HealthGuide_Lao

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HealthGuide_Lao

2012 - Lao
52,957
2001
$ 53,431
$5,000 (ACS, 2008)
2010
14.2%
3%
2012
Lisa Scott
Sonia Ryang,
Henny Ohr,
Mone Aye (Karen), Cawi Tling (Burmese),
Christine Her & Neng Xiong (Hmong), Hoang Tran
(Vietnamese), Phensy Pane (Lao), Nara Chea (Khmer)
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
[email protected]
2
Henny Ohr
Executive Officer
Office of Asian and Pacific
Islander Affairs
Iowa Department of
Human Rights
[email protected]
1-800-922-8917
Lorna Hines & Tom Baccam
(Primary Health Care), Ana Coppola (Polk County Health
Department), Jeff Scott & Deb Meyer (Scott Pharmacy),
Shelley Horak (Iowa Department of Public Health),
Christine Taylor (Iowa Department of Human Rights),
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
12
EMERGENCY
911
911
Walk-in clinic
5 pm
911
clinic
t
911
(Ambulance)
t
t
"I speak Lao"
(Ambulance).
t
(Ambulance)
t
t
(Ambulance).
3
t
t
t
t
t
t
t
t
t
t
t
t
t
t
t
t
t
Form
t
t
(Title VI of the Civil Rights Act)
Visit their website at http://www.hhsgov/ocr/
4
(816) 426-7277.
(Form)
,
9
10.
(ID)
clinic
( programs )
Medicare
5
IOWA CARE
Iowa Care Transportation Program
t
319-356-2346
t
t
MEDICAID
t
twww.ime.state.ia.us/IowaCare/index.html
t
http://www.uihealthcare.org/
otherservices.aspx?id=227582
t
http://www.ime.state.ia.us/docs/
IowaCare_MedicalHomeExpansionMaps.pdf
Public Transit Systems
t
2012
EMERGENCY MEDICAID
t
515-233-7870
MEDICAID
Visiting Nurse Services:
515-558-9972; 48
21
Iowa Medicaid Non-Emergency Transportation Services
866-572-7662; 72
twww.ime.state.ia.us/Members
MEDICARE
t1-800-633-4227 (1-800-MEDICARE)
tOfficial U.S. Government Handbook on Medicare
thttp://www.medicare.gov/publications/pubs/pdf/10050.pdf
www.medicare.gov,
t
t
t
(Social Security)
1-800-772-1213
6
MEDICARE
IOWA CARE
HEALTH AND WELL
KIDS OF IOWA
(HAWK-I)
IOWA WOMEN, INFANTS,
& CHILDREN (WIC)
12
rMedicare Part A:
rMedicare Part B:
rMedicare Part C:
(A & B)
(D)
rMedicare Part D:
t
t
t
t
t
t
t
t
t
19-64
19
t
t
t
t
(December 2013)
t
t
2013
$40/
t
t(WIC)
7
HMO (Health
Maintenance
Organization)
PPO (Preferred
Provider
Organization)
Co-payment
Patient Advocate
Deductible
Co-insurance
Exclusions
Medical Home
Pre-existing
conditions
Premium
Paycheck
State
Primary Care
Doctor
1-888-955-1212
Referral
Service Area
8
Health History Intake Form
PATIENT HISTORY - #
PATIENT HISTORY Last Name
First Name
MI
Address
City
State
Home Phone #
Gender
Male
Employer:
Female
Marital Status:
Date of Birth
Zip
Single
Married
Other
Occupation:
Primary Care Physician:
Ethnicity
Number:
Languages Spoken
Insurance:
Policy #
Need an interpreter?
Yes
No
Group #
(Insurance card)
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? Check box if yes and write their relationship to you.
Diabetes:
High Blood Pressure:
Heart Disease:
Cancer:
Stroke:
Epilepsy/Seizure:
9
HEALTH HISTORY 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/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 -
10
Date
Reason
Date
Reason
Date
Reason
(bacteria)
(bacteria)
SCOTT
PHARMACY
1-800-246-0024
1-800-246-0024
238
S. Main St. Box 188
Fayette, IA 52142
Jeff W. Scott, R. Ph.
NO : 9 7 3 9 5 4 C BILL JONES, MD
03/15/12
JOHN SMITH
123 SOUTH MAIN ST ANYTOWN, IA 52211
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.
REFILLS: 0
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
National Institute on Aging
Safe Use of Medicines
Iowa Department of Human Rights
211
For Medical Emergencies
911
Iowa Poison Control
1-800-222-1222
515-242-5655
http://www.humanrights.iowa.gov/
800-222-2225
http://www.niapublications.org/tipsheets/pdf/
Safe_Use_of_Medicines.pdf
Iowa Department of Public Health
Rx Assist
515-281-7689
http://www.idph.state.ia.us/
Free Clinics of Iowa
Email: [email protected]
www.rxassist.org
Iowa Department of Human Services
515-954-7509
http://www.freeclinicsofiowa.org/clinics
County Health Departments in Iowa
515-281-7689
List of Iowa County Health Departments:
www.idph.state.ia.us/webmap/default.
asp?map=public_health_contacts
(food stamps)
http://www.dhs.state.ia.us/
Visiting Nurse Services
Community Resources Directory
515-288-1516
http://www.vnsdm.org/resources-directory.php
RHIN: Refugee Health Information Network
Florida Literacy Coalition
Staying Healthy Guide
Community Health Services
http://rhin.org/
407-246-7110
http://www.floridaliteracy.org/literacy_resources_
teacher_tutor_health_literacy.html
Primary Health Care, YMCA,
Selected Patient Information Resources
in Asian Languages (SPIRAL)
Families USA
Consumer Resources
http://healthfinder.gov/
617-636-2481
http://spiral.tufts.edu/
Health Resources and Services Administration
Iowa Women’s Health Information Center
877-464-4772
http://findahealthcenter.hrsa.gov/
Search_HCC.aspx
Senior Health Insurance Information Program
(Medicare)
800-351-4664
http://www.shiip.state.ia.us/
http://www.womenshealthiowa.info/
Women’s Health.gov
202-690-7650
http://www.womenshealth.gov/
Iowa Dental Association—Community Services
Florida Poison Information Center
Herbal Products
800-828-2181
http://www.iowadental.org/about_ida/
community_services.cfm
I-Smile™
866-764-5315
http://www.ismiledentalhome.iowa.gov
800-222-1222
http://www.poisoncentertampa.org/herbals.aspx
202-628-3030
http://familiesusa.org/resources/
resources-for-consumers/
Health Care
Affordable Care Act
877-696-6775
http://www.healthcare.gov
Iowa International Center
Welcome to Iowa Resources
515-282-8269
http://www.welcometoiowa.org/site/
Iowa International Center
Medical Terminology
515-282-8269
http://www.welcometoiowa.org/site/
medical-services/medical-vocabulary/

HealthGuide_Lao

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