General Adult Standing Orders
Anemia:
If patient has diagnosis of anemia on their problems list:
1. Test Hemoglobin every 3 months, or as ordered by Provider.
a. For patients with chronic anemias (sickle cell disease, Thalassemia) only as ordered.
OB Standing Orders
Establishing an OB patient/ positive pregnancy test:
Medical Assistants must attach a Centering brochure to the labels of each patient with a new diagnosis
of pregnancy prior to entering the room. A new diagnosis of pregnancy includes:
1. Patient with positive pregnancy test
2. Patient establishing prenatal care
It is the responsibility of the provider to deliver the brochure to the patient and explain the Centering
program. At the provider’s discretion, the MA may be asked to describe the Centering program to the
patient. LCHC offers the Centering Program (to be renamed June 2011) to women with low risk
pregnancies. It allows a Provider to give women prenatal education as a group. This allows them to
discuss their various experiences and provide support for one another. Each expectant mother will have
a chance to speak with the Provider alone that same day, but there is no waiting period. Centering has
had great outcomes, and has been the foundation of many close friendships.
Urine Cultures- All patients with positive nitrites in a Urinalysis Dipstick, must have their urine sent out
for a urine culture.
The following govern what an MA may do with OB patients:
A. Last Menstrual Period: Always record first day of Last Menstrual Period (LMP) in EMR
B. Urine: The following must be done on a patient’s urine:
 Perform confirmatory pregnancy test (urine HCG)
 Send out Urine Culture and Urine Tox screen at confirmatory visit
o Urine Culture (Pregnant) *make sure you select this one, not the regular Urine
Culture*
 Perform urinalysis (UA) and dipstick at every visit
C.
D.
E.
F.
Print WIC, Verification of pregnancy as needed
CBC, RPR and Glucola done at 26-28 weeks
GBBS and Genprobe done at 35-37 weeks
Questionnaires: Administer Edinburgh/HITS for every visit 0-65 days postpartum
G. Glucola
The guidelines for diabetes screening in pregnancy are changing. Each patient with a positive pregnancy
test will have a A1c done with the prenatal labs. The A1c does NOT need to be done by the MA. An A1c
over 6.5 will be referred to OBGYN (ie Drs. Haas, Hazra or Kwak). Also, instead of the 1hr glucola, MOST
patients will get a 2hr glucola and they will need to be FASTING. Fasting means 8 hours prior to the test
no food or water .


Glucola 1 hr (pregnant) - 50gm – rare circumstances only
Glucola 2 hr w/ fasting (pregnant) -75gm – this will be most patients
A point of care glucose should be taken prior to any fasting glucola being administered to patients. If the
result is <120, the patient can be given the glucola test and all specimens sent. If the result is >=120, the
ordering provider will be notified verbally or by flag and a fasting glucose test will be ordered & sent to
MSH lab.
Asthma Standing Orders
The following orders govern for MA responsibility for Asthma management:
Pull in Asthma Control Test (ACT) form in the EMR, print and have patient fill it out.
Ask patient first 4 questions on ACT form
ACT every 30 days for ALL asthmatic patients. Ask Kara Greeley
Pregnant patients DO need the ACT every month
Administer Spirometry testing yearly
Diabetes Standing Orders
The following orders govern what an MA may do involving diabetic patients.
1. Test HbA1C every 3mo (OB excluded)
2. Test BS every visit unless provider orders otherwise. If also testing HbA1C, use only ONE finger
prick.
3. Prepare patient for Lower Extremity Amputation Prevention (LEAP) foot exam: MA will ask
patients to remove shoes and socks before provider enters room.
4. Send out Microalbumin/Creat Ratio once a year (OB excluded)
General Pediatric Standing Orders
Urine: As with adults, all pediatric patients with positive nitrites in their Urinalysis dipstick must have
their urine sent out for a urine Culture.
Questionnaires:

Ages and Stages Handouts (Birth, 2mo, 4mo, 6mo, 9mo, 12mo, 15mo, 18mo, 2yrs, 3yrs, 4yrs and
5yrs)

Edinburg (newborn, 1mo, 2mo, 4mo, 6mo)

HITS (newborn, 1mo, 2mo, 4mo, 6mo, 1yr, and 2yrs)

MCHAT at 24-30mo visit

TRACK (asthma) at every visit (at least every 30 days) until the patient turns 5.
Vaccinations : Anytime a vaccination is required, the appropriate Vaccine Info Sheet must be given to
the patient’s
parents or guardians.
Consent for vaccines: Parents or guardians of the patient must sign a consent form for any vaccination
before administration.