Iowa (ACS, 2008) 14.2% Lisa Scott Sonia Ryang. Henny Ohr. Iowa. Iowa. Iowa: Nara Chea. Lorna Hines & Tom Baccam
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1 Khmer
2 52,597 Iowa % Iowa (US census, 2000) $53,431 $5,000 Iowa (ACS, 2008) 14.2% Iowa Iowa Des Moines IowaIowa Lisa Scott Sonia Ryang Iowa Henny Ohr Iowa Iowa Iowa: Iowa Sonia Ryang Professor of Anthropology and International Studies C. Maxwell and Elizabeth M. Stanley Family and Korea Foundation Chair of Korean Studies University of Iowa sonia-ryang@uiowa.edu Henny Ohr Executive Officer Office of Asian and Pacific Islander Affairs Iowa Department of Human Rights henny.ohr@iowa.gov Mone AyeCawi Tling Christine HerHoang Tran Phensy Pane Nara Chea Lorna Hines & Tom Baccam Ana Coppola Polk County Jeff Scott & Deb Meyer Scott Shelley Horak Iowa Christine Taylor Iowa Karen Association of Iowa, Linda Her Thao, Naro Chea, Aung Han, Laury Aye, Mary Siang, Mal Sawm, Beverly Poduska, EMBARC, Vietnamese American Community in Iowa (VACI) Ngan Hoang Florida Staying Healthy: An English's Learners Guide to Health Care and Living Healthy, 2
3 (Urgent Care) (Walk-In Clinic) Iowa 12 EMERGENCY "I speak Khmer." 3
4 Medicaid Medicaid (816)
5 (allergies) 9-10 (ID) (Medicare) 5
6 IOWA CARE TRANSPORTATION PROGRAM Transportation to University of Iowa Hospitals Patient Transportation Services at services.aspx?id= IowaCare_MedicalHomeExpansionMaps.pdf Public Transit Systems 2012 IowaCare $1 $ MEDICAID Free Transportation to health care appointments Medicaid Visiting Nurse Services 21Medicaid Iowa Medicaid Non-Emergency Transportation Services Medicaid Iowa Medicaid Mileage Reimbursement Policy MEDICARE Official U.S. Government Handbook on Medicare (1-800-MEDICARE) (Medicare) (Social Security) (Medicare) MEDICAID EMERGENCY MEDICAID MEDICARE 65 IOWA CARES MEDICAID HEALTH AND WELL KIDS OF IOWA (HAWK-I) IOWA WOMEN, INFANTS, & CHILDREN (WIC) 6
7 12 3 (Medicaid) Medicare A: Medicare B: Medicare C: A & BD Medicare D: Iowa (DHS) IowaIowa Cares 2013 Affordable Care Act Iowa 19 $40 Iowa Iowa 7
8 HMO (Health Maintenance Organization) PPO (Preferred Provider Organization) Co-payment Deductible Co-insurance Exclusions Medical Home Pre-existing conditions Premium Primary Care Doctor Referral Service Area (PHP) (credit score) (Patient Advocate) Iowa (Consumer Assistance Program)
9 Health History Intake Form PATIENT HISTORY - # PATIENT HISTORY - Last Name First Name Middle Initial Date of Birth 1 Address City State Zip Home Phone #: Gender Male Female Marital Status: Single Married Other Employer: Occupation: Primary Care Physician Phone #: Ethnicity: Languages Spoken: Need an interpreter? Yes No Insurance: Policy # Group # Emergency Contact Relationship Phone # HEALTH HISTORY - Please list all the medications you are taking right now, including vitamins, herbs, and over-the-counter medicine. Medication How many times/day Strength Allergies and reactions to foods/medicines: Has anyone in your family ever had these problems? Check box if yes and write their relationship to you. Diabetes: High Blood Pressure: Heart Disease: Cancer: Stroke: Epilepsy/Seizure: 9
10 HEALTH HISTORY - Please check all that apply. - High Blood Pressure Diabetes Cancer Mental Illness Stroke Seizures Migraines High Cholesterol HIV/AIDS Heart Disease Liver (Hepatitis) Tuberculosis (TB) Asthma Ulcers Arthritis Hearing/Vision Problems Other: SOCIAL HISTORY - Do you smoke cigarettes? Yes No How many per/day Do you drink alcohol? Yes No How many drinks per day/week Do you use drugs? Yes No Which drugs? Do you use any illegal drugs? Yes No Do you have your immunization records? HOSPITALIZATION HISTORY - Date Reason Date Reason Date Reason SURGERY HISTORY - Date Reason Date Reason Date Reason 10
11 SCOTT PHARMACY REFILLS: S. Main St. Box 188 Fayette, IA Jeff W. Scott, R. Ph. NO : C BILL JONES, MD JOHN SMITH 03/15/ SOUTH MAIN ST ANYTOWN, IA JS LIPITOR 20MG TAB (PARK D WAR) #30 1 TABLET EVERY DAY IN THE EVENING FOR CHOLESTEROL Avoid alcohol and grapefruit juice. Report muscle joint pain or fever. Discontinue if PREGNANT. Exp date: 03/13 Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed. 11
12 IMPORTANT NUMBERS 211 For Medical Emergencies 911 Iowa Poison Control FREE OR LOW COST HEALTH CARE SERVICES Free Clinics of Iowa County Health Departments in Iowa List of Iowa County Health Departments: asp?map=public_health_contacts Community Health Services Primary Health Care, YMCA, Free Clinics and others INSURANCE Health Resources and Services Administration Search_HCC.aspx Senior Health Insurance Information Program Iowa Medicare DENTAL Iowa Dental Association: Community Services community_services.cfm I-Smile STATE AGENCIES Iowa Department of Human Rights Iowa Iowa Department of Public Health Iowa Iowa Department of Human Services food stamps MULTILINGUAL HEALTH INFORMATION RHIN: Refugee Health Information Network Selected Patient Information Resources in Asian Languages (SPIRAL) WOMEN S HEALTH Iowa Women s Health Information Center Iowa jpeterso@idph.state.ia.us Women s Health PHARMACY/MEDICINE Florida Poison Information Center: Herbal Products National Institute on Aging: Safe Use of Medicines Safe_Use_of_Medicines.pdf Rx Assist info@rxassist.org GENERAL RESOURCES Visiting Nurse Services: Community Resources Directory Polk County Florida Literacy Coalition: Staying Healthy Guide resources teacher_tutor health_literacy.html Families USA: Consumer Resources resources-for-consumers/ Health Care: Affordable Care Act (Affordable Care Act) Iowa International Center: Welcome to Iowa Resources Iowa International Center: Medical Terminology medical-services/medical-vocabulary/
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Amarillo Endoscopy Center Srinivas Pathapati, MD., PA 6833 Plum Creek Drive Amarillo, TX (806)
Today s Date: / / PATIENT INFORMATION Patient s Last Name First Middle Mr. Miss Mrs. Ms. Marital Status (Circle one) Single / Mar / Div / Sep / Widow Legal Name (If applicable) Maiden Name Birth Date Age
The Priority Care Center
The Priority Care Center Care Coordination Services The Priority Care Center offers Care Coordination services to individuals needing extra support in meeting their health related goals. Services include:
DRUG / MEDICATION ALLERGIES: (include: Type/Reaction)
NASSAU CHEST PHYSICIANS PC MEDICAL QUESTIONNAIRE 1 DATE: PATIENT NAME: DOB: DRUG / MEDICATION ALLERGIES: (include: Type/Reaction) 9/1/2014 PHARMACY NAME PHARMACY PHONE PHARMACY Street Address City State
3-Steps to Organizing Your Medical Life Program Overview
3-Steps to Organizing Your Medical Life Program Overview Developed by Extension Educators: Annetta Jones ajones1@purdue.edu Mary Ann Lienhart Cross lienhart@purdue.edu Program Description When was the
Hale Ola Kino Maika i
We ve teamed up to make it easier for students to access healthcare in their school! Together, we are your School-Based Health Center! Waianae High School (WHS) is proud to partner with Waianae Coast Comprehensive
BETHESDA DENTAL GROUP
PLEASE COMPLETE ALLINFORMATION THAT APPLIES TO YOU - THANK YOU PATIENT LAST NAME: FIRST: INITIAL How did you hear about us? Whom may we thank for your referral? Date of Birth: Single: Married: Divorced:
School Year
2017-2018 School Year Dear Parents/Guardians: Did you know that your son or daughter can get Health Care at school? Vashon Island High School has a School-based Health Center (SBHC) that is located in
Independent Wellness Center 1000 W. Apache Trail, Suite #108, Apache Junction, AZ Phone# Fax #
PATIENT INTAKE Welcome t o Independent Wellness Center. In order to provide you with the best health care and assist you with other details of our clinic, we have provided the following information. We