Specific Types of Appointments and Procedural Processes

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Dental Pre Op Appointments

  • Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and complete medication reconciliation.
  • Document physical exam
  • Complete pre-op form and indicate if patient is cleared for surgery.

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    • If not cleared for surgery contact surgical department and make the department aware
    • If you are uncertain if a patient is appropriate for surgery in Bethel, please discuss the case directly with the CRNA prior to approving or denying the surgery. We have CRNA’s to do anesthesia for pediatric cases here; more complicated patients who require an anesthesiologist’s presence are more appropriately managed in Anchorage.
  • Return chart to clerk and inform nurse that patient is ready to be transported to surgery department.

Well Child and Sports Physical Appointments

  1. Well child forms are located in RAVEN. Obtain the correct form for the age of your patient. If patient falls at an in between age use the lower age and document appropriate developmental age.
  2. Review patient chart for past medical and surgical history, recent hospitalizations and recent illness via RMT. Review current medications and perform reconciliation.
  3. Document Physical Exam
  4. Apply Flouride varnish to teeth if indicated. Located in physician consult room.
  5. Order current immunizations needed. Inform nurse that patient is ready for vaccines. Order varicella prior to appointment since it comes from pharmacy and can take up to 30 minutes.
  6. Give patient a reach out and read book at appropriate ages located in physician consult room
  7. Adolescent patients: Remember to review SBRIT (ages 14-20) and IMPACT Form for ages 15-20. Make appropriate referrals as needed.
  8. Sports Physical: Make sure parent has completed history on form. Document physical exam on form. Make a photocopy which will be scanned by clerk into multimedia section of RAVEN and hand parent the original form. Please make sure to check for hernia on exam if not previously documented.
  9. Head Start Program: Requires a PPD to be placed and reported before patient can start. Give parent a copy of well child form.

Developmental Delay

(last updated 11/17/20)

If the child is less than 3 years old

please be sure to submit a FIT (Family Infant Toddler Program) referral. Anyone can submit a FIT referral- health aides, providers, even the family can call and ask for an evaluation. You can submit a FIT referral from an RMT. This is for any delays with speech, gross motor, or fine motor. They can also start early before any delays are noted in patients who have risk factors for delay.

Language delay and/or fine motor delay only

  • if older than 3 years old or severe delay
  • Ability clinic in Anchorage can see these patients. They have a 4-6 week wait list currently for speech therapists, none for OT. They can do telehealth with village based patients.
  • To make a referral to Ability clinic, please choose “Refer to Peds Other” and one of the drop down options is Ability Clinic.
  • (Ability clinic does not have a consistent physical therapist)

Multidisciplinary Neurodevelopmental Clinic

  • If they are a NICU graduate, you have concern for Autism or Fetal Alcohol Exposure, or they have enough complicating issues that you think they would benefit from a full evaluation
  • Order: "Refer to Child Family Developmental Services External" (included in below power plan)
  • We have a specific power plan for the Child and Family Developmental Services Clinic at ANMC now.
    • In the Peds Referral folder (or by searching AMB Developmental Delay Referral External) you can access this power plan. It is also now included on all Well Child Powerplans.
  • Be clear which clinic you are specifically referring to (NICU grad, autism, FASD, Neurodevelopmental clinic, or just PT/OT/ST)
  • For any of the multidisciplinary clinics, they require labs, hearing and vision screenings as well as a full documented Well Child visit within the last 12 months with the referral. The power plan lists these things out and makes ordering them easy
    • If the child has not had hearing or vision screening within the past 12 months, place in the comments, “child requires hearing and vision screening in Anchorage.” and will get scheduled the day prior to appointment
  • We are working on making it possible for them to have VTC in the village and Bethel, but currently patients do have to travel to Anchorage

If you are non-pediatric provider and have any questions or think they need a more specific referral, you are welcome to either refer to pediatricians at YKHC for in person or telehealth OR consult a pediatrician by Tiger Texting them (Peds Wards on Duty or the inpatient or outpatient pediatrician directly).

If you think the child would benefit from pediatrician evaluation, we are doing a lot more telehealth now and we can get a lot done with good parent reporting. Please be sure to refer these kids to Bethel for pediatrician evaluation. Message the ChronicPediatricsCaseManagement Raven message address if you need any special attention.


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