CALLING THE OFFICE

What happens if I call the office with a medical question?

The receptionist will give the message with your chart to the medical assistant, who will then call you back, usually within a few hours. You may be asked to schedule an appointment, if one is needed.

If you are asking for a prescription, please give us a pharmacy number, state any allergies, and say specifically what you would like to have. You may be asked to schedule an appointment.

What if I want to speak directly to the doctor?

Calls "for the doctor or nurse practitioner only" usually can't be returned until after 6 pm, or sometimes during the next business day. You will get a much faster response if you leave a message with the medical assistant, who can then relay a response from the doctor.

What if my doctor or nurse practitioner is not available, or out of town?

Leslie Vietmeier can see patients for Dr. Starkebaum and Dr. Graunke, if they are not available.

If Leslie is not available, Dr. Starkebaum will see her adult patients. Dr. Graunke will see her children and adolescent patients.

REFERRALS

What do I need to know about referrals? How do I get one?

Generally, you should bring your concerns to your primary care provider first. If your insurance requires a referral in order for them to cover a visit or a test, we need to agree in advance that a referral is indicated.

Referral forms must state
-to whom (full name, address and fax),
-for what problem,
-and for how many visits.

They may need to be "renewed" after three or more months. We will try to make the referral to a specialist who is contracted with your insurance.

Retroactive referrals are generally not accepted by insurance companies.

Referrals are generally done in our office on Tuesday or Wednesday unless it is very urgent.

IMPORTANT: If a specialist suggests you see another specialist, check back with our office first! Many times, your insurance company will only pay if the referral is from your primary care-giver - in advance. Please tell us before you see the second specialist!

If you plan to see another practitioner, but don't need a referral:

Please let us know.

You will get better care if we can send them some of your medical history.

Please ask them to send us a report, so we can take better care of you.

Part of our job is to help coordinate your care, and avoid duplications and omissions.

What if I want a second opinion?

We will be happy to help you arrange for a second opinion.

FORMS

If I need a form filled out by my doctor or nurse practitioner, what do I do?

For any paper-work you would like us to do for you, please make an appointment and bring the form in at the time of the visit. Even if you have just been in, we may not have the information we need. If it is important enough to do, then it needs to be done right.

Such paper-work may include school or other "physicals," disability documentation, prescriptions for medical equipment, justification for "un-covered" meds, L&I (workman's comp), Family Medical Leave Act or POLST (advanced directive) forms, work excuses, retirement home admission forms, etc.

LAB TESTS

Where will my lab tests be done?

We do some tests in the office, including urinalysis, rapid strep, glucose, pregnancy, microscopic exams. We bill for these directly.

Blood work and other tests are usually sent to NW Hospital, sometimes to Dynacare or LabCorps. They will bill your insurance. We will bill a small specimen collection fee.

You may also request that we fax a prescription for lab work to another lab site, including Children's Hospital, if that is more convenient. You would generally need an appointment here first to determine what tests are appropriate.

What is a "fasting" blood test?

If you are asked to "fast", do not eat or drink anything for 8 hours before the test, except water, tea or coffee without sugar or milk. Blood sugar and cholesterol tests may be more accurate if you are fasting.

How will I be notified of test results?

We will report all lab and other test results to you, within one or two weeks, either by letter or by telephone.

Please let us know if it is OK to leave a message.

If you would prefer that we send you an actual copy of your lab results, please ask.

If you do not get a result within 2 weeks, please call us.

IMMUNIZATIONS

What immunizations do you offer?

For children:
DTaP (diphtheria, tetanus, acellular pertussis)
MMR (measles, mumps, rubella)
IPV (Polio)
Hepatitis B
Hepatitis A
Rotavirus
HIB (hemophilus)
PCV-7
Varicella (Chicken Pox)
Influenza
Gardisil ( for HPV)

For adults: Td and Tdap (tetanus, diphtheria, acellular pertussis)
Pneumovax
Influenza
Gardisil (HPV)

We can write prescriptions for:
Hepatitis A and B for adults
Zostavax (for people over 60, to prevent shingles)

MEDICAL RECORDS

Who has access to my medical records?

PATIENT SATISFACTION

What if I have bad side effects, or my treatment doesn't work?

Please tell us, so we can work together to find a better treatment plan or send you to see a specialist, if that is needed.

What if I am unhappy with my care?

Please tell us! It is our intention that you get excellent care. But we can't fix what we don't know about. Call, come in or write us a letter so we can work with you toward a solution.

What if I am happy with my care?

Tell all your friends! Put it on the internet!

Our practice grows with your satisfaction.

ADVANCED DIRECTIVES

What about Advanced Directives and Medical Power of Attorney (MPOA)? What is a POLST form, and do I need one?

Physician Orders for Life-Sustaining Treatment form (usually on bright green paper) is a list of medical orders, signed by your medical practitioner, stating what medical interventions you do, or do not, want for end of life care, if you are not able to speak for yourself. Usually you would ask your provider for this form when your death within the next six to twelve months would not be surprising.

Advanced Directives and Medical Power of Attorney statements are more general. If you have these, please bring in a copy and discuss it with your doctor or nurse practitioner. We need to know what you want, so we can order correctly for you.

Any and all medical care is done with your consent, and you have a "line-item veto" power. You would be responsible for the consequences, of course, if you don't follow medical advice. But care cannot be forced on you without your consent.

Advanced directives, medical power of attorney and POLST forms only take effect when we are not able to ask you. When we are able to ask you directly, we do. And you are entitled to change your mind at any time, regardless of what you have written in the past.

In the absence of any instructions, in a crisis, or when in doubt, we will do everything we can to protect your life. But "tubes" can always be removed, if they are not serving your wishes. And we would always act to keep you as comfortable as possible.

Regarding life-sustaining treatment, the crucial question is - Under what circumstances would your life no longer be meaningful to you? In other words, at what point would you want to be treated for comfort only, and not to prolong your life.

If you have named a Medical Power of Attorney, that person is supposed to authorize for you what you would have wanted if you were able to speak for yourself. Therefore, it is important that you tell that person directly what you would want. It would be helpful if you would tell your practitioner also, so we can comply with your wishes.