are sold to raise money for community cultural events. Come and be amazed at the talent hiding in your neighborhood!

===Knitting===
Knitting is a favorite pastime in Bethel. Lisa’s Party Store on East Avenue, Swanson’s, and AC sell yarn.

===Kuskokwim University Campus (KuC)===
Work on college courses and expand your horizons and education. Courses are offered during the fall and spring semesters and they sponsor short community oriented workshops. Look for announcement throughout the year or online at https://www.uaf.edu/bethel/. If you have a class you would like to offer, you can also contact the campus office. Be on the lookout for special classes on how to make a qasqeq (traditional Yup’ik dress/shirt), fur mittens, hats, etc.

===Kuskokwim 300 Sled Dog Race===
The K300 is the premier middle distance sled dog race, and it usually takes place the 3rd Friday in January. There is the 300-mile race, as well as the Bogus Creek 150, and the Akiak Dash. Many volunteers are needed to help set up, work at headquarters, host mushers, and provide transportation. It is a great opportunity to be involved in the community and they sell nice swag.

Contact person – Race Manager at 543-3300 or https://www.k300.org/

===KYKD (100 FM)===
A Christian station, KYKD is a Christ ministries organization located out of Nenana, Alaska. Volunteers needed. Contact 543-KYKD.

===KYUK (640AM)===
KYUK is the oldest Native-owned media organization in the United States and the only station providing daily news in an indigenous language. It is the source of NPR News and All Things Considered and Alaska Public radio News. The website is a good place to read the local news (https://www.kyuk.org/).

Have you ever wanted to be a DJ on a PBS station? Well now’s your lucky chance! Volunteers are always needed in many areas from country/western to top 40. Call 543-3131 and ask for the volunteer coordinator. Always in need and deserving of monetary and volunteer support. NPR sponsored by the Medical Staff.

===Library===
The Kuskokwim Consortium Library is a part of the University of Alaska system, so books that are not in the library can be ordered. The kid’s selection is great. Ask about the book discussion group, children’s story hour, and friends of the Library group. Besides books, there are Videos available for two-day rental and Internet access available in 30-minute blocks free.

This is a great quiet place to sit in a sunny room and watch the ducks and muskrat on the pond. They are also part of the OVERDRIVE system that allows you to check out electronic books on your e-reader for free using your library card.

https://www.uaf.edu/bethellibrary/ or 543-4516

===License (car)===
Division of Motor Vehicles (DMV) 543-2771. Currently open most weekdays, but call first. Service is intermittent so if you need to obtain a driver’s license, the only alternative is to go to Anchorage.

You will need proof of a physical address when applying for your Alaska driver’s license. A rental agreement, mortgage statement, or utility bill with your physical address will work. You will also have to take a written test (and pass) before you will be issued your license. There are books available so you can study.

You can also register your automobiles or boat at the DMV. By law, you need to have current license plate tags (but many people do not).

The DMV is located in City Hall. http://doa.alaska.gov/dmv/

===Lions Club===
A service organization, with emphasis on eye care, and youth in the community. Meetings are held the 1st and 3rd Thursday of each month. They also host a monthly food drive for those in need. Contact: 543-4300 or https://www.facebook.com/BethelAKLions

===Lodging===
Bethel has several hotels and some Bed and Breakfasts; check with local residents for recommendations.

===Medical Services===
Yukon Kuskokwim Delta Regional Hospital 543-6300

State of Alaska Public Health Nursing Bethel Health Center, a State of Alaska Facility. For Immunizations, Well Child Care, and Women’s Health Issues and Family Planning. 543-2456.

Bethel Family Clinic - The Bethel Family Clinic is located on Main Street. You can be seen for primary care or behavioral health concerns. Staffed by Nurse Practitioners or Physician Assistants.
The only pharmacy in Bethel is at YKHC, so any prescriptions written by a non-YKHC provider need to be obtained via mail order.

LifeMed - commonly used medevac service to transport critical patients (or people who are unable to travel on a commercial flight) to Anchorage for higher level medical care. They offer a membership that all residence should apply for that covers the cost of a medevac that insurance does not cover (for many insurances that cover 80% of medical bills, 20% of an over $20,000 bill can be significant). see: https://www.lifemedalaska.com/membership to apply.

===Meeting Space===
Cultural Center, local churches and non-profits usually have meeting space for rent. You can also rent space at the Lion’s Club and the Longhouse Hotel.

===Movie Theatre===
Bethel has a two-screen movie theatre that has several showing throughout the week. Check out their Facebook page at Suurvik Cinema at Kipsuvik for movies and show times.

===Mud===
There is plenty of it here, especially during spring break-up. It is composed of fine alluvial silt, which, when dry, creates a fine ubiquitous dust. Politeness dictates you remove your shoes in the Arctic entryway prior to entering anyone’s home to cut down on the amount carried into the house.

===Museums===
One is located in the Cultural Center, but temporarily closed. Fish and Wildlife has a nice display also.

===Northern Lights (Aurora Borealis)===
Keep an eye out for these in the winter during the late evening or early morning. Not as common an event here as in other parts of Alaska. Best viewing is north of town out past the dump or at Hangar Lake to avoid the city lights.

===Playgrounds===
There are many little playgrounds tucked away around town. Some are skimpy and in disrepair and some are fancy and all have something unique to offer.

Pinky’s Park hosts softball games and other activities, Other playgrounds are at Ayalpik Apartments (Senior Citizen Housing) located in “housing” near Anica, ME School (next to high school in “housing”), across from the Kuskokwim University Campus, near small boat harbor, on Ptarmigan Road, and next to AVCP housing authority.

===Preschools===
There are a few preschool programs in Bethel: Involved Parent’s Preschool, Baptist Church Preschool, and Busy Bees

===Parks and Recreation===
Pool and Recreation center – See Yukon Kuskokwim Fitness Center.

The Teen Center is the headquarters for Bethel Parks and Rec: 543-2088 Sponsors activities for kids and adults too. Call for what is going on.

===Post Office===
The Bethel Post Office is the mail-processing center for the YK Delta. There is no home delivery of the mail, and because they do not deliver the mail, you do not have to pay for the rental of your box. When you apply for a box, you will need proof of a physical address in Bethel.

If you do not want to rent a box, you can have your mail and packages sent to General Delivery and will need to show you ID to pick up your mail.

You can pay to send packages next day; however, they will not arrive next day. A priority package sent out typically arrives at its destination in three to four business days. Likewise, when someone sends you a package, if send priority, will arrive in three to four business days.

Gold Streak is an option to ship mail or packages out of Bethel the same day, and is a service provided by Alaska Air. https://www.alaskacargo.com/product#goldstreak

When placing internet orders, do not rely on the delivery date provided by the company. Certain items may arrive in three days, and others take two weeks. Most online stores honor their “free shipping on purchases over $XX”, but read the small print, because not all do.

===QFC # 2===
Located on Chief Eddie Hoffman Highway—like a 7-Eleven with gasoline. Open until midnight.

===Quyana===
the Yupik word for “thank you”

===Real Estate===
You can rent an apartment or house, or you can purchase a home in Bethel. Housing can be difficult to find, so patience and perseverance are needed. Bethel, AK Housing Wanted on Facebook is a good place to start. People will post apartments and homes for rent or sale and you can post that you are in search of (ISO) housing.

Trulia and Zillow list Bethel homes for sale. There are realtors in Bethel that can help you find a home as well. Ask around for names and numbers.

===Restaurants===
There are many restaurants in town (and they are smoke free!) offering Chinese, Italian, and American cuisine. Your best bet is to talk to someone who has been in Bethel for a while for recommendations.

You can also visit http://www.eatbethel.com/ to see menus. Some restaurants allow for online ordering, and most deliver free.

===Schools===
There are two school districts in the YK Delta, the Lower Kuskokwim (which includes Bethel) and the Lower Yukon. Information can be found at https://www.lksd.org/ and https://lysd.org/

In Bethel, there are two elementary schools and one middle/high school. Mikelnguut Elitnaurvait (known as M.E.) is for kids in grades kindergarten through second grade. Gladys Jung is for third through sixth, and Bethel Regional High School is for seventh through twelfth grade.

The Bethel schools offer many activities for school kids. They have the opportunity to participate in LEGO robotics (fourth through eighth grade), archery, cross-country, wrestling, basketball, volleyball, and swimming.
There is also Native Youth Olympics, in which kids participate in traditional Native Alaskan athletic contests (open to Native and non-Native!) https://creekwoodinn-alaska.com/the-outsiders-guide-to-alaskas-native-youth-olympics/

===Shipping===
You can send packages at the Post Office. There are no UPS or FedEx stores.

A few words on how to get packages to your house . . .
*Patience is necessary.
*Try to get things mailed via the US Postal Service. They will put an infamous yellow slip in your box, which you take to the counter, and then receive you package. If you have an oversized item, you will still get yellow slip, but it will have “BACK” written on it and will have to go to the loading dock in the back of the building.
*If the shipper will not ship to the post office, use your physical address and then put your box number (4036 Tunralik, #3370). Sometimes they say they will not ship to a P.O. box, but that is where the package ends up.
*If you purchase something that is shipped via UPS, it will be delivered to your doorstep. Bethel has a person who has a contract with UPS to deliver its packages. She is very reliable.
*Bethel also has a person with a contract to deliver packages from FedEx. Not as reliable, but you will still get your merchandise.
*If you judiciously monitor the tracking of your package, be aware that the internet may tell you the package has been delivered, but it is not in Bethel. Depending on the mode of delivery, some tracking states delivery when the package is in Anchorage waiting to be picked up by a third party.

===Shopping===
The two big stores in Bethel are “The AC” (Alaska Commercial) and Swanson’s. The selection of groceries and foods has improved over the past few years . . . you can find capers, couscous and other exotic foods if you cruise the aisles with an eagle eye. And AC even carries Ben and Jerry’s Ice Cream! Watch the sales in the weekly paper and hit both on shopping days. Prices are high.

Corina’s Caselot Groceries (across the Brown Slough bridge) is Bethel’s version of a mini Costco. They purchase bulk items in Anchorage and bring them back to Bethel. If you like shopping in bulk, you can save some money here and her selection is consistent and pretty darn good. Both AC and Swanson’s also have a bulk food aisle.

Anchorage is the ultimate shopping haven when you live in Bethel, and everyone is talking about Costco. Conveniently located near the Anchorage Airport, you can hit Costco on your way back to Bethel purchasing bulk foods at great prices. Fred Meyer (Discount Giant) and Long’s Drug Store have Bush Mail Service and you can order what you want and have it sent out. In fact, many businesses in Anchorage will take over-the-phone credit orders for merchandise and mail out COD.

There is always mail/internet order.

===Snow===
There is not a lot of snow in Bethel; however, there is a lot of drifting. If you need your driveway plowed, you may find someone on Facebook who does it, or you can post that you need assistance.

The snow is typically dry and wispy, not wet and packable for making snowmen or snow forts. Igloos and quinzhees have been built out of big drifts.

===Snow machine/Snow Go===
A snow machine is great way to get around in the winter. Like boats, snow machines can be bought used. The Prop Shop sells snow machines. Make sure you have warm winter clothes before going out and never go alone.

Get one and open up a new world of exploring and winter camping. Follow the K-300 dog race through its course or just use for tool errands. There is a lot of country to see!

===Tax===
Although Alaska has no state sales tax, the City of Bethel does. You will pay 6% on all items purchased, including food. You will also likely be charged 6% tax on your online purchases.

===Taxi===
It has been reported that Bethel has the most cabs per capita in the country. There are two cab companies, Kusko Cab and Alaska Cab Company. The cabs charge a flat fee for a one-way trip and they will stop along the way to pick up other passengers. When you call for a cab, you will need to know your house number and which subdivision you are in. ''(e.g.: If you tell them 5717 Necrelaq Loop, they will not know where you are. You will need to say 5717 Kasayuli.)'' Kids under three ride free.
*Kusko Cab: 543-2169
*Alaska Cab: 543-2111

===Utilities===
Electric- AVEC: 543-2038

Oil –Top Fuel, Delta Western, Vitus

An oil-fired furnace heats most houses in Bethel and many hot water heaters are oil heated too. Set up an account with the fuel companies and have them top off your tank if it is not full when you move in. Then, set up a delivery schedule with them ...try once a month. Check up with a dipstick (broom handle) now and then to make sure they do not forget... especially important around February.

Propane -North Star Gas: 543-4277 Some ovens and dryers run on propane. If so, the tank (big, cylindrical tank standing up outside somewhere) will need to be filled periodically. If you wait until your tanks are empty, North Star Gas will fill them up at your house. If they are not completely empty and you want them filled, you have to bring over to their office for filling. The way to tell when your tank is getting low is when you start smelling propane in your house . . . and they are empty when the King Salmon fillet for your twenty guests is stone cold when you take it out of the oven.

Telephone - GCI Alaska

Water/Sewer - Utility Billing Office (City Offices) 543-3150. Unless you live in a house with large silver pipes running into an outside wall, you will have to have your water delivered to a holding tank located somewhere in your house. The sewer truck must evacuate your sewer tank, which may be buried on the property. You need to set up a schedule for water delivery and sewer evacuation when you sign up for service.
*How much water will I need? First, find out how big your water tank is. Sizes range from 300 gallons to 1500 gallons. It may be hit or miss at first as to how much water you will use as this depends on family size, shower time, laundry and toilet flushing preferences. You start by estimating that a family of four can get by with around 100 gallons a day and using conservative techniques can get down as low as 50 gallons a day. Then, see how it goes. You can always change your delivery schedule to fit your own needs. You are charged for the delivery, not the amount you use.
*How much water am I am using? One way to see how you are doing on water is to float a cork in your tank, attach it to a length of fishing line or string and tie a nail to the end. The cork floats in water and the nail hangs on the outside of the tank. You can watch the nail move up the tank as you use water....you can even mark with chalk on the tank how much water you should use a day so you can quickly assess your consumption.
*The water truck knows when your tank is full when the overflow pipe starts pouring out water during filling. A major potential problem exists in the wintertime if the overflow pipe gets plugged with ice. Some overflow pipes are wrapped with heat tape and should be turned on 24 hours before you expect water delivery when it is cold out. If you do not have the heat tape, pour boiling water on the pipe if it is frozen until the ice plug comes out.
*Sometimes the water or sewer truck may forget to come to your house. This is rare, but it has happened on occasion. Check your tank on water day to make sure you got your water.

If you smell a “sewer” type smell in your house after the sewer truck has evacuated your tank, this is probably due to the suction from the truck pulling the water out from the water traps in the sinks and toilets. The sewer gas is then able to escape from the tank back into your house. If this happens, just run the sinks for a few seconds and flush the toilets to fill the water seals again.

Garbage- There is no garbage pick-up in Bethel. You need to throw your trash into the dumpsters around town. You will pay for this privilege on the bill for your water and sewer services.

Recycling is voluntary. AVCP will pick up aluminum cans and #1 plastic bottles for recycling.

===Volunteer===
There are always a lot of great organizations or activities to be involved with. Ask around for volunteering opportunities. You never know whom you will meet or what skills you will gain.

===Voter Registration===
You can register to vote at KYUK, at the Legislative Office (located behind the green Subway building), at City Hall, and when you apply for an Alaska driver’s license. You can also register online. You do need to be registered to vote before Election Day.

===Wood===
If you plan to heat with wood, or if you have a steam bath, you will need to find a wood supply. You can use pallets or collect driftwood and dead wood by boat or snow machine (upriver a bit).

Check Facebook for wood sales. A sled load (less than a chord) of uncut, un-split wood will cost $300-$600.

===Weather===
Bethel has two seasons: Winter and summer. Winter is long and lasts close to 7 months and summer can be rainy with lots of mosquitoes. In the winter, the weather can be very bipolar with temperatures ranging from minus 40 degrees or colder or up to 40 degrees above zero, and this fluctuation can happen in a few days. Summer generally sees temperatures from 50 degrees to 80 degrees but most often, it stays in the 60-degree range. Be prepared—you may need a hat and down coat in the summer.

Actually, the weather is not as bad as some say. It does change quickly, so having an extra layer of warmth is never a bad idea. The summer days are very enjoyable, and even the cold winter days offer pleasure and beauty.

The sun will come up in the winter, but not until around 11:00am. It will set around 4:00pm. You will see daylight a couple of hours before actual sunrise and twilight a couple of hours after sunset.

The sun does go down in the summer, but not for long. You will see sunrises at 5:00am and sunsets at 12:30am (yes, the sun goes down on a different day that it comes up!). Black out curtains are recommended to help you sleep in the summer.

===Wildlife===
Bethel is located in the Yukon Delta National Wildlife Refuge. The U.S. Fish and Wildlife Service office is on the highway just past the hospital. You can call at 543-3151 or visit their website for more information. https://www.fws.gov/refuge/yukon_delta/

Surprisingly, you will not see big game roaming the tundra in Bethel. You will have to travel by boat or snow machine to see moose. Bears are spotted, but not often. There are caribou herds, but the numbers are falling, and they too, are not seen very often.

Musk ox live on Nunivak Island and Nelson Island and there have been several sightings close to Bethel. There is a lottery every year for a tag to hunt musk ox.

Please do not harass the wildlife. Give them plenty of space, it is the right thing to do, and they can be dangerous.

Many different birds nest here in the YK Delta. You will see arctic turns, jaegers, plovers, shorebirds, osprey, and swans that are migratory. Eagles and ravens are seen year-round. For more information on birds: https://www.fws.gov/refuge/yukon_delta/wildlife_and_habitat/birdlist.html

===Wind===
A constant fact in Bethel, usually brisk and from the North. South and East winds will bring storms with them. It will be your continuous winter companion and will help you quickly understand the importance of a fur ruff on your parka.

===X===

While the Athabascan alphabet does include the letter “X” the Yupik alphabet does not.

===Yukon Kuskokwim Regional Aquatic Center===
Bethel’s new pool and recreation center was opened in November of 2014. It has a six-lane pool with a slide and kiddie pool. The gym center has treadmills, a stair machine, elliptical machines, bikes and top of the line weight equipment. Classes such as Spinning, Zumba, Yoga, Boot camp, and Judo are offered as well as swimming lessons. Contact the YK Fitness Center for more information. 543-0390 or http://www.ykfitness.org/

===Zoning===
It may not seem like Bethel has any zoning, but there are a few rules. Some areas are zoned general use and are wide open for any type of enterprise, others are more strictly residential. Some subdivisions allow up to two dogs, such as Blueberry and Hoffman, others allow dog yards of 10 or more, such as City Subdivision. For more information, contact City Hall at 543-2047 or https://www.cityofbethel.org/

Specialty Referrals

2025-11-12T18:48:56Z

LiamG: /* MRI (Pediatric) */

==Introduction==
For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing '''"Refer to"''' and then select '''"ENTER"'''
*'''Refer to ___ Internal''' means you are referring a patient within the YKHC system
*'''Refer to ______ External''' means you are referring a patient outside the YKHC system

'''INTERNAL''' referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.
*Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
*Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
*Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with '''anmc (lower case)'''.

'''EXTERNAL''' referrals are indicated when the patient needs to travel to see the specialist.
*External referrals are use d for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

''For all referrals'', the provider documentation should:
*Specify the reason for the referral with as much past medical information as possible
*Include Beneficiary/Non-Beneficiary status
**If a non-beneficiary, case management will also need the name of the provider they want to see
**If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
*Indicate what, if any, Multimedia files are applicable to case
**Images and/or scanned documents should be uploaded into Multimedia
**Dermatology always wants pictures
**Case management will need to know which Multimedia files should accompany an external referral
*Indicate STAT status if warranted and inform case management ASAP. (if not STAT, expect referrals to be processed within 2 weeks)
*Include current patient contact information. If a peds referral, also include escort name/DOB.

''Please, do not enter multiple referrals for the same patient, same problem.'' This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

''Case Management does not make ANMC appointments''. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.
[[File:Specialty Calendar.pdf|none|thumb|886x886px|Field Clinics at YKHC]]

==Referrals from the ER==
#Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
#Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
#Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.
return to the [[:Category:Emergency Room|Emergency Department Main Page]]

==ACT/Behavioral Health==
*Be sure to include good contact numbers
*Include a statement indicating that the patient agrees to talk to Behavioral Health.

==Allergy/Immunology==
'''Orders Available'''
*Refer to Allergy/Immunology External
'''Clinics Available'''
*ANMC Allergy/Immunology Clinic
*Allergy, Asthma, and Immunology Center of Alaska

==Cardiology (Adult)==
'''Orders Available'''
*Refer to Adult Cardiology External
'''Things to include'''
*labs
*Chest X-ray (if indicated)
*ECG (REQUIRED)
'''Clinics Available'''
*ANMC Cardiology
**all referrals are reviewed for possible scheduling at Bethel Field Clinic
''any time you consult with a Cardiologist at ANMC who requests that a patient be seen in the cardiology field clinic at YKHC, please send the patient information over to Case Management to coordinate scheduling''

==Cardiology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Cardiology External/Internal
'''Available Groups'''
*Alaska Children's Heart Center (External Only)
*Seattle Children's Pediatric Cardiology
**Have a Bethel Field Clinic

==Colonoscopies/EGDs==
''Do '''NOT''' order a referral to GI for EGD/CS''

'''Orders Available'''
*For Colonoscopy/EGD procedures to be done in Bethel,
**Refer to Adult Surgery Internal (YK Colonoscopy)
***Refer to Adult Surgery Internal - YK EGD
**For Colonospcopy/EGD procedures to be done at ANMC
***Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
***There is no ANMC Surgery Internal Referral.
*''In order that your Endoscopy orders do not get cancelled automatically by the system after 3 years, please be sure to complete the now ‘blank required’ field “Requested Start Date/Time” filed with the appropriate future date (e.g., if a repeat colonoscopy in 5 years, make sure to add the date as 5 years in the future).''

'''Colonoscopy'''
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

'''To screen for colon cancer when the patient cannot do a colonoscopy'''
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic. If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.

'''EGD'''
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.

==Dental==
*All referrals are processed through YKHC Dental Department.
*Referrals to ANMC must be processed through YKHC Dental.
*If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

==Dermatology==
'''Orders Available'''
*Refer to Dermatology External
'''Things to Include'''
*treatments/medications previously tried
*Derm requires pictures

==Dermatology (Pediatric)==
'''Orders Available'''
*Refer to Pediatric Dermatology External
'''Clinics Available'''
*ANMC Dermatology Clinic
*Alaska Family Dermatology Clinic (Dr. Gina Brown; Pediatric Dermatologist)

==Developmental (Pediatric)==
'''Orders Available'''
*Refer to Family, Infant, Toddler Program Internal
*Refer to Child Family Developmental Services External
*Refer to Peds Other External (Ability Clinic)
see [[Specific_Types_of_Appointments_and_Procedural_Processes#Developmental_Delay|Specific Pediatric Processes Section about Developmental Delay]] for more details.

==Endocrinology (Adult)==
'''Orders Available'''
*Refer to Adult Endocrinology External
'''Things to Include'''
*Consider TSH, T3, Free T4

==Endocrinology (Pediatric)==
'''Orders Available'''
*Refer to Peds Endocrinology External/Internal
'''Clinics Available'''
*ANMC Peds Endocrinology Clinic
**Bethel Field Clinic 3-4 times a year

==Gastroenterology (Adult)==
'''Orders Available'''
*Refer to Adult Gastroenterology External
'''Clinics Available'''
*ANMC Gastroenterology Clinic
*Internal Medicine Associates

==Gastroenterology (Pediatric)==
'''Orders Available'''
*Refer to Peds Gastroenterology External
'''Clinics Available'''
*Providence Pediatric Gastroenterology Clinic
*Seattle Children's Hospital Gastroenterology Clinic

==Hematology/Oncology (Pediatric)==
'''Orders Available'''
*Refer to Peds Hematology/Oncology External
'''Available Clinics'''
*AK Pediatric Hem-Onc Clinic
*ANMC Peds Hem-Onc Clinic

==Hepatology (Adult)==
'''Orders Available'''
*Refer to Adult Hepatology External
*refer to Adult Hepatology Internal
'''Things to Include'''
*Liver Ultrasound
*Liver Panel
*Hepatitis B panel if patient has Hepatitis B

==Imaging (Pediatric EEG/VFSS/Hip US)==
'''Orders Available'''
*Refer to Pediatric Clinic External (EEG/VFSS/Hip US)
Studies completed at facilities outside YKHC

==MRI (Adult)==
'''Orders Available'''
*Refer to Internal Medicine External
'''Things to Include'''
*answer all yes/no questions on order (REQUIRED)

==MRI (Pediatric)==
'''Order Available'''
*Refer to Pediatric Clinic External: MRI
'''Required information'''
*Reason for referral
*Sedation required: yes or no
*Contrast: yes or no
For urgent cases, consult with the relevant specialist and include their name in the order.

==Nephrology (Adult)==
'''Orders Available'''
*Refer to Adult Nephrology External
'''Things to Include'''
*Renal ultrasound
*labs including Renal panel, UA, UPCR, CBC

==Nephrology (Pediatric)==
'''Orders Available'''
*Refer to Peds Nephrology External
'''Clinics Available'''
*Providence Pediatric Nephrology
*Seattle Children's Pediatric Nephrology

==Neurology (Adult)==
'''Orders Available'''
*Refer to Adult Neurology External
*Refer to Adult Neurology External-Back/Neck Eval
*Refer to Adult Neurology Internal
'''Things to Include'''
*CT or other imaging within the last 6 months

==Neurology (Pediatrics)==
'''Orders Available'''
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
'''Available Clinics
*Providence Pediatric Neuroscience
*ANMC Pediatric Neurology Clinic
**for urgent/emergent referrals
*Seattle Children's Pediatric Neurology
**for non-urgent and chronic management
**providers very available for questions (see Pediatric Reference Guide for contact information)
**Bethel Field Clinic 3-4 times a year

==Neurosurgery==
'''Orders Available'''
*Refer to Neurosurgery External
'''Things to Include'''
*X-ray within last 6 months (REQUIRED)

==OB/GYN Referrals==

'''Orders Available'''
*Refer to Gynecology External
*Refer to Gynecology Internal

'''Refer GYN INTERNAL'''
*order: "Refer to Gynecology Internal"
*The queue is managed by GYN Case Managers.
*Almost all referrals should start here as most insurance will require that the patient be seen locally first.
*''for patients you want Dr. Compton to see for a consultation in the clinic''
*These should be services specific to GYN consultation only- if you have questions message or call the gyn case manager – appts are limited.
*Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

'''Refer GYN - External'''
*''for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond''
*order: "Refer to Gynecology External"
*The queue is managed by GYN Case Managers.
*Important things to remember or talk with patients about:
**If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. The gyn case manager can still send the referral, but it’s always nice that patients know this ahead of time.
**We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

==Optometry/Ophthalmology==
*All referrals are processed through YKHC Optometry.
*Referrals to ANMC must be processed through YKHC Optometry.

==Ophthalmology (Pediatric)==
'''Orders Available'''
*Refer to Chronic Peds Ophthalmology External
'''Clinics Available'''
*ANMC Ophthalmology
**all referrals sent here
*Alaska Children's Eye and Strabismus
**some of the ANMC Ophthalmology referrals will be reviewed by their clinic and sent here
''Please discuss with a YKHC pediatrician if you think that a child needs a referral to be seen by Pediatric Ophthalmology. Many eye issues can be addressed by YKHC optometry prior to being referred to pediatric ophthalmology.''

==Orthopedics==
'''Orders Available'''
*Refer to Orthopedics External
*Refer to Orthopedics Internal
*Refer to Hand Orthopedics External
'''Things to Include'''
*current X-rays
'''Resources'''
[[Media:ANMC Hand Ortho - 1-30-2019.pdf|Hand Orthopedics 2019]] (PowerPoint Presentation)

==Pain Management==
'''Orders Available'''
*Refer to Pain Management External
'''Things to Include'''
*Comprehensive Pain Management Questionnaire (REQUIRED)
**have patient fill out at appointment and turn in before leaving
*X-rays within the last 6 months

==Pulmonology (Adult)==
'''Orders Available'''
*Refer to Adult Pulmonology External
'''Things to Include'''
*Chest X-ray
*labs including AFBx3, Quantiferon, sputum culture, CBC, CMP, and others as needed

==Rheumatology (Adult)==
'''Orders Available'''
*Refer to Adult Rheumatology External
*Refer to Adult Rheumatology Internal
'''Things to Include'''
*X-rays if deformities present
*labs including CBC, CMP, CRP, ESR, and others as needed

[[Media:Rheumatology Field Clinic Pre-visit Guidelines.pdf|Rheumatology Referral Process Guidelines]]

==Surgery (General)==
You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

''Anyone needing to be seen by surgery will need an accepting physician'' so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

'''Orders Available'''
*Refer to Adult Surg Ext (no EGD/CS)
*Refer to Adult Surg Ext (only EGD/CS)
*Refer to Adult Surgery Internal - YK EGD
*Refer to Adult Surgery Internal - YK General
*Refer to Adult Surgery Internal (YK Colonoscopy)
*Refer to Surgery-Vasectomy

'''ANMC Adult Surgery Referrals'''
*order: "Refer to Adult Surg Ext (no EGD/CS)"
*Stages
#CM in Bethel collects information and sends it to Anchorage.
#CM in Anchorage reviews the information and presents it to a provider.
#The provider makes a decision.
''If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.''

'''Vasectomy'''

* Order: "Refer to Surgery-Vasectomy"
* The queue is managed by the Surgery Case Manager.

'''Other minor procedures to be done in Bethel'''
*Send message (phone, TigerText, or email) to schedulers requesting next available minor procedures clinic appointment.
*There may be an order in Cerner in the future as of 12/30/2024, but the old one is not active now.

'''For Everything Else'''
*Order: "Refer to Adult Surgery External (no EGD/CS)"
*The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

==Urology (Adult)==
'''Orders Available'''
*Refer to Adult Urology External
*Refer to Adult Urology Internal
'''Things to Include'''
*labs including UA, Urine Protein/Creatinine
*Renal US (if indicated)
*If referring for sterilization, consent to sterilize (REQUIRED)
**Complete and sign with the patient at visit

==Non-Beneficiaries==
*Referrals to Ortho, Neurosurgery, (or anywhere that needs imaging)- Please order a disc from radiology for the patient to pick up to take with them to their appointment.
*Refer to other external: Please obtain info on where patient wants a referral sent. If they do not know- let them know to get started with the homework and be prepared with referral information (where they want to be seen) prior to CM or CM Assistant calling them.
*''Providers/Nurses can always google Providence Hospital''
**''click on website''
**''click on Find a Doctor''
**''search for specialties''
**''put in Anchorages Zip code (99501) or Bethel Zip code (99559, just pick 500 miles if using Bethel zip code)''
**''there will then be a list of Providers and their offices and if they are accepting new patients, click on the provider you want and there will be a phone number to add to referral.''
**''A couple choices would be nice.''
**''Also let patient know that they will need to make sure that the office accepts their insurance.''

==PEDIATRIC Specialty Services==
General Specialty Consults: use outside specialists only if absolutely needed. There are not many of them and they are seeing their own patients as well as providing consultation to providers around the state. You can TigerText the ANMC specialty provider on call (which can be determined by calling the ANMC operator to find out who to text) OR contact our non ANMC specialty providers found on the [[Media:Peds Reference Phone Numbers.pdf|Peds Reference Phone Numbers]] in the peds folder. This list gives the best contact options for our pediatric subspecialist. Be sure to email consultants if consult is not urgent.

Call/text pediatric subspecialists during regular hours unless it is urgent or an emergency. If you have to call, take a couple of minutes before calling to summarize the patient problem and develop a clear and concise request of the specialist. Use SBAR communication including letting consultants know who you are and where you are calling from. A consult call should take no longer than 5-10 minutes. See [[Media:Use of Consultants.pdf|Consultations YKHC Clinical Guideline]] -be quick and concise with both your YK as well as external consults.

'''Pediatric specialist referrals:'''
*Seasoned pediatricians review pediatric subspecialty referrals even for new pediatricians and may cancel or redirect the referral or help make a new follow up plan.
*The referral orders for ENT are a good resource: for the indications for BMT and T&A.

===Orders Available===
*Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Family, Infant, Toddler Program Internal (see [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Developmental Delay Section]] for more details)
*Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
*Refer to Peds Cardiology External/Internal
*Refer to Peds Endocrinology External/Internal
*Refer to Peds Gastroenterology External
*Refer to Peds Hematology/Oncology External
*Refer to Peds Nephrology External
*Refer to Peds Neurology External
*Refer to Peds Neurology Internal
*Refer to Peds Other External
*Refer to Peds Psychiatry Internal
*Refer to Peds Pulmonology External
*Refer to Peds Pulmonology Internal
*Refer to Peds Rheumatology External
*Refer to Peds Surgery External
*Refer to Peds Urology External
*Refer to Chronic Peds Ophthalmology External
*Refer to Devt/Behavioral Peds External

===Pediatric Specialty Bethel Field Clinics===
We have Pediatric Specialty Field Clinics in Bethel intermittently throughout the year. These include:
* Pulmonary (from Seattle Children's Hospital) three to four times a year
* Endocrinology (from ANMC) three times a year
* Cardiology (from Anchorage clinic associated with Seattle Children's Hospital) four times a yearly
* Neurology (from Seattle Children's Hospital) twice a year

The schedule for these clinics comes out just before the new year and is updated and added to occasionally throughout the year. The newest Field Clinic Schedule for adult and pediatric specialty field clinics should be posted in the peds folder with many of our other references.

===Anchorage Pediatric Specialty Services===
These and more specialty services are also available in Anchorage. Please look at the [[Media:Pediatric-Specialty-Table.pdf|Pediatric Specialty Services Grid]] for more details.

===Developmental Delay Services===
To refer a patient with developmental delay for services, please see the [[Specific Types of Appointments and Procedural Processes#Developmental Delay|Pediatric Developmental Delay Section]] for more details.

*[[Family Infant Toddler (FIT)]]
**For children less than 3 years old
*Infant Learning Program (ILP)
**Anchorage based equivalent of FIT (see [http://dhss.alaska.gov/dsds/pages/infantlearning/default.aspx their website here])
**children discharged from Anchorage-based hospitals that are in need of OT/PT/Speech services will often have a referral to this program. If they return to the Bethel service area, they will need a referral to FIT.
*Local School Department
**for children older than 3 years old
**discuss with parents to request ILP through their school system
**many villages have [https://www.akheadstart.org/ Head Start Programs]
*Ability Clinic in Anchorage
**for children older than 3 years old and needing more intensive OT/PT/speech therapy
**Order: "Refer to Peds Other” and one of the drop down options is Ability Clinic.
*Multidisciplinary Neurodevelopmental Clinic
**Order: "Refer to Child Family Developmental Services External"

File:NirsevimabCheatSheet.pdf

2025-10-26T01:51:01Z

LiamG:

Nirsevimab

2025-10-26T01:50:39Z

LiamG:

Administration of nirsevimab (Beyfortus) for eligible infants and toddlers starts October 1, 2025.

The administration of maternal Abrysvo (given between 32–36 weeks of pregnancy) will continue year-round in the YK delta region.

The 50mg dose can be found in the OB pyxis, the OPC fridges have a supply of 50mg and 100mg, and village clinics and SRCs are in the process of being stocked.

If you have a specific patient in need of nirsevimab, or any questions at all, don’t hesitate to reach out to Kristina Morris, or the immunizations department, to assist. Keep in mind, Vactrak will NOT forecast correctly, especially 2nd season doses.

There is no projected shortage this 2025-2026 season and we aim to immunize as many as possible, as early in the season as possible. As of October 1, 2025, the YK delta has NOT yet seen RSV circulating in the waste water or a lab positive case of RSV.

Resources

[[Media:NirsevimabCheatSheet.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season Cheat Sheet]]

[[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]

[[https://health.alaska.gov/en/resources/respiratory-virus-snapshot/|Weekly Alaska Department of Health Respiratory Virus Snapshot]]

State of AK Epi Bulletin, RSV immunization guidance for the 2025-2026 season- RSV 2025-26 Season

Nirsevimab

2025-10-26T01:50:24Z

LiamG:

Administration of nirsevimab (Beyfortus) for eligible infants and toddlers starts October 1, 2025.

The administration of maternal Abrysvo (given between 32–36 weeks of pregnancy) will continue year-round in the YK delta region.

The 50mg dose can be found in the OB pyxis, the OPC fridges have a supply of 50mg and 100mg, and village clinics and SRCs are in the process of being stocked.

If you have a specific patient in need of nirsevimab, or any questions at all, don’t hesitate to reach out to Kristina Morris, or the immunizations department, to assist. Keep in mind, Vactrak will NOT forecast correctly, especially 2nd season doses.

There is no projected shortage this 2025-2026 season and we aim to immunize as many as possible, as early in the season as possible. As of October 1, 2025, the YK delta has NOT yet seen RSV circulating in the waste water or a lab positive case of RSV.

Resources
[[Media:NirsevimabCheatSheet.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season Cheat Sheet]]
[[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]
[[https://health.alaska.gov/en/resources/respiratory-virus-snapshot/|Weekly Alaska Department of Health Respiratory Virus Snapshot]]

State of AK Epi Bulletin, RSV immunization guidance for the 2025-2026 season- RSV 2025-26 Season

File:Specialty Calendar.pdf

2025-10-26T01:47:58Z

LiamG: LiamG uploaded a new version of File:Specialty Calendar.pdf

Regularly updated schedule field clinics at YKHC

File:YKHC Formulary.pdf

2025-10-23T00:33:44Z

LiamG: LiamG uploaded a new version of File:YKHC Formulary.pdf

YKHC Formulary, Hospital Formulary, formulary

Nirsevimab

2025-10-03T04:45:17Z

LiamG:

Administration of nirsevimab (Beyfortus) for eligible infants and toddlers starts October 1, 2025.

The administration of maternal Abrysvo (given between 32–36 weeks of pregnancy) will continue year-round in the YK delta region.

The 50mg dose can be found in the OB pyxis, the OPC fridges have a supply of 50mg and 100mg, and village clinics and SRCs are in the process of being stocked.

If you have a specific patient in need of nirsevimab, or any questions at all, don’t hesitate to reach out to Kristina Morris, or the immunizations department, to assist. Keep in mind, Vactrak will NOT forecast correctly, especially 2nd season doses.

There is no projected shortage this 2025-2026 season and we aim to immunize as many as possible, as early in the season as possible. As of October 1, 2025, the YK delta has NOT yet seen RSV circulating in the waste water or a lab positive case of RSV.

Resources

[[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]
[[https://health.alaska.gov/en/resources/respiratory-virus-snapshot/|Weekly Alaska Department of Health Respiratory Virus Snapshot]]

State of AK Epi Bulletin, RSV immunization guidance for the 2025-2026 season- RSV 2025-26 Season

Nirsevimab

2025-10-03T04:44:14Z

LiamG: Created page with "Administration of nirsevimab (Beyfortus) for eligible infants and toddlers starts October 1, 2025. The administration of maternal Abrysvo (given between 32–36 weeks of pregnancy) will continue year-round in the YK delta region. The 50mg dose can be found in the OB pyxis, the OPC fridges have a supply of 50mg and 100mg, and village clinics and SRCs are in the process of being stocked. If you have a specific patient in need of nirsevimab, or any questions at all, don..."

Administration of nirsevimab (Beyfortus) for eligible infants and toddlers starts October 1, 2025.

The administration of maternal Abrysvo (given between 32–36 weeks of pregnancy) will continue year-round in the YK delta region.

The 50mg dose can be found in the OB pyxis, the OPC fridges have a supply of 50mg and 100mg, and village clinics and SRCs are in the process of being stocked.

If you have a specific patient in need of nirsevimab, or any questions at all, don’t hesitate to reach out to Kristina Morris, or the immunizations department, to assist. Keep in mind, Vactrak will NOT forecast correctly, especially 2nd season doses.

There is no projected shortage this 2025-2026 season and we aim to immunize as many as possible, as early in the season as possible. As of October 1, 2025, the YK delta has NOT yet seen RSV circulating in the waste water or a lab positive case of RSV.

Resources

[[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]

The respiratory virus snapshot for the state, published weekly- Respiratory Virus Snapshot | State of Alaska | Department of Health

State of AK Epi Bulletin, RSV immunization guidance for the 2025-2026 season- RSV 2025-26 Season

Category:YKHC Guidelines

2025-10-03T04:40:53Z

LiamG: /* Preventative Health Care & Outpatient Protocols */

<pre style="color: green">
If you are having difficulty finding a specific guideline, Please use Ctrl+F. "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. If you are in a document or in a web browser, pressing the Ctrl key + the F key will bring up a search box in the top right corner of the screen.
</pre>

'''LOCAL GUIDELINE COLLECTIONS'''
 [[Media:Clinical Resource Book.pdf|YKHC Clinical Guidelines (Clinical Resource Book)]]
 [https://anmc.org/medical-professionals/clinical-guidelines/ ANMC Clinical Guidelines]

'''CLINICAL GUIDELINES (Arranged by system)'''

==General==
* [[Media:Use of Consultants.pdf|Consultations]]; [[:Category:Consults#Internal (Bethel) Consult Services|supplement]]
* [[Media:Guideline guideline.pdf|Guideline Guideline]]
* [[Media:Orders change process.pdf|Process to Update the EHR to Match Guidelines]]

==Critical Care & Emergency Medicine==
* [[Media:Acetaminophen overdose.pdf|Acetaminophen Overdose (Adult and Pediatric)]]; [[Acetaminophen Overdose|supplement]]
* [[Media:MI.pdf|Acute Coronary Syndrome (ACS/MI)]]; [[Myocardial Infarction – Acute|supplement]]
* [[Media:Burns Guideline.pdf|Burns (Adult and Pediatric)]]; [[Burn Evaluation and Treatment|supplement]]
* [[Media:VillageCode.pdf|Cardiac Arrest in Village]]; [[Village Code|supplement]]
* [[Media:Stroke.pdf|Cerebrovascular Accident]]; [[Ischemic Stroke – Acute|supplement]]
* [[Media:Adult Critical Care Guide.pdf|Critical Care Medications Guide (Adult)]]; [[Adult Critical Care|supplement]]
* [[Media:Pediatric critical care guide.pdf|Critical Care Medications Guide (Weight-Based – Pediatric)]]
* [[Media:Death.pdf|Death Protocol]]; [[Death Protocol|supplement]]
* [[Media:Frostbite.pdf|Frostbite (Adult and Pediatric)]]; [[Frostbite|supplement]]
* [[Media:Head injury adult.pdf|Head Injury (Adult)]]
* [[Media:Head injury peds.pdf|Head Injury/Concussion (<18 years)]]; [[Head Injury / Concussion Under 18 Years|supplement]]
* [[Media:HFNC.pdf|High-Flow Nasal Cannula (HFNC) (Pediatric)]]; [[High-Flow Nasal Cannula (HFNC) — Pediatric|supplement]]
* [[Media:Hypothermia.pdf|Hypothermia]]; [[Hypothermia|supplement]]
* [[Media:Intubation adult and peds.pdf|Intubation (Adult and Pediatric)]]; [[Intubation – Adult and Peds|supplement]]
* [[Media:ET CO2.pdf|Intubated Pediatric Patients: ET CO2 Monitoring]]
* [[Media:MTP.pdf|Massive Transfusion Protocol (≥14 years)]]
* [[Media:Medevac village to Bethel.pdf|Medevac Activation: Village to YKHC]]; [[:Category:Medevacs and Transport#Village to Bethel Medevacs|supplement]]
* [[Media:Medevac Bethel to Anchorage.pdf|Medevac Activation: YKHC to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:MedevacTrauma.pdf|Medevac/Transfer Process for Trauma]]; [[Medevac for Trauma|supplement]]
* [[Media:Activating emergency military transport.pdf|Military Transport for Emergencies (RCC)]]; [[:Category:Medevacs and Transport|supplement]]
* [[Media:Peds medevac.pdf|Pediatric Medevacs: Bethel to Anchorage]]; [[:Category:Medevacs and Transport#Bethel to Anchorage Medevacs|supplement]]
* [[Media:Procedural Sedation.pdf|Procedural Sedation & Analgesia Outside the OR (PSAOOR)]]; [[Procedural Sedation|supplement]]
* [[Media:Respiratory distress.pdf|Respiratory Distress & Bronchiolitis Management (<5 years)]]; supplement
* [[Media:Seizure evaluation peds.pdf|Seizure Evaluation (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Sepsis adult.pdf|Sepsis (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis meds adult.pdf|Sepsis Medications (Adult)]]; [[Sepsis – Adult|supplement]]
* [[Media:Sepsis peds.pdf|Sepsis (Pediatric)]]; [[Sepsis – Pediatric|supplement]]
* [[Media:Spinal cord injury.pdf|Spinal Cord Injury Management]]
* [[Media:Status Tx Adult.pdf|Status Epilepticus Treatment (Adult)]]
* [[Media:Seizure treatment peds.pdf|Status Epilepticus Treatment (Pediatric)]]; [[Seizure Evaluation – Pediatric|supplement]]
* [[Media:Strangulation.pdf|Strangulation]]; [[Strangulation|supplement]]
* [[Media:Trauma outside Bethel.pdf|Trauma Outside Bethel]]
* [[Media:Villages without health aides.pdf|Villages without Health Aides]]

==Abuse/Assault==
* [[Media:Adult sexual assault.pdf|Sexual Assault (≥18 Years)]]; [[SART|supplement]]
* [[Media:Suspected pediatric child abuse.pdf|Suspected Physical Abuse Procedure (Pediatric)]]; [[SART|supplement]]
* [[Media:Suspected pediatric sexual abuse.pdf|Suspected Sexual Abuse Procedure (Pediatric)]]; [[SART|supplement]]

==Endocrine==
* [[Media:Type 2 diabetes.pdf|Diabetes, Type 2]]; [[Type 2 Diabetes|supplements]]
* [[Media:Endocrine links page.pdf|Pediatric Endocrine Protocols (DKA, Endocrine Emergencies, and Follow-Up)]]

==Gastrointestinal==
* [[Media:CSID.pdf|Congenital Sucrase-Isomaltase Deficiency Resource]]; [[Congenital Sucrase-Isomaltase Deficiency (CSID)|supplement]]
* [[Media:H pylori dyspepsia.pdf|Dyspepsia/H. pylori (Adult and Pediatric)]]; [[Dyspepsia – H. Pylori|supplement]]

==Hematologic==
* [[Media:AdultAnemia.pdf|Anemia in Adults]]; [[Anemia in Adults|supplement]]
* [[Media:IV Iron.pdf|Iron Infusion for Chronic Iron-Deficiency Anemia (Adult and Pediatrics)]]; [[IV Iron|supplement]]

==Infectious Disease==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Botulism.pdf|Botulism]]; [[Botulism|supplement]]
* [[Media:Bronchiectasis peds.pdf|Bronchiectasis/Chronic Cough (<18 years)]]; [[Chronic Cough/Bronchiectasis – Pediatrics|supplement]]
* [[Media:EUA Molnupiravir.pdf|COVID: Molnupiravir, Emergency Use]]
* [[Media:EUA Paxlovid.pdf|COVID: Paxlovid]]
* [[Media:Croup stridor.pdf|Croup/Stridor (6 months - 3 years)]]; [[Croup/Stridor: Evaluation & Treatment|supplement]]
* [[Media:Fever less than 90 days.pdf|Fever (0-90 days)]]; [[Fever – Infants 0-90 days|supplement]]
* [[Media:UnderimmFever.pdf|Fever in Underimmunized Children]]; [[Fever in Underimmunized Children|supplement]]
* [[Hepatitis C]]
* [[Media:Influenza.pdf|Influenza (Adult and Pediatric)]]; [[Influenza|supplement]]
* [[Media:Cervical lymphadenitis peds.pdf|Lymphadenitis, Acute Cervical (Pediatric)]]; [[Acute Cervical Lymphadenitis Evaluation & Treatment – Pediatrics|supplement]]
* [[Media:Dex in meningitis from ANMC.pdf|Meningitis: Use of Dexamethasone]]
* [[Media:MIS-C.pdf|Multisystem Inflammatory Syndrome (MIS-C)]]
* [[Media:AOM peds.pdf|Otitis Media, Acute (3 months - 12 years)]]; [[Otitis Media 3 months–12 years|supplement]]
* [[Media:Peritonsillar abscess guideline.pdf|Peritonsillar Abscess (Adult and Pediatric)]]; [[Peritonsillar Abscess|supplement]]
* [[Media:GAS Guideline.pdf|Pharyngitis (Adult and Pediatric) (Group A Strep)]]; [[Pharyngitis|supplement]]
* [[Media:Pneumonia adult.pdf|Pneumonia (Adult)]]; [[Pneumonia – Adult|supplement]]
* [[Media:Pneumonia peds.pdf|Pneumonia Treatment (3 months - 18 years)]]; [[Pneumonia – Pediatric More Than 3 Months|supplement]]
* [[Media:Pertussis.pdf|Pertussis]]; [[Pertussis|supplement]]
* [[Media:Rabies.pdf|Rabies Prevention]]; [[Rabies|supplement]]
* [[Media:STI guideline.pdf|Sexually Transmitted Infections (STI)]]; [[Sexually Transmitted Infections|supplement]]
* [[Media:Joint and bone infections.pdf|Suspected Septic Arthritis and Osteomyelitis]]
* [[Media:Sinusitis peds.pdf|Sinusitis (4-18 years)]]; [[Sinusitis More Than 5 Years|supplement]]
* [[Media:SSTI.pdf|Skin and Soft Tissue Infection (Adult and Pediatric)]]; [[Skin and Soft Tissue Infection|supplement]]
* [[Media:Active TB.pdf|Tuberculosis: Active Pulmonary (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:LTBI.pdf|Tuberculosis: Latent/LTBI (≥14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Peds TB.pdf|Tuberculosis: Evaluation and Treatment (<14 years)]]; [[Tuberculosis (Active and LTBI)|supplement]]
* [[Media:Induced sputum peds.pdf|Tuberculosis: Induced Sputum Collection]]; [[Pediatric Induced Sputum Collection|supplement]]
* [[Media:UTI adult.pdf|Urinary Tract Infection (UTI in Adults)]]; [[UTI – Adult|supplement]]
* [[Media:UTI peds.pdf|Urinary Tract Infection (UTI from 3 months to 5 years)]]; [[UTI – Children 3 Months–5 Years|supplement]]
* [[Media:Varicella.pdf|Varicella (Chickenpox), Suspected]]; [[Varicella|supplement]]

==Neonatal/Pediatric Growth & Development==
* [[Media:PedsClinicAdmit.pdf|Admissions from Clinic (Pediatric Direct Admit)]]; [[Admissions from Clinic (Pediatric)|supplement]]
* [[Media:Caffeine Guideline.pdf|Caffeine Protocol, Post-NICU Discharge]]
* [[Media:FTT.pdf|Failure to Thrive in Children <24 Months]]
* [[Media:Hip infant.pdf|Hip Exam and Surveillance in Infants]]; [[Pediatric Hip Exam and Surveillance Protocol|supplement]]
* [[Media:Jaundice neonatal.pdf|Jaundice in a Baby <4 Weeks]]; [[Jaundice – Neonatal Evaluation & Treatment|supplement]]
* [[Media:Late preterm.pdf|Late Preterm and Low Birth Weight Newborns]]; [[Late Preterm|supplement]]
* [[Media:MPEWS flow.pdf|mPEWS Protocol for Pediatric Patients]]
* [[Media:Neonatal Abstinence Syndrome.pdf|Neonatal Abstinence Syndrome (NAS)]]; [[Neonatal Abstinence Syndrome|supplement]]
* [[Media:NCPAP.pdf|Neonatal Nasal CPAP Set-Up Guide]]
* [[Media:Newborn sepsis.pdf|Newborn Early Onset Sepsis/GBS]]; [[Newborn GBS & Infection Evaluation and Treatment|supplement]]
* [[Media:Glucose neonatal.pdf|Neonatal Glucose Screening]]; [[Neonatal Glucose Screening Evaluation and Treatment|supplement]]
* [[Media:Neonatal resuscitation summary.pdf|Neonatal Resuscitation Summary]]
* [[Media:NeoPuff set up.pdf|Neopuff™ Set-Up Guide]]
* [[Media:Surfactant Clinical Resource.pdf|Surfactant (Curosurf®) Administration Protocol]]; [[Curosurf Administration|supplement]]
* [[Media:HIEprotocolPAMC.pdf|Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy (HIE)- PAMC NICU Protocol]]
* [[Media:Village delivery (peds).pdf|Village Deliveries]]; [[Pediatric Village Delivery Orientation|supplement]]

==Obstetrics==
* [[Media:Anemia in pregnancy.pdf|Anemia in Pregnancy]]; [[Anemia in Pregnancy|supplement]]
* [[Media:Aneuploidy.pdf|Aneuploidy]]
* [[Media:Gestational diabetes.pdf|Diabetes, Gestational]]; [[Gestational Diabetes|supplement]]
* [[Media:Ectopic pregnancy.pdf|Ectopic Pregnancy Treatment]]; [[Ectopic Pregnancy – Treatment|supplement]]
* [[Media:First trimester vaginal bleeding.pdf|First Trimester Vaginal Bleeding]]; [[First Trimester Vaginal Bleeding: Ectopic Pregnancy Diagnosis & Treatment of Non-Viable Early Pregnancy|supplement]]
* [[Media:GBS maternal.pdf|Group B Streptococcus (GBS) Maternal]]; [[Group B Streptococcus (GBS) – Maternal|supplement]]
* [[Media:HIV prenatal screening and care.pdf|HIV Screening and Prenatal Care]]; [[HIV Prenatal Screening and Care|supplement]]
* [[Media:Chronic hypertension in pregnancy.pdf|Hypertension in Pregnancy, Chronic]]; [[Chronic Hypertension in Pregnancy|supplement]]
* [[Media:Gestational hypertension.pdf|Hypertension, Gestational]]; [[Gestational Hypertension|supplement]]
* [[Media:Severe HTN in pregnancy guideline.pdf|Hypertension in Pregnant and Postpartum Patients, Severe]]; [[Gestational Hypertension|supplement]]
* [[Media:Induction of labor.pdf|Induction of Labor]]; [[Induction of Labor|supplement]]
* [[Media:IHCP.pdf|Intrahepatic Cholestasis of Pregnancy (IHCP)]]; [[Intrahepatic Cholestatis of Pregnancy (IHCP)|supplement]]
* [[Media:IUGR.pdf|Intrauterine Growth Restriction (IUGR)]]; [[Intrauterine Growth Restriction (IUGR)|supplement]]
* [[Media:Village labor.pdf|Labor Patient in a Village]]; [[OB RMT#Labor in the Village|supplement]]
* [[Media:Molar pregnancy.pdf|Molar Pregnancy]]; [[Molar Pregnancy|supplement]]
* [[Media:Oligohydramnios.pdf|Oligohydramnios]]; [[Oligohydramnios|supplement]]
* [[Media:Post dates pregnancy.pdf|Post Dates Pregnancy]]; [[Post Dates Pregnancy|supplement]]
* [[Media:PPH.pdf|Postpartum Hemorrhage]]; [[Postpartum Hemorrhage (PPH)|supplement]]
* [[Media:Prenatal care.pdf|Prenatal Care]]; [[Prenatal Information|supplement]]
* [[Media:Preterm labor.pdf|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]]; [[Preterm Labor – Screening and Prevention|supplement]]
* [[Media:PPROM.pdf|Preterm Premature Rupture of Membranes (PPROM)]]; [[Preterm Premature Rupture of Membranes|supplement]]
* [[Media:Anti D immune globulin.pdf|Rhogam®]]; [[Anti-D Immune Globulin|supplement]]
* [[Media:TOLAC.pdf|Trial of Labor After Caesarian (TOLAC/VBAC)]]; [[Vaginal Birth After Cesarian|supplement]]

==Preventative Health Care & Outpatient Protocols==
* [[Media:Amoxicillin allergy trials.pdf|Amoxicillin Allergy Trials (Pediatric)]]; [[Amoxicillin Allergy Trials|supplement]]
* [[Media:Aspirin.pdf|Aspirin for Adults >40 without Known Cardiovascular Disease]]; [[Aspirin|supplement]]
* [[Media:Breast cancer screening.pdf|Breast Cancer Screening]]; [[Breast Cancer Screening|supplement]]
* [[Media:Cervical Cancer Screening.pdf|Cervical Cancer Screening with hrHPV]]; [[Cervical Cancer Screening|supplement]]
* [[Media:Colorectal Cancer Screening.pdf|Colorectal Cancer Screening]]; [[Colorectal Cancer Screening|supplement]]
* [[Media:Chronic pain.pdf|Chronic Pain Eligibility and Follow Up]]; [[:Category:Chronic Pain|supplement]]
* [[Media:Hyperlipidemia.pdf|Hyperlipidemia]]
* [[Media:Htn.pdf|Hypertension]]
* [[Media:Lead.pdf|Lead Evaluation (Pediatric)]]; [[Lead Evaluation – Pediatrics|supplement]]
* [[Media:Nirsevimab.pdf|Nirsevimab (RSV Antibody) 2025-2026 Season]]; [[Nirsevimab|supplement]]
* [[Media:Osteoporosis Screening and Treatment.pdf|Osteoporosis Screening and Treatment]]; [[Osteoporosis|supplement]]
* [[Media:Pre anesthesia management.pdf|Pre-Anesthesia Testing]]; [[Pre-Anesthesia Testing|supplement]]
* [[Media:NICU grad checklist.pdf|Primary Care for Ex-Premies - Checklist]]
* [[Media:Primary prevention CVD.pdf|Primary Prevention of Cardiovascular Disease]]
* [[Media:Return to sports guideline.pdf|Sports Clearance for Pediatric Patients with History of COVID-19 (return to play after COVID)]]; [[Sports Clearance for Pediatric Patients with History of COVID-19|supplement]]
* [[Media:Wound care supplies.pdf|Wound Care Supplies]]

==Psychiatry==
* [[Media:Alcohol hangover withdrawal.pdf|Alcohol Hangover/Withdrawal]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:ADHD.pdf|Attention Deficit Hyperactivity Disorder (Pediatrics)]]; [[Attention Deficit Hyperactivity Disorder in Children|supplement]]
* [[Media:Escalating patients.pdf|Care of an Agitated/Aggressive/Escalating Patient on Inpatient or DES]]; [[Escalating Patients|supplement]]
* [[Media:Intoxicated ED patient.pdf|Intoxicated Patient]]; [[Alcohol Hangover/Withdrawal|supplement]]
* [[Media:Title 47.pdf|Involuntary Psychiatric Admissions (Title 47)]]; [[Title 47 Hold|supplement]]
* [[Media:Psychiatricadmission.pdf|Psychiatric Admissions (General)]]

==Documentation==
* [[Media:Checklist for care conferences.pdf|Care Conference Checklist]]
* [[Media:DME documentation requirements.pdf|DME Documentation Requirements]]
* [[Media:Incontinence documentation requirements.pdf|Incontinence Supplies Documentation Requirements]]
* [[Media:Nutritional supplement documentation requirements.pdf|Nutritional Supplements Documentation Requirements]]