Procedures for Resuming In-Office Appointments

As plans emerge to reopen society, we are committed to providing your family exceptional care and have carefully considered how to best support our patients during this time. Your family’s health and safety is our top priority as we implement procedures to resume in-office appointments beginning MONDAY, June 1, 2020.

Our goal is to maintain our office as a COVID-free environment, and to prevent the further spread of this disease in our community. Please be assured that we are taking every step possible to make our office safe for patients and staff, and we aim to be one of the safest establishments you will visit during this pandemic. We appreciate your understanding and cooperation with these new office procedures.


PREVENTION & SAFETY

Preventing Infection
Transmission of COVID-19 is mainly through respiratory droplets and close contact when an infected person coughs, sneezes, or talks. The CDC defines close contact as being within 6 feet or within a room or care area for a prolonged period without personal protective equipment OR having direct contact with secretions of a person with COVID-19 infection. SARS-CoV-2 is known to survive on surfaces for up to a week and in the air as aerosolized particles for up to 3 hours. The incubation period is thought to be 2-14 days. Patients are thought to be most contagious when they are symptomatic, however pre-symptomatic and asymptomatic patients can be contagious and able to spread the virus. The best way to avoid infection is to stay at least 6 feet (about 2 arms’ length) away from other people. Many of our new procedures are designed to make this possible.

Masks
The CDC recommends the use of cloth masks in public settings where social distancing measures are difficult to maintain. The use of masks serves two purposes:

  • To protect other people by acting as a physical barrier that limits the spread of viral and bacterial particulates from your nose and mouth.
  • To protect health care workers and other professionals who are not able to maintain appropriate social distancing measures because of their job.

We have set up separate work areas for our employees so they can maintain a distance of at least 6 feet during most of their work day. Our employees will wear masks whenever their tasks require close contact with other employees, and they will wear masks whenever they are assisting patients.

For the protection of all patients and employees, we require everyone 2 years and older to wear a mask while they are in our office. If you don’t have a mask, we will provide one.

Cleaning & Sterilization
We have increased our regular, thorough cleaning, and clean commonly-touched surfaces with disinfectant throughout the day where appropriate. Additionally, we use UV light to sterilize surfaces and air in exam rooms between each patient and in our reception and waiting room at night.


APPOINTMENTS & SAFETY PROCEDURES

The following procedures are aimed at making our office one of the safest businesses you will visit during this pandemic.

Most appointments will be by TeleVisit or phone:
For TeleVisits, instructions on how to log in through the Healow application will be given to you prior to your appointment. We are temporarily lifting the requirement that patients need to be seen in the office for a physical exam at least once annually so that prescriptions, forms, and letters may be completed in a timely manner. A TeleVisit may be required before forms, letters and prescriptions can be completed. When shelter-at-home orders are lifted, we will again require a yearly physical exam to maintain care with our practice.

In-Office Appointments:

  • Both parents may be present for in-office appointments, but all other adults and siblings who do not have appointments should remain at home. We can arrange for people staying home to attend the in-office appointment by TeleVisit.
  • Before all in-office appointments, we will be confirming that everyone attending the appointment is free of all COVID-19, cold and flu symptoms including fever, chills, cough, shortness of breath, loss of taste or smell, muscle pain, sore throat, nausea, vomiting, diarrhea, etc. If you or your child do have symptoms, we will reschedule your appointment and coordinate appropriate care. In-office screening for fever and other symptoms may also occur before your appointment.
  • Everyone 2 years and older must wear masks the entire time they are in the office. If you do not have a mask, you will be given one when you enter the office.
  • Toys have been removed from our waiting and exam rooms. Please bring any toys for your child that they would like to have during their appointment.
  • All check-in and check-out will be done virtually. Our reception will confirm demographics, insurance and payment information before each visit.
  • Patients will wait in their cars until the time of their visit, at which time our reception will call and instruct patients to go directly into an exam room.
  • I will wear a mask, eye protection, gloves and scrubs that will be changed for each appointment.
  • I will alternate appointments between two exam rooms. Between appointments, exam room surfaces will be cleaned with disinfectant, and UV light will be used to sterilize surfaces and air.
  • At the end of your appointment, our reception will do check-out while you remain in the exam room. Should you need supplements, our reception will gather them and put them in a paper bag labeled with your name on the shelf near the front door to take with you as you leave.
  • Please avoid gathering in the waiting room area or around our reception desk.

Supplement orders and pick-ups:
In the office, our reception will gather the supplements you need from the shelves for you. We ask that you try to place supplement orders in advance, as opposed to walk-in purchases, so we can have them packaged up and ready for you in advance. All pick-ups are no-contact. Supplements will be placed in a paper bag with your name clearly labeled on a shelf just inside our front door. Hours for supplement pick-up are Monday-Friday, 10am-6pm.

We are open for supplement orders by email or phone Monday-Friday, 10am-6pm, and you may place orders anytime through my new online store Healthy Kids Happy Kids Store (https://store.HealthyKidsHappyKids.com). All supplements are stored and shipped from our office, there is a “Pick Up At Office” shipping option, and shipping is free for orders over $99.


SPECIFIC APPOINTMENT TYPES & DETAILS

Well-child and immunization appointments. All well-child appointments will now be performed in 2 parts:

  • A 30-minute Televisit to discuss any questions and concerns, review developmental milestones, discuss anticipatory guidance, and give treatment and supplement recommendations. Having this appointment as a Televisit will allow a more comfortable “face-to-face” dialogue in the comfort of your home without wearing masks.
  • A 15-minute, in-office physical exam that minimizes contact and potential exposures for patients and staff.
  • These appointments may be scheduled on different days.
  • The cost for the TeleVisit well-care appointment is $220 and the in-office physical exam is $110. The combined cost of these two appointments is the same as our regular well-care appointment ($330).

Any child who is ill will be required to reschedule their in-office, well-child physical exam or immunization appointment until they are well. Please call us first thing in the morning of your child’s visit if you need to reschedule.

We are temporarily lifting the requirement that patients need to be seen in the office for a physical exam at least once annually before prescriptions, forms, and letters may be completed. When shelter-at-home orders are lifted, we will again require a yearly physical exam to maintain care with our practice. Please note that if more than a year has passed since your child’s last physical exam, you may be required to have a Televisit to complete certain forms, letters or prescriptions.

I encourage everyone to maintain the 30-minute Televisit portion of the well-care appointment so we can stay on top of optimizing your child’s growth and development. If you are able to weigh and measure your child’s height, these can be added to their Televisit. During the Televisit, we can determine whether the 15-minute in-person physical exam is necessary sooner rather than later. If new concerns have come up in between the Televisit and physical exam, you can schedule a follow-up Televisit first.

While I consider regular well-child appointments to be very important, during these extraordinary times, if your child is well and you have no concerns, it is not unreasonable to delay this appointment. Be assured that your child will remain a patient in our practice.

I am assuming schools will open on time in the fall, so when you are planning your child’s well-care appointments, please be sure to schedule them now if you will need an appointment before school starts. Summer is always surprisingly short, I want to make sure all our patients are prepared for school in the fall, and I anticipate late-summer appointments will fill up quickly.

Immunization appointments will proceed as scheduled. Please note that I am assuming school will start in the fall and that vaccine requirements will be the same and stringently enforced.

If you wish to reschedule or cancel your child’s existing well-child or immunization appointment, PLEASE call our office as soon as possible so that we may open that timeslot for another patient.


Sick/Urgent Appointments:

  • Any sick child who has a fever, COVID-19 symptoms, or known COVID-19 exposure will have the option to first do a TeleVisit if appropriate, and/or be referred to PAMF San Carlos Urgent Care, After Hours Pediatrics in San Mateo, an urgent care facility, or an emergency room where COVID-19 testing can be performed safely.
  • Sick visits will be offered as TeleVisits if appropriate.
  • We will see limited in-office sick visits, which will be scheduled after 3pm.

Lab review and other follow-up appointments:
All lab review or follow-up appointments will be done as TeleVisits or phone calls.


COVID-19 INFORMATION AND RESOURCES

A Holistic Pediatrician’s Guide to the Pandemic
(https://healthykidshappykids.com/pandemic-masterclass-replay/)
I taught this free, online Masterclass on how to be prepared for COVID-19, with in-depth information on actions and supplements to support your child’s immune system and reduce the risk of serious infection. Please take the time to listen if you haven’t already.

Integrative & Functional Medicine Strategies for the Pandemic
(https://healthykidshappykids.com/pandemic-strategies/)
I also created an online program where I go into much greater detail on how to strengthen our immune systems, specific supplement recommendations and dosages by age, and how to manage symptoms if you or your child gets sick with COVID-19.

Healthy Kids Happy Kids Blog
(https://healthykidshappykids.com/blog/)
Finally, I have published a large amount of detailed information about COVID-19 and what we can all do to stay safe on my blog and my social media accounts on FaceBook and Instagram. I am continuously publishing any new information I think will benefit all of us as we try to stay healthy during this pandemic. I encourage you to use these resources and to let me know if you have additional questions.


Your family’s health and safety is our top priority. Thank you for your understanding and your cooperation in keeping our community healthy and safe during these uncertain times. Please do not hesitate to contact us with any questions.

Sincerely,
Elisa Song