We often are asked if a new patient appointment can be scheduled as an annual visit, because many insurance companies require 1 annual visit per year, and often no co-pay / payment is required by the patient.
The focus of these 2 appointment types is significantly different, so our approach at Pure Medicine (and most primary care offices) is to schedule your first visit as a new patient appointment and during that visit, we will schedule your annual visit at the appropriate time after you are an established patient.
Once you're an established patient with Pure Medicine, annual visits are normally scheduled every year with labs drawn the week prior, so Dr. Pastorek can go over your lab results during the annual visit. Insurance companies generally require that your annual visit is at least 365 days after your last annual, so if you've had an annual visit done by a different clinic, it's important to know what date you were seen the previous year, so we can make sure we schedule your annual visit that date or later in the current year.
If you are unable to make your scheduled appointment for any reason, please give us a 48-hour notice, or you will be charged a $50 No-Show Fee.
We understand that situations arise which result in a need to reschedule your appointment. In such a circumstance, please give us a 48-hour notice by calling our office at (469) 414-9660 (press option 2 and leave a voicemail if needed).
Missing a scheduled appointment without giving us a 48-hour notice is considered a No-Show, which will result in a $50 No-Show Fee.
At your initial visit, we will ask you to sign consents/policies and answer questions about your medical history, including a list of the medications you're currently taking. Please have a list of all medications as well as doses and how you take the medication (once a day, twice a day, 2 at bedtime, etc.).
We'll need to know if you have any allergies to medication or if you've had any other issues or intolerable side effects with certain medications in the past.
We also will need to know what medical diagnoses you are currently dealing with or have dealt with in the past (e.g. hypertension, diabetes, high cholesterol, blood clots, cancer, heart disease, sleep apnea, thyroid problems, stroke, seizures, etc.), and what, if any, surgeries you've had.
We will ask for a family history - parents/grandparents/children/etc. - heart disease, diabetes, stroke, heart attack, blood clots, cancer, etc.
A social history helps us assess risk for certain health conditions, and we'll ask if you're a current or former smoker and how much alcohol (if any) you drink.
A review of systems is a list of yes/no questions going through every organ system and looks like this:
Constitutional Fever/Chills No. Weight Loss No. Night Sweats No.
Eyes Visual Changes No. Double Vision No. Blindness No.
Ears, Nose, Mouth, Throat Sore Throat No. Runny Nose No. Difficulty Swallowing No.
Endocrine On Hormone Replacement No. Diabetes No. Thyroid problems No.
Respiratory Asthma No. Coughing Up Blood No. Shortness of breath No.
Cardiovascular Heart Disease No. Chest pain No. Ankle Swelling No.
Gastrointestinal Abdominal pain No. Nausea No. Vomiting No.
Hematologic/Oncologic Cancer No. Blood Clots No. Anemia No.
Musculoskeletal Muscle Weakness No. Joint Pain No. Walk with cane/walker or use wheelchair No.
Skin Hair Loss No. Open Sores No. Rash No.
Neurologic Chronic Headaches No. Confusion No. Stroke No.
Psychiatric Anxiety/Depression No. ADHD No. Schizophrenia No. BiPolar Disorder No.
Symptoms not included above and/or explain any YES answers: ______________________________________________
We'll need a copy of your insurance card and drivers license for our records, and we'll take a face picture to attach on your electronic health record.
Once the consents/policies are signed and the medical history questions are answered, one of our medical assistants will take you back to an exam room, go over your medication list and answers to the review of systems questions, and take vital signs, including temperature, blood pressure, pulse, oxygen saturation, height, weight, and calculated BMI.
If you're 35 or older, or if you're younger and may potentially be place on any stimulant weight loss medication or if you have any cardiac symptoms/risk factors, we'll get a baseline EKG. If you've had a normal EKG within the last 6 months or if you are currently/regularly seeing a cardiologist, we may skip the EKG. You'll get a copy of your EKG after it is reviewed.
After our medical assistant is finished with vital signs/etc., you'll be taken to another exam room to see the doctor.
Dr. Pastorek will ask questions verifying/clarifying your medical history and will want to know the following:
Dr. Pastorek then will do a brief exam, listen to your heart and lungs, and ask if you're having any fever/chills/chest pains/shortness of breath/nausea/vomiting/abdominal pain or any other concerns.
Depending on your symptoms and/or lab or exam findings, Dr. Pastorek may recommend any of the following: over-the-counter treatments, life-style changes, prescription medications, further work-up (imaging studies/labs/etc.), physical therapy, or referral to a specialist.
Based on how long it's been since your last annual visit/lab tests, Dr. Pastorek likely will schedule you for your annual visit or a follow-up visit (if you need to be seen before your annual visit is due) and will order labs to be done the week prior to your annual visit or follow-up visit, so he can go over the results with you at your annual/follow-up appointment.
Most insurance companies require that your annual visits each year be done 365 or more days later than your previous one, so if your last annual was July 2nd, you can't do your next annual visit until July 2nd of the next year.
Annual visits also must be in person - they cannot be telemed visits.
For follow-up telemed visits (annual visits cannot be telemed visits), you'll need to have the capability to check your blood pressure, pulse, and weight and will need an internet or smart phone connection. You'll email your vital signs (blood pressure/pulse/weight) and near your appointment time, our office will send you a link. The visit with Dr. Pastorek will be similar to a Zoom call using doxy.me and can be done on a laptop (audio/video required) or smart phone.
Follow-up appointments are typically scheduled based on what issues are being addressed.
Examples:
Dr. Pastorek will electronically send most medications as needed (90 day supplies with refills for most non-controlled medications). If medication refills are needed before your next scheduled follow-up appointment, please call the office, press 1 for refill request, and let the operator know which medication refills you need, if Dr. Pastorek has prescribed this medication in the past, and if we should send the refill to the same pharmacy or a different pharmacy.
Please allow 2 business days for our office to process the refill request.
Dr. Pastorek only very rarely will prescribe Schedule II medications (most ADHD medications and narcotic pain medications are Schedule II medications).
For ADHD patients who need ongoing Schedule II medications, Dr. Pastorek normally refers them to psychiatry for their ongoing management and prescription refills.
For patients with chronic pain, requiring ongoing Schedule II narcotics, Dr. Pastorek typically refers them to a pain management specialist.
Certain anxiety medications (Xanax/Ativan/Valium) if taken daily, likely will require a referral to a psychiatrist for ongoing management or transition to more appropriate long-term therapy. For patients who take benzodiazepines such as Xanax/Ativan/Valium infrequently, Dr. Pastorek may refill them as needed if dosing doesn't become more frequent over time (would require psychiatry evaluation).
For sick visits, we may process certain rapid tests in the office (results in 5-15 minutes):
We also can collect a sample for a throat culture if needed, and we can collect a urinalysis and urine culture to send off if there are urinary symptoms or concerns for a urinary tract infection.
When Dr. Pastorek orders lab tests, we currently have a phlebotomist from Quest Diagnostics, who draws labs on site.
Samples are then sent to the Quest Lab for processing (can take a few days to get results for most labs - some labs, specifically hormone labs, can take a week or longer).
Alternatively, we can send the order to Quest Diagnostics or LabCorp if you prefer to have your labs drawn somewhere else (some labs have extended office hours, so this may be an option for you if you want labs drawn on a Saturday).
Fasting lipid panels and fasting blood glucoses are the 2 most common tests that require fasting. These labs are routinely ordered for the annual visit. You should be fasting at least 8 hours (12 hours is better) but should drink plenty of water, because it's sometimes difficult to draw blood from someone who is dehydrated. Also be aware that even black coffee has caffeine, which can raise your blood sugar (a water-only fast is preferred 8-12 hours before you have fasting labs drawn).
For most patients, Dr. Pastorek will order the following lab tests for the annual visit:
For patients on hormone replacement therapy or those who are having symptoms and require hormone labs, Dr. Pastorek will add the following lab tests:
Note: Prolactin level is only checked initially to make sure a pituitary adenoma isn't causing suspected hormone deficiencies.
NOTE: Dr. Pastorek does prescribe PrEP (Truvada/Descovy) for those requesting it.
PrEP requires that your STD/STI panel be checked twice a year and HIV testing be done every 3 months.
