HealthGuide_Khmer

2012 - Khmer
52,597
Iowa
2010
Iowa
4
2001
27.6
10%
37.6 (US census, 2000)
$53,431
$5,000
14.2%
Iowa (ACS, 2008)
Iowa
Iowa
Des Moines
2010
2012
Iowa
Iowa
Lisa Scott
Sonia Ryang
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
[email protected]
2
Iowa
Henny Ohr
Executive Officer
Office of Asian and Pacific
Islander Affairs
Iowa Department of
Human Rights
[email protected]
1-800-922-8917
Mone Aye
Her
Hoang Tran
Nara Chea
Cawi Tling
Phensy Pane
Christine
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,
Iowa
12
EMERGENCY
911
(Urgent Care)
911
(Walk-In Clinic)
5
911
911
"I speak Khmer."
3
Medicaid
Medicaid
http://www.hhs.gov/ocr/
4
(816) 426-7277
(allergies)
9 - 10
(ID)
(Medicare)
5
IOWA CARE TRANSPORTATION PROGRAM
Transportation to University of Iowa Hospitals
Patient Transportation Services at 319-356-2346
MEDICAID
www.ime.state.ia.us/IowaCare/index.html
http://www.uihealthcare.org/other
services.aspx?id=227582
http://www.ime.state.ia.us/docs/
IowaCare_MedicalHomeExpansionMaps.pdf
Public Transit Systems
2012
IowaCare
$1
$1
EMERGENCY
MEDICAID
515-233-7870
MEDICAID
Free Transportation to health care appointments
Medicaid
MEDICARE
65
Visiting Nurse Services
21
Medicaid
515-558-9972
48
Iowa Medicaid Non-Emergency Transportation Services
Medicaid
Iowa Medicaid Mileage Reimbursement Policy
IOWA CARES
MEDICAID
866-572-7662
www.ime.state.ia.us/Members
72
MEDICARE
Official U.S. Government Handbook on Medicare
r 1-800-633-4227 (1-800-MEDICARE)
r http://www.medicare.gov/publications/pubs/pdf/10050.pdf
www.medicare.gov
(Medicare)
(Social Security)
1-800-772-1213
(Medicare)
6
HEALTH AND WELL
KIDS OF IOWA (HAWK-I)
IOWA WOMEN, INFANTS,
& CHILDREN (WIC)
12
3
(Medicaid)
3
Medicare
A:
Medicare
B:
Medicare
C:
Medicare
D:
65
65
A&B
19
D
Iowa
64
(DHS)
Iowa
Iowa Cares
2013
Affordable Care Act
Iowa
19
$40
Iowa
Iowa
7
HMO (Health Maintenance
Organization)
PPO (Preferred
Provider Organization)
(credit score)
Co-payment
Deductible
Co-insurance
(Patient Advocate)
Exclusions
Medical Home
(PHP)
Pre-existing conditions
Premium
Iowa
(Consumer Assistance Program)
Primary Care Doctor
1-877-955-1212
Referral
Service Area
8
Health History Intake Form
PATIENT
HISTORY
-#
PATIENT
HISTORY
Last Name
First Name
Middle Initial
Date of Birth
1
Address
City
Home Phone #:
Gender
State
Male
Female
Employer:
Zip
Marital Status:
Single
Married
Other
Occupation:
Primary Care Physician
Ethnicity:
Phone #:
Languages Spoken:
Need an interpreter?
Insurance:
Policy #
Group #
Emergency Contact
Relationship
Phone #
Yes
No
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
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 -
10
Date
Reason
Date
Reason
Date
Reason
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 : 97 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
I-Smile™
IMPORTANT NUMBERS
National Institute on Aging:
Safe Use of Medicines
866-764-5315
http://www.ismiledentalhome.iowa.gov
211
For Medical Emergencies
911
Iowa Poison Control
1-800-222-1222
800-222-2225
http://www.niapublications.org/tipsheets/pdf/
Safe_Use_of_Medicines.pdf
STATE AGENCIES
Iowa Department of Human Rights
Rx Assist
Iowa
515-242-5655
http://www.humanrights.iowa.gov/
FREE OR LOW COST
HEALTH CARE SERVICES
Free Clinics of Iowa
[email protected]
www.rxassist.org
Iowa Department of Public Health
Iowa
515-954-7509
http://www.freeclinicsofiowa.org/clinics
515-281-7689
http://www.idph.state.ia.us/
County Health Departments in Iowa
Iowa Department of Human Services
food stamps
515-281-7689
List of Iowa County Health Departments:
www.idph.state.ia.us/webmap/default.
asp?map=public_health_contacts
[email protected]
http://www.dhs.state.ia.us/
[email protected]
http://rhin.org/
617-636-2481
http://spiral.tufts.edu/
877-464-4772
http://findahealthcenter.hrsa.gov/
Search_HCC.aspx
Senior Health Insurance
Information Program
Iowa
Medicare
800-351-4664
http://www.shiip.state.ia.us/
DENTAL
Iowa Dental Association:
Community Services
800-828-2181
http://www.iowadental.org/about_ida/
community_services.cfm
Florida Literacy Coalition:
Staying Healthy Guide
407-246-7110
http://www.floridaliteracy.org/literacy_
resources__teacher_tutor__health_literacy.html
Selected Patient Information Resources
in Asian Languages (SPIRAL)
INSURANCE
Health Resources and
Services Administration
Polk County
515-288-1516
http://www.vnsdm.org/resources-directory.php
MULTILINGUAL HEALTH INFORMATION
RHIN: Refugee Health Information Network
Community Health Services
[email protected]
Primary Health Care, YMCA, Free
Clinics and others
http://healthfinder.gov/
GENERAL RESOURCES
Visiting Nurse Services:
Community Resources Directory
WOMEN’S HEALTH
Iowa Women’s Health Information Center
Iowa
[email protected]
http://www.womenshealthiowa.info/
Women’s Health
Families USA: Consumer Resources
202-628-3030
http://familiesusa.org/resources/
resources-for-consumers/
Health Care: Affordable Care Act
(Affordable Care Act)
877-696-6775
http://www.healthcare.gov
Iowa International Center:
Welcome to Iowa Resources
202-690-7650
http://www.womenshealth.gov/
PHARMACY/MEDICINE
Florida Poison Information Center:
Herbal Products
800-222-1222
http://www.poisoncentertampa.org/herbals.aspx
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/