Medical Clearances

AKA “Good Faith Exams”

INITIAL CLEARANCE GUIDELINES

The Portrait patient registration / GFE process needs to be comparable to the standard of care of an in-person examination. If the photos or history aren’t adequate to do a clinical assessment, please get the information you need. If there are discrepancies in the profile, clarify them prior to proceeding.

*** **You cannot evaluate, comment on, or clear for what you cannot see *****

***** When in doubt open a dialogue with the patient with your concerns *****

***** If you are uncertain after review of materials, please contact the Medical Director *****

Evaluate photos
1. Note that a photo is the only real detail you have for the patient. If photos are not appropriate, request new photos if possible before your appointment
  1. No filters, no group photos, no “senior year headshots” or IG/FB photos
  2. Color photos only
2. Even if photos are acceptable, please keep in mind the photos you are provided
  1. Ex: you cannot approve
    1. Sclerotherapy without photos of the legs
    2. Kybella without photos of submental area
    3. QWO without photos of buttocks/thighs
Skin Profile Section
1. It is important to consider that the patient has reported their own skin type
  1. This may need to be updated, as misrepresentation will drive system flags
  2. Review sunscreen frequency when considering what services to approve, and chart any guidance you give your patient
    1. “Please perform strict photo precaution measures for 2 weeks after microneedling procedure”
Medical Profile Section
1. Allergies – it is imperative that we screen for contraindications for services
  1. Overall, consider what the patient may be exposed to peripherally for any proposed treatment
    1. Patient reports allergy to lidocaine
  2. No Dysport if pt reports allergy to milk protein, dairy, bovine collagen
  3. No filler if reports allergy to gram positive bacterial proteins
    1. Warning for patients allergic to bee stings
  4. Consider ingredients in products
    1. Pt reports allergy to salicylic acid, they cannot be cleared for peels
  5. If you have any questions about allergies, please review the Notion page, which is found here.
2. Review current medications
  1. Expect that patients may list medications, but not the conditions for which they take them
    1. The EHR will flag procedures if the patient has an autoimmune condition, but this works only when the patient appropriately reports their condition. Some scenarios:
      1. If the patient is taking levothyroxine, it is imperative that you message the patient to inquire if their autoimmune thyroiditis is stable/controlled
      2. If the patient reports that they use Lantus, it is imperative that you inquire if they know their recent A1c and/or if their blood sugars are stable
3. Consider current topical medication
  1. If the patient is using a retinol and you are considering a peel, chart your guidance to the patient
    1. “Please discontinue use of retinols 1 week before and 1 week after chemical peels or microneedling”
4. Consider medical conditions
  1. Do not clear those with unstable neurologic conditions for neuromodulators
  2. Do not clear those with unstable autoimmune conditions for filer
  3. If you have any questions about what conditions are contraindicated for patients, please review the Notion page, which is found here
    1. If you are uncertain about a contraindication, please notify the Medical Director
5. Consider previous procedures
  1. The patient has tolerated neuromodulators or fillers in the past without complications.
    1. While this does not guarantee they will remain without complication, it’s important to take into consideration when clearing for proposed repeat procedures
Diagnoses Section
1. Your clinical judgment is imperative, and limited to the photos provided
  1. Your Clinical Directors will review your charts regularly, please provide images for their evaluation
  2. You are limited by what you see
    1. You cannot comment on localized adiposity in the submental area if that area is not in the photo you have
  3. Please be certain to comment on the negative findings
    1. No signs of infection or ptosis noted. These are pre-populated for your convenience
  4. Comment on what you see in the photo
    1. “Erythematous acneiform eruption noted at the medial cheeks and glabella, patient may benefit from superficial peels”
  5. Templates are in place for each diagnosis, but these must be edited to make them patient-specific.
Indicated treatments section
1. Here you will select the options the patient will be cleared for
  1. Approach clearances for everything patient are medically eligible for
    1. Use the “Sticky Notes” section of the chart to provide comments/instructions for the patient’s next visit (ex: note medical indication for propranolol)
    2. The “Medical Acknowledgment” section can be used to put a pop-up that will appear at each visit going forward (ex: confirm patient’s multiple sclerosis is inactive prior to treatment”
2. When reviewing options for treatment, please keep in mind: flags are dependent on hx the patient provides
  1. The patient may not list the conditions they have
    1. Patient reports levothyroxine, but not an autoimmune disorder
    2. Skin Type is self-reported and may need adjustment
  2. Keep in mind contraindications
    1. Patients with genuine Skin Type IV-VI
    2. Patients with a history of keloids
    3. If you have any questions about contraindications, please review the Notion page, which is found here
      1. If you are uncertain about a contraindication, please notify the Medical Director
3. Standing orders
  1. It is important that the standing orders you generate are customized for a given patient.
    1. Ex: a patient with a very small forehead or resting heavy brows should not receive the full “FDA indicated dosing”
    2. Standing orders should not and cannot be the same for every patient

RE-CLEARANCE GUIDELINES

Do NOT assume that the previous GFE is accurate (treat this as a new exam).