COVID-19 OFFICE POLICY

I hope you all are staying safe and healthy! Get ready, this is a long one, and I ask that you read the entire document - I will need for you to print it out, sign the bottom and bring it to your appointment.

On July 1, 2020, the New Mexico Governor Lujan-Grisham extended the executive order 2020-004 order until August 30, 2020.

What does that mean for my upcoming appointment?

The restrictions set forth by the Public Health Order issued March 27, 2020 which affect the health care services and procedures I am able to provide have been reinstated.

What restrictions are those?

Health care facilities, ambulatory surgical facilities, dental, orthodontic and endodontic offices in the State of New Mexico are prohibited from providing nonessential health care services, procedures, and surgeries.

Non-essential health care services, procedures, and surgeries include those which can be delayed for three (3) months without undue risk to the patient's health. Examples of criteria to consider in distinguishing between essential and nonessential actions include:

a. Threat to a patient's life

b. Threat of permanent dysfunction of an extremity, including teeth, jaws, and eyes

c. Risk of metastasis or progression of staging

d. Prenatal and postnatal care

e. Any other factors that will conserve medical resources without creating an undue risk of permanent harm to patients.

This Order's prohibition on non-essential health care services, procedures, and surgeries is not meant to apply to:

1. The provision of emergency medical care or any actions necessary to provide treatment to patients with emergency or urgent medical needs

2. Any surgery or treatment that if not performed would result in a serious condition of a patient worsening

What does that mean for me?

You warrant care in my facility and need to keep your scheduled appointment, if you meet any of the following criteria:

• Pain Level is 6 or more on the 0-10 pain scale - see The PAIN Scale in the blog post below.

• You perform Fukada's Test (the MONSTER MARCH) for 60 seconds and you: move forward more than 1 foot, and/or step to either side more than 6 inches, and/or turn either direction more than 10 degrees, and/or you move backwards more than 6 inches.

• You are having or have had seizures since your last visit.

• You are having or have had facial or extremity twitching or paralysis since your last visit.

• You are having or have had a decline in your cognitive functioning since your last visit.

• You are having or have had debilitating migraines since your last visit.

• You are having or have had any of your joints slip out/dislocate, and/or lock up/freeze since your last visit.

• You are having or have had any extremity burning, numbness, tingling or altered sensation since your last visit.

• You are having or have had any extremity weakness since your last visit.

• You are having or have had any uncontrollable tremors or shaking of your head and/or extremities since your last visit.

• You are having difficulty performing your regular activities of daily living.

If you do not meet any of the above stated criteria, then I need to reschedule your appointment for after August 30, 2020.

I take the health of each of my patients VERY SERIOUSLY and want to protect each of you the best that I can. It is my hopes you will be respectful and help protect the health of other patients, as well as my health, so I may continue to protect yours. During the COVID-19 crisis, there will be some changes to your office visit experience. In order to be open and remain open, while following the New Mexico Department of Health guidelines and restrictions, I must implement the following which are NON-NEGOTIABLE. If you feel you cannot abide by the following guidelines, I respectfully ask that you do not come in to the office at this time.

1. Only one patient will be allowed in the office at any given time.

a. If families or spouses come with the person being treated, they must remain in the vehicle during the treatment session.

b. If multiple family members are being treated on the same day, the persons not being treated must remain in the vehicle until they are given the clear to come in for their treatment session OR sit in the office with a face mask/covering on the entire time they are waiting their turn.

2. Please look at the door prior to coming in for your treatment.

a. If there is a RED Do Not Enter sign, please do not come in the office - either there is already a patient in the office being treated or the office is being decontaminated from the previous patient.

b. If there is a GREEN Safe to Enter sign, the office has been vacated by the previous patient and the office has been decontaminated.

3. When you come for your appointment, please leave any bags, purses or personal items which you will not need for your appointment in your vehicle.

4. Please have a face mask/covering on BEFORE you come into the office.

a. Face mask/covering must be worn at all times.

b. Face mask/covering must cover your nose AND mouth at all times.

c. Halloween and/or tribal masks/coverings are not considered appropriate at this time.

5. Upon entering the office:

a. Please stand by the door until I am able to take your temperature. If your temperature is at or above 99.5° F, you will be asked to leave the office immediately and call the New Mexico Department of Health for follow up for COVID-19 testing.

b. If your temperature is below 99.5° F, you are to remove your shoes – if you do not have socks on, please inform me and I will provide you with a pair.

* It is preferable you wear your own socks to your appointments.

* It is preferable that you not wear shorts or short skirts to your appointments.

6. Once in the office, go to the Restroom and place your keys, cell phone, and wallet on the designated black counter top by the sink.

7. Remove your shirt.

8. Wash your hands, forearms and elbows with the red foam cleanser on the sink and dry the areas with the provided towels. IT DOES NOT MATTER THAT YOU JUST TOOK A SHOWER, THE RED FOAM CLEANSER IS AN ANTIMICROBIAL AND YOU OR SOMEONE AROUND YOU MAY HAVE PUT RESPIRATORY DROPLETS ON THESE AREAS VIA COUGHING OR SIMPLY SPEAKING ANY TIME BEFORE YOUR APPOINTMENT. I WILL BE TOUCHING THESE AREAS WITH MY BARE HANDS.

9. Put on the long sleeved T-shirt provided.

10. Put your face mask/covering back on if you removed it while in the bathroom.

11. When treatment is completed, remove the provided long sleeved T-shirt and socks, along with any towels you may have used, and place them in the laundry bin.

12. If you use the toilet at any time during your time in the office – WASH YOUR HANDS WITH SOAP AND WATER AFTERWARDS.

Please wash your hands PRIOR TO helping yourself to cookies, coffee or tea, AND use the disinfecting wipes to wipe down any containers, knobs, tea machine, and/or refrigerator door surface you may have touched.

SCREENING PROTOCOL:

I respectfully request that you delay making or reschedule your appointment if you or anyone you have come in close contact with currently meets or within the past 14 day has met any of the following:

• Has common cold or flu-like symptoms OF ANY TYPE - runny or stuffy nose, loss of smell, sneezing, chest congestion, sore throat, loss of taste, cough, fever, shaking chills, nausea, vomiting, or diarrhea. DO NOT MISTAKE THESE SYMPTOMS FOR ALLERGIES, IF YOU HAVE TAKEN AN ALLERGY MEDICATION AND STILL HAVE THE SYMPTOMS IT IS CONSIDERED A COLD OR FLU.

• Has been in person-to-person contact with someone with common cold or flu-like symptoms OF ANY TYPE

• Has been in person-to-person contact with someone who works around someone with common cold or flu-like symptoms OF ANY TYPE

• Has been diagnosed with Covid-19

• Has been in person-to-person contact with someone diagnosed with Covid-19

• Has been in person-to-person contact with someone who works around someone diagnosed with Covid-19

• Has travelled to high risk areas of COVID-19 (any area – village, town, city, county, state, country – with more than 5 confirmed cases), and/or they did not wear protective face mask/covering while in public, and/or did not practice appropriate social distancing while in public, and/or did not self-quarantine for 14 days after any of the aforementioned

• Has been in person-to-person contact with someone who has travelled to high risk areas of COVID-19 (any area – village, town, city, county, state, country – with 5 or more confirmed cases), and/or they did not wear protective face mask/covering while in public, and/or did not practice appropriate social distancing while in public, and/or did not self-quarantine for 14 days after any of the aforementioned

• Has been, yourself, or in person-to-person contact with someone who has been to a dine in or patio seating restaurant or bar. It does not matter if you or they did or did not wear a protective face mask/covering, as the protective facemask/covering had to be removed in order to consume food/drink, you/they have been in enclosed, poorly ventilated areas, or in an air draft outside with multiple people who were close enough to be exposed to a Covid-19 carrier.

• Has been, yourself, or in person-to-person contact with someone who has been to an on site/campus school (they have physically been going to a school or campus in any capacity) or has taken a school bus. It does not matter if they did or did not wear a protective face mask/covering, as the protective face/mask covering had to be removed in order to consume food/drink, you/they have been in enclosed, poorly ventilated areas, or in an air draft outside with multiple people who were close enough to be exposed to a Covid-19 carrier.

* IF YOU WORE A MASK WHILE IN CONTACT WITH THE AFOREMENTIONED, YOU MAY COME IN – EXCEPT THOSE GOING TO RESTAURANTS, BARS OR SCHOOLS

* IF YOU DID NOT WEAR A MASK WHILE IN CONTACT WITH THE AFOREMENTIONED, PLEASE REFRAIN FROM COMING IN AT THIS TIME.

NOTE: Santa Fe and the surrounding counties are all high risk areas at this time.

For your safety:

• I will be wearing a face mask and scrub cap while you are in the office;

• I will wear protective glasses while you are face up on the treatment tables;

• I will be changing all linens after each patient;

• I will spray down and wipe all surfaces with a combination of ODO-BAN disinfectant (EPA-registered) and hydrogen peroxide, and 95% isopropyl alcohol – using a fresh cloth each time and on each different surface;

• I will be using UVC and Ozone Lights in each room after each treatment;

• I will be changing my scrubs, scrub hat, protective glasses, and face mask after each decontamination procedure from the previous patient;

• As always, I will be continuously cleaning my hands and arms with disinfecting wipes and isopropyl alcohol during treatment and using chlorhexidine gluconate solution when I wash up between patients and decontamination procedures.

• The office now has a state-of-the-art air purifier in each room which filters and cleans the air of ultrafine particulate matter down to the size of .03 microns. (The average size of the corona virus particle is 0.120 microns).

Thank you for taking the time to read through this entire message. It is my hopes you will be honest and respectful of the new office guidelines - I do not enjoy having to call the New Mexico Department of Health to report people who have put me at risk, nor do I enjoy having to be constantly tested for COVID-19 and having to shut down for 14 days after someone violates the guidelines and lied about it in order to come in.

Please let me know if you have any questions or concerns. I look forward to continuing to assisting you with your healthcare needs.

Yours for better health,

Dr. P. Nadine Gonzales – Dr.G

PS - Some may have lost their jobs and/or their health insurance because of the COVID-19 crisis. Please call Medicaid at 855-637-6574 to see if you qualify for coverage. If you do not qualify for Medicaid, you can apply for discounted premium health insurance at BeWellNM.com or call 833-862-3935. Note that I am treating established cash patients and established patients who now qualify for Medicaid PRO BONO until July 31, 2020.

___________________________________________________

PATIENT SIGNATURE

 ___________________________

 DATE

THE PAIN SCALE

0 – Pain free.

Mild Pain - Nagging, annoying, but doesn’t really interfere with daily living activities. (1-3 Pain Level)

1 – Pain is very mild, barely noticeable. Most of the time you don’t think about it.

2 – Minor pain. Annoying and may have occasional stronger twinges.

3 – Pain is noticeable and distracting, however, you can get used to it and adapt.

Moderate Pain - Interferes significantly with daily living activities. (4-6 Pain Level)

4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.

5 – Moderately strong pain. It can’t be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.

6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.

Severe Pain - Disabling; unable to perform daily living activities. (7-10 Pain Level)

7 – Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.

8 – Intense pain. Physical activity is severely limited. Conversing requires great effort.

9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.

10 – Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.

When rating their pain, the most common mistake people make is overstating their pain level. That generally happens one of two ways:

Saying your pain is any number greater than 10 on a scale of 0 to 10.

While you may simply be trying to convey the severity of your pain, what your doctor hears is that you are given to exaggeration and he will not take you seriously.

Smiling and conversing with your doctor, then saying that your pain level is a 10.

If you are able to carry on a normal conversation, your pain is not a 10 - nor is it even a 9.

Consider the fact that natural childbirth (no epidural or medication) is generally thought to be an 8 on the pain scale. Just as with the first example, your doctor will think you are exaggerating your pain and it is probably not nearly as bad as you say.