Welcome! Thank you so much for attending here at SFFC! We hope you have a terrific time teaching and helping our patients get great primary care.  

Chart Documentation  

If possible, please review and sign off on notes before you leave.   

Please review the Epic documentation video before your first clinic session. Even if you have used Epic before, the video covers clinic-specific work flows — feel free to watch at 1.5 speed if you are comfortable with Epic in the outpatient setting. The video is “for trainees”, but the information is equally relevant for attendings!

Health Care Access 

All patients eligible for insurance programs (Medi-Cal, Medicare, HSF) should be encouraged to sign up. We have a social worker Beth and case manager Sumner who can help patients navigate the insurance system. Patients who have health care needs outside the scope of our clinic (need ongoing specialty care, need advanced imaging, etc), should be referred for insurance counseling.  

Labs:   

Please order labs judiciously, as they can be expensive. Labs should only be ordered from the EPIC “Preference List”, as these are set up to interface with the correct lab and account. Please have a provider walk you through the process of using the preference list if it is your first time. If you would like to order a lab that is not on the “Preference List” please let a regular attending know to ensure the laboratory is ordered correctly.  

Imaging studies:   

SFFC pays for the following imaging studies: 

$25-$75 per Xray   

$75-$225 per ultrasound (limited to 5 per month) , 2-3 times more expensive for TVUS

Hundreds of dollars for CT/MRI   

Though discretion lies with the attending provider, we generally don’t perform surveillance imaging (for example yearly surveillance ultrasounds for thyroid nodules or ovarian cysts). Any requests for CT/MRI will need to be approved by the medical director. If imaging is needed URGENTLY, please refer to the ED. Please see the posted policy in the Doctor’s Lounge for more details.

Medications:   

We have a supply of medications, but if patients can afford low-cost prescriptions, please send a prescription instead. (Antibiotics are the exception to this – feel free to dispense these regardless of ability to pay.)   

Options for low-cost medications include:   

https://www.goodrx.com/provider   

https://costplusdrugs.com/providers/   

https://tgtfiles.target.com/pharmacy/WCMP02-032536_RxGenericsList_NM7.pdf   

If you are dispensing meds from our supply closet, please be sure someone helps to sign them out and remember to update the medication list in Epic.  Sometimes patients get medications through us through a Patient Assistance Program.   

Visitors from abroad

While we have never delineated the geographic scope of those we care for, in general we would like to avoid extensive work-ups, annual exams, and specialty referrals for short-term visitors who have access to adequate care in their home countries. Please see posted policy in the Doctor’s Lounge for additional details.

Referrals to specialists:   

SFFC has a network of volunteer specialists who will see patients for free as a one-time consultation. Talk with the M.A. staff about how to refer. Please be careful that patients sent to specialists will not be overly demanding. If you are not sure how a patient might behave, please refer them to the back-up county system (i.e. usually SFGH). You may also get an e-consults through the MAVEN Project (talk to regular attending or medical director about how to refer).

Procedures 

The following is a list of procedures that are offered ‘in-house’ by either staff attendings or specialists that see patients in clinic: 

  • Toenail removal 

  • Cryotherapy 

  • IUD placement/removal 

  • Joint injections (knee, shoulder) 

  • Endometrial biopsy 

  • Colposcopy 

  • Skin biopsy (punch, shave, excision) 

  • Cyst removal (location dependent) 

In general, we do not perform cosmetic procedures at SFFC. However, if there is a medical reason for the procedure (e.g., if a cyst becomes irritated or inflamed), it may be performed.  

Patients not eligible for insurance may be able to get procedures and surgeries done through Operation Access.    
   

In-house specialists include:   

  • Gynecology   

  • Psychiatry   

  • Rheumatology   

  • MSK clinic   

  • Physical therapy (limited – often just one time)   

  • Dietitian   

  • Social work (for insurance referrals as well as limited counseling)   

  • DM retinopathy screening 

    
Colon cancer screening:   

We do not have ready access to colonoscopy, so please offer FIT testing instead.   

Breast cancer screening:   

We can obtain free mammograms through the CPMC Breast Health Center. They require a screening breast exam prior to referral (if abnormal, they will do a diagnostic instead of a screening mammogram).   

Vaccines:   

These are available in clinic: 

  • Tdap   

  • COVID (Moderna) 

  • Influenza  

  • Hepatitis A, Hepatitis B (2-dose Heplisav), TwinRix (3-dose Hep A/B)   

We can apply for patients to get (or refer to DPH vaccine clinic for free/lowcost vax):   

  • Gardasil   

  • Shingrix    

Referral to county services:   

As a reminder, our patients are uninsured. If you have to send them to the county hospital for specialty or acute/emergent care, we cannot guarantee what the cost might be. Many are likely eligible for some assistance, but for patients with a travel or student visa, there may be little to no discount. Please be sure to send patients to the county hospital where they reside. (It is also important to ensure they understand we do not have control over the financial piece.)   

Diabetes patients:   

Dr. Ashley Tsang runs our Wednesday morning diabetes clinic. If possible, when seeing a diabetes patient, please use .DMTEMPLATE in the “Overview” section of the problem list to document health care maintenance.  We have CGMs to give patients but typically reserve their use for patients on insulin. Other patients w/ uncontrolled DM may be offered a short trial of CGM (2 weeks or 4 weeks) if felt that it would change management, at attending discretion.  

After-hours care:

The clinic is closed after office hours. We do not take any after-hours call, so patients are referred to urgent care or the ER on the phone message system. 

Emergency kit: 
Has epinephrine, IV Benadryl, NTG, ASA… 
Located in laboratory above sink. 
Eyewash and eyeshields are also in the lab. 
Oxygen tank is in room 5. 
In a real disaster, there are emergency food and water rations downstairs in the basement.