Introduction

In order to best position our company during the coronavirus (COVID-19) pandemic, we are closely monitoring the situation around the world, in our country and our communities.

Az Integrated is instituting strict measures companywide to help contain the spread of the coronavirus to protect our patients and staff alike.  Nothing is more important to us than the well-being of our patients, clients, staff, providers and officers.  We are keenly aware of the importance of doing anything and everything possible to help contain this deadly virus for the sake of our patients, community, and our world.  As such, we’re taking several new measures and strengthening other existing measures to safeguard all who come in contact with our business.

We take this public health emergency with utmost seriousness and we will expend continuous effort to combat this disease and save lives.  The following measures are currently being implemented.

AZ integrated and Telemedicine Service

As a healthcare provider at the community level we are offering services via telemedicine. On March 6^th Congress passes HR6074, Coronavirus Preparedness and Response Supplemental Appropriations Act. The bill gave The Department of Health and Human Services (HHS) the authority to lift restrictions on telemedicine services provided to Medicare beneficiaries. Currently, The Centers for Medicare and Medicaid Services (CMS) does reimburse for some remote care provided to patients. This includes virtual check-ins for all Medicare beneficiaries and medical visits at specified sites of service for Medicare beneficiaries living in rural areas. We are following CMS fact sheet for this developing information.

https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf

AZ integrated has decided to provide telemedicine service regardless of billing situation. We would bill and collect copay as regular face to face visit as mentioned in the above fact sheet. Please call us at 6233225700 if you would like to see your provider via the telemedicine platform.

Staff Training

Proper training of our staff is critical to deliver quality care in the safest possible manner.  All staff members who come in direct physical contact with patients are being trained on proper infection control measures as well as how to protect themselves so they don’t become patients themselves.

Below is an excerpt from our staff training:

In order for us to provide the best care to our patients, we need to follow strict infection control guidelines.  When it comes to caring for those in need during an epidemic of an infectious disease, the well-being of our patient is our top priority as is your well-being, therefore, the following measures must be strictly followed:

• Make sure you’re free from any respiratory illness when on duty; any “appearance” of being ill with a respiratory illness while caring for a patient is unacceptable during the COVID-19 outbreak; if you have severe allergy symptoms not well controlled with medications, discuss it with the management as early as possible prior to going to work
• Strictly follow the infection control guidelines you have learned during your training days. Review the CDC guidelines in the following link as soon as you have a chance:  (https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html)
• Always have a surgical mask ready around your neck so it can be worn right away before coming in close contact with a patient (within 6 feet); greet patients when they enter the clinic without a mask (and with a smile), then place the mask and explain it is for mutual protection (although most people will understand and appreciate it even without any explanation); wear disposable gloves when helping patients
• Only test patients with symptoms or in the high-risk category (travel or exposure history) until there’s an abundance of test kits
• When collecting specimens for COVID-19 (not applicable for all clinics), make sure you are wearing a face mask, eye shield and disposable gloves for your own protection
• Make sure you collect the specimen from patient’s nasopharynx (currently recommended by the CDC) as directed in the following link (https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html)
• Any patient in the following categories should have a face mask placed on them right away, and be referred to the nearest Emergency Room ASAP, then notify the ER that this patient is on their way and the reason for the referral:
  • Anyone with severe signs and symptoms of the flu such as fever, headache, myalgias, cough, dyspnea, chest discomfort, nausea or vomiting, etc.
  • Anybody who returned from high risk countries (China, Iran, Italy, South Korea, Japan, and other European countries) in the past 2 weeks and show any signs or symptoms suggestive of the flu
  • Those who had a known contact with anyone who returned from a high-risk country (above), or with anyone who was diagnosed with COVID-19, in the past 2 weeks
• Dispose of any potentially contaminated items according to infection control guidelines

Work Location

All Az Integrated employees whose function allow them the flexibility to work remotely from home are being allowed to telecommute to minimize physical gathering and possible transmission of communicable diseases.  Critical staff in our clinic locations are being trained and their prior knowledge reinforced so they practice the infection control measures in everything they do and with every patient they come in contact with. 

Communication

• To our Vendors and drug representatives – We are limiting visitation of any external personal for critical needs only. At this time we are advising drug company representatives to only provide written updates to their literature.
• To our patients – patients visiting our physical clinic locations will be managed according to the strictest infection control measures as delineated by the CDC guidelines; proper signage will be posted in each location and infection control measures will be taught by our staff
• To our staff – Az Integrated staff members are the heart of our organization and as such, they will be given all the necessary information of the current events involving the COVID-19 and how to best endure the hardships to protect themselves, their families and our patients; all Az Integrated staff will be trained in proper use and disposal of Personal Protective Equipment (PPE)

Providers

All Az Integrated providers are advised to adhere to general infection control measures so as to protect themselves, their family members and their patient

Recommendations Given to our Patients and Staff

The following are our recommendations to help control the COVID-19:

• Patients with neurological conditions such as MS, ALS, Parkinson’s disease, Alzheimer’s disease, seizures and other neurological illness should continue their treatment. There are no neurology specific recommendations from CDC.
• Avoid mass gatherings such as movie theaters, concerts, churches, meetings, crowded restaurants, etc. as much as possible as close contacts facilitate transmission of respiratory diseases like COVID-19.
• Stay away from people with respiratory diseases especially if they are coughing or sneezing, by keeping at least 6 feet distance which will significantly decrease your chances of catching the COVID-19 and other respiratory diseases.
• Avoid touching public surfaces (door knobs, other handles, handrails, etc.) as much as possible because germs can survive in inanimate objects for hours and be “picked up” by an unsuspecting person who touches the object then touches their face (eyes, nose or mouth).
• Wash your hands often – if you don’t have the habit of washing your hands often, this is a great opportunity to start a good habit; if you already do wash your hands often, keep it up – proper handwashing consists of rubbing hands and fingers with soap and running water for at least 20 seconds.
• Avoiding touching your face, especially the mouth, nose and eyes (the “T” zone) with unclean hands because these areas are the entry points for germs; as a general rule of thumb, you should refrain from touching your face with fingers as much as possible.
• Stay home when sick and cover your cough or sneeze with a tissue or shirt sleeve.
• Keep a “healthy” distance (social distancing) of at least 6 feet from others if you’re sick and coughing/sneezing.
• Notify your doctor ASAP if you develop “flu-like” symptoms such as fever, cough, body aches, abdominal pain, nausea, vomiting, diarrhea, etc.
• Notify your doctor and prepare to self-quarantine for 14 days if you have been in contact with anyone who returned from areas of the world with an outbreak such as China, Iran, Italy, South Korea, Japan or other European countries, or have themselves been exposed to someone with coronavirus.
• If you recently (within the past 2-3 weeks) returned from a high-risk country (China, Iran, Italy, South Korea, Japan or other European countries), you should be imposing self-quarantine for at least 14 days, if not already mandated by the government officials. If you have any symptoms suggestive of the “flu,” you MUST notify your doctor and/or local health department immediately, wear a surgical mask if you own one, avoid coughing or sneezing near others, call and notify beforehand and go to the nearest emergency room of a hospital while avoiding close contact with anyone until healthcare professionals “isolate you” with a face mask and other contact precautions.
• Whenever possible, utilize telemedicine services instead of visiting an ER or urgent care center to minimize exposure to “bugs” often present in waiting rooms.
  

Travel Recommendations According to Risk Levels

We divide our patient population into low, moderate and high-risk groups regarding travel and provide level-specific travel recommendations

• Low Risk
• Age < 60 with minor or no comorbidities and domestic travel
• Individuals in the low risk group are likely to have no symptoms or a mild form of COVID-19 (similar to mild flu) if infected with coronavirus.
• Moderate Risk
• Age < 60 with minor comorbidities and domestic travel destination or to low risk countries such as Canada
• Age 60-75 with no or minor comorbidities and domestic travel destination or to low risk countries such as Canada
• Individuals in the moderate (intermediate) risk group are probably going to be okay if infected with coronavirus, however, they should be careful and seek medical care as soon as possible following an exposure to be tested and to minimize possible complications.
• High Risk
  • Any age with major comorbidities regardless of travel destination
  • Any age regardless of comorbidities and travel destination to high risk countries
  • Individuals in the high-risk group are at high risk of developing the serious form of COVID-19 if infected with coronavirus, therefore, they should do everything they can to avoid catching it from others.

Our Stance on Face Masks

The use of a face mask provides a false sense of security but it does very little to protect the wearer of the mask from communicable diseases as tiny respiratory droplets can easily enter the airways of the person wearing a mask around the mask, through the mask, and through the eyes.  With that in mind, a mask will give some protection against larger respiratory droplets from an infected person, if they come directly on the face of the person wearing the mask, but if the droplet lands in the person’s eyes, they can become infected.  On the other hand, face masks can be very helpful in preventing the spread of respiratory diseases if the sick person coughing or sneezing wears it, as the mask traps most of respiratory particles coming from the sick person’s cough or sneeze.

In Summary

We will continuously monitor the rapidly evolving situation on COVID-19 at local, national and worldwide levels, and continue to adapt to best serve our patients, clients, staff, providers and all stakeholders associated with Az Integrated.