How do I make an appointment?
There are several ways you can make appointment. You can call the clinic during regular business hours M-F from 07:30AM to 16:30PM. *Note we are closed every Thursday beginning at noon and on all Federal Holidays. The appointment number is (717) 245-3400. If you call for an urgent appointment after hours when clinic is closed, you will be directed to the answering service who will contact the on-call provider. You should call 911 or go to your nearest Emergency Room for all medical emergencies. We DO NOT provide Emergency Services. Appointments can also be booked on-line at http://www.tricareonline.com. You will need to register each family member and follow the on-line prompts to do complete this process. A parent must enter the child’s user ID and password to book an appointment for their child. The system will not accept the parent’s password to book an appointment for their children; you MUST use the child’s unique password. Follow-up appointments requested by the provider can be made by a nurse before you leave the clinic.
What is Patient-Centered Medical Home (PCMH)?
PCMH is a patient-focused approach to primary care practice that is supported by major health care organizations such as: the American Medical Association (AMA), American Academy of Family Physicians (AAFP) American Academy of Pediatrics (AAP) and the American College of Physicians (ACP). It provides a “Team-Based” delivery of healthcare to our Soldiers, retirees and family members. An important part of this process is to develop a partnership between you and the Medical Home Team. This partnership will assist you in developing realistic strategies that target your health care issues as well as preventive strategies to prevent chronic disease.
Why are we doing it?
PCMH is mandated by the Office of the Secretary of Defense as the standard practice model for Primary Care delivery across the Military Health System, because it is consistently associated with better outcomes and reduced mortality. Using a patient-focused care coordination approach has resulted in: fewer preventable hospital admissions for patients with chronic diseases, lower service utilization, improved patient compliance with recommended care, decreased healthcare costs and higher patient and staff satisfaction.
What improvements can I expect?
You can expect improved access to Primary Care appointments by managing telephone calls and electronic appointment scheduling. All in-coming calls follow a pre-determined algorithm by our Call Center, whose goal is to: reduce waiting time for the caller by efficiently routing calls to the appropriate person. The Clinical Care Coordinator is a Registered nurse who will communicate your questions or messages to your Provider. This nurse also coordinates urgent care issues in the clinic. This system greatly improves communication of your needs to the team as your telephone requests are quickly and accurately processed to the appropriate resource.
Another benefit of PCMH is that you will see an increased number of same-day appointments thus reducing unnecessary clinic visits by maintaining appropriate access for acute, chronic and preventive care. The emphasis of PCMH is on continuity of care. Each patient is assigned a Primary Care Provider and each provider is part of a Patient-Centered Team. The team coordinates the care and uses tools such as web-based health education and beneficiary information to provide convenient and quality primary health care services.
How will this new process affect me?
You will notice a change in the flow of your visit. This is outlined below:
Check-in: A Check-in sign located near the clinic entrance is your first stop. Paperwork such as: privacy compliance notification, Patient’s Rights and Responsibilities and Third Party Insurance information will be obtained at this time. You are encouraged to call DEERS (Defense Enrollment Eligibility Reporting System) at 1-800-538-9552 or update contact information such as: e-mail address or home address changes, phone/mobile changes. This can also be done on the DEERS website at: https://www.dmdc.osd.mil/appj/. It is advised that you update this information prior to your appointment at Dunham.
From the check-in area, you will be directed to the waiting area location of your provider: Corridor A through F until called by a team staff member.
Screening: Once you are escorted into an exam room the nurse will take your vital signs, weight and blood pressure. He or she will review your current medications. The nurse will ask you a series of questions to assess the reason for your visit as well as other questions assessing any preventive screenings that you may need: such as a PAP smear or Mammogram. All health needs identified will be documented on the Care Coordination flow sheet. Please be sure to tell the nurse if you need any medication refills or need a new referral or renewal at this time.
Encounter: Your Primary Care Provider (PCP) will enter the same exam room to assess and manage your health issue. They will review the flow sheet items that you have identified for and discuss your treatment plan. A computer is available in each exam room, so that the provider can immediately document as well as place orders for labs tests, referral requests and medications into your electronic health record. This allows the other members of the team to coordinate the aspects of your visit that have been identified such as: consult and test result requests as well as patient education. The provider will update the Care Coordination Flow sheet so that the discharge nurse can perform the final phase of your visit: Discharge Instructions.
Discharge Instructions/ Out-processing: A nurse will review the Care Coordination flow sheet with you. This flow sheet will include any discharge instructions pertinent to the reason for your visit as well as any new medications. Patient education such as dressing changes, smoking cessation education or care of a sick child will also be reviewed. Follow-up appointments if needed can be made at this time. If you need any additional lab work, radiology or medications, you will be directed to those departments. Computer kiosks are available if you need assistance in enrolling to Tricare-on-line. Tricare-on-line- allows you to book future appointments from the convenience of your own home as well as enroll in Express Scripts. Once you enter your medication Refill requests into Express Scripts, you will receive medication refills by mail directly to your home.
Follow-up Appointments: One of the goals of PCMH is to provide you with any follow-up appointments that may be needed before leaving the clinic.
What if I am late for my appointment? If you are late for an appointment (exceed 10 minutes from scheduled appointment time) you will be advised that if the providers schedule permits you will be seen, but may have to wait. We cannot delay the next patient’s appointment. If the Provider has availability we will try and fit you in. You will be notified of your options at that time. Staff can assist you in rescheduling if you choose to cancel and reschedule. If the Provider is running behind, you will be given the option to reschedule or wait to be seen.
How do I obtain a referral for Specialty Care services not provided at Dunham, FIG or DDC?
Medical services not provided at Dunham, FIG or DDC such as: Cardiology, Neurology, Orthopedics or Maternity services require your physician to make a referral to a specialist in the community. Any new referral requests must first make an appointment at Dunham to be evaluated by your Primary Care Provider. If the Provider determines that you need specialty care, he or she will enter a consult order in your electronic health record. Once the order is placed, the request goes to the Health Benefits Advisor (HBA) who determines if the referral meets the Tricare benefits coverage criteria. If yes, the referral is forwarded to a Health Net Federal Services specialist to locate a network provider appropriate for the specialty care needed. A referral Authorization/Approval Letter is then mailed to you within 10 business days and provides the specialists contact information and authorization dates. You have 30 days to schedule an initial visit with the specialist. If you cannot obtain the initial appointment within that time frame, the referral may need to be extended. Contact Tricare to do this.
How do I continue Specialty Care once my referral has expired?
It is the patient’s responsibility to contact their Primary Care Provider (PCP) here at Dunham to request continuation of specialty care once the authorization has expired. The expiration date can be found on your initial Authorization letter from HealthNet Federal Services. If you cannot find this letter, call them at 1-877-TRICARE (874-2273). The patient must call Dunham clinic 245-3400 to a make a renewal request. Once the request is received, the Clinical Care Coordinator will send the provider an electronic message indicating the reasons for the request. The provider may contact the specialty care doctor or service to discuss the need for on-going care. You may be asked to make an appointment with your PCP at Dunham if your PCP at Dunham has some concerns. Once approved, you will receive another Authorization Letter by mail. It is important to wait until you receive this letter before scheduling an appointment so that the Tricare office confirms that the specialty care provider will continue to accept Tricare payment. If you make an appointment without Tricare authorization or the specialty care provider no longer accepts Tricare insurance, you will be responsible for the costs related to this care.
Can I obtain radiographic services at Dunham or DDC and FIG?
Dunham Radiology Department performs in-house x-rays, but no tests requiring contrast. If more complex radiological tests are needed, such as: MRI’s, CT Scans and Ultrasounds, Dunham will provide the patient with a list of contracted facilities ask them to select one. Dunham will FAX a copy of the script/information to the selected facility to facilitate that appointment. If a patient wants to go to a facility not on the provided list they are directed to a Health Benefits Counselor located within the clinic. Digital mammography is also provided here at Dunham, but not at DDC or FIG.
DDC does not provide radiology services. Patients are referred to contracted facilities to perform radiology testing. FIG radiology services are limited to screening X-rays.
Dunham does not have an on-site Radiologist. All films are sent out to be read. When the results of the test(s) are returned to the ordering provider, they will be scanned into the electronic record and a message sent to the provider to view the results. In some cases, the Radiologist will communicate the results directly to your provider. In any event, you should allow 5 to 7 work days to receive notification of the results.
What labs tests does Dunham, DDC and FIG provide?
Patients may have blood tests drawn at any of our three locations. The blood tests may be ordered by one of our providers or by a provider outside of our facilities.
Laboratory orders from providers outside of our system must contain the patient name, date of birth, requested test(s), date, FAX number for report delivery, and ordering provider name, address and signature. Lab results for an outside provider are FAXED directly to the ordering provider as indicated on the original order.
Patients may be referred to another facility for blood draw if the tests require special handling that we cannot accommodate. All out-sourced lab and test results are sent to Dunham via our secure FAX line.
Dunham Laboratory performs basic testing such as: URINALYSIS, CHEMISTRY, SPECIAL CHEMISTRY, HEMATOLOGY, COAGULATION and SEROLOGY. Labs processed here are sent to the patient’s electronic health record. A message is sent to your Provider notifying him/her that the results are available.
Laboratory tests not performed at Dunham are transported to a contracted laboratory facility. Results are returned to Dunham and entered into the patient’s electronic health record.
PATIENTS can request a copy of their own laboratory test results by contacting our Medical Records Department.
How do I get my medications- after appointment, refills, renewal?
After an Appointment: New medications or medication refills are ordered by the provider into the patient’s electronic health record. The patient is directed to take a number at the Pharmacy window. They will be required to show identification as well as an Other Health Insurance (OHI) Card if they have other health insurance. They are asked to select a button A, B, C, D on the number kiosk (A=Active Duty, B=New Prescriptions or C=Refills, D= Provider prescribed during your visit) to help the pharmacy identify if this is a new medication, a medication refill or if they are active duty. A numeral ticket is printed out. The number will be announced overhead as well as displayed on screens in the pharmacy area. When the patient’s number is called they should proceed to the appropriate pharmacy window for service. New prescriptions will not be available for pick up at the PX Pharmacy Pick up site. Medications ordered for patients receiving care at DDC or FIG are instructed to call the Pharmacy Refill line at 1-800 248-6337 and select the location (Dunham, Dunham PX, FIG or DDC) where they would like to pick up their prescription. DDC and FIG DO NOT have a Pharmacy- a courier delivers medications to these clinics. A patient can take a prescription to a commercial pharmacy (i.e. Rite Aid/CVS), but they will have a co-pay for each medication. To obtain home delivery of non-narcotic prescription medication refills, log onto http://www.express-scripts.com/ to enroll. If you do not have a computer, you can obtain assistance with enrolling at the Tricare Office located within Dunham clinic.
What is the difference between a medication refill and a medication renewal?
A medication REFILL is a prescription that has a limited number of pills dispensed at one time. Typically, when your Provider writes a new medication prescription that you need to take over a long period of time such as; blood pressure or cholesterol medicine, you are given refills. For example, if you get a prescription that has 90 days worth of medicine (e.g. pills) and you have 2 refills listed on the bottle. The initial set of 90 pills will be dispensed first, but to obtain the next 90 pills, you need to call the Pharmacy refill line at 1-800 248-6337. This number is also listed on the pill bottle. You should do this when you are within 2 weeks of being out the first set of pills. Refills expire within 1 year from the date they are written and although you may still have unused refills, you must contact your Provider to have the prescription renewed. * Note: certain medications such as narcotics or controlled substances expire 6 months from the date prescribed.
A medication RENEWAL is considered a new prescription (when your prescription has expired or when you run out of refills) and typically requires an appointment. If you are out of refills, you should make an appointment to be re-evaluated for renewal of any prescription medication.
Refill Requests On-Line Dunham website: The quickest way to request a refill is to go to the Dunham website: http://dunham.narmc.amedd.army.mil/pages/Pharmacy.aspx Select “Pharmacy” under Services on the left hand column. Under Refill Request: click on “On-line Refill Request” Click “Ok” to the pop up message. Complete steps 1 through 5, then click the “Send this request “button. You will immediately receive a message that tells you the date and time your medication will be available for pick-up. If you have no refills left, you will receive a message that indicates no refills remaining; most likely you will need a renewal of the prescription. Call 245-3400 to discuss this with the Clinical Care Coordinator.
Refill Requests by Phone: Please have the following information ready when calling in for a refill request: Sponsors full social security number, name of medication (You may be asked to spell the drug name on the bottle, the strength (ie 25 mg), how often you take it (ie. Once daily, twice a day) and phone number you can be reached if we have any questions. Refill requests made by phone are entered into your electronic health record by the Clinical Care Coordinator nurse after she validates that you are eligible for a refill without an appointment. Pharmacy technicians can also enter refill requests. You will be instructed that your meds will be available for pick-up in 2 working days either at the Pharmacy Clinic window or the Post Exchange. The outlying clinics DDC and FIG receive their meds from Dunham via a courier. Patients in the outlying clinics will be contacted by phone if the medications have not been picked up in 5 working days.
Renewals: Medication renewals are not automatic. The decision to renew a medication is a clinical decision made by your provider. You may be directed to make a follow-up appointment with your PCP to discuss long-term medication therapy or to check your blood work to make sure there are no problems.
What happens if I need help when the clinic is closed?
If you call the central appointment line: 717-245-3400, you will be informed that the clinic is closed and to call 911 or go to the nearest ER if it is a medical emergency. For non-emergent medical issues that cannot wait until the clinic reopens our on-call provider can be reached at 245-4047.
How does your organization provide patient education?
Patient education is provided through a variety of mediums: nursing and providers provide education related to preventive care as well as education specific to the reason for your visit. We have a smoking cessation class once a month and a self-care class open to all enrollees. Schedules are available in the atrium. We do not have a Certified Diabetic Educator. If you have newly diagnosed diabetes or otherwise qualify, you may receive a referral to a Tricare participating diabetic educator. Dunham may be able to provide some limited interim education.
Tricare on-line at: https://www.tricareonline.com/portal/page/portal/TricareOnline/Portal provides a free link to Medline which provides extensive information about drugs, herbs, and supplements health information to over 750 health topics covering conditions, diseases, and wellness. It also has an extensive surgical video library that allows you to watch almost any surgical procedure available.
How do I enroll to become a patient at Dunham?
You must first be enrolled in DEERS (Defense Enrollment Eligibility Reporting System). Once your eligibility is confirmed, you will meet with a Tricare intake worker and complete the necessary paperwork. The PCM (Primary Care Manager/Provider) is assigned at this time and education is provided about the PCM team.
Can I change my PCP (Primary Care Provider) also referred to as PCM (Primary Care Manager)?
You may change your PCP/PCM at any time, provided the new PCP/PCM has openings for new patients. You may call TRICARE directly at 1-877-874-2273 and request to change your PCM, or you can stop by the Tricare Service Center and speak to a Tricare representative at the Dunham clinic who can change your PCM. *Note: in order to best service our walk-in patients, our TRICARE Service Center Representatives does not accept telephone calls. Your feedback is important! If you are dissatisfied with the care you received from your Provider, please express your concerns on a Commanders Comment form. These forms are located throughout the Clinic. Your comments will be held confidential and will only be used for performance improvement identification purposes. For inquiries regarding a TRICARE claim please call 1-877-874-2273.
Do you provide preventive screenings and do I need a consult to obtain these screenings?
We have a HEDIS (Healthcare Effectiveness Data and Information Set) coordinator that tracks all patients at Dunham to assure that preventive screenings are not missed. She/he may send a reminder letter to you if you need to be seen for preventive screenings (such a Mammogram for Breast Cancer or a PAP smear for Cervical Cancer screening) within the recommended guidelines. You may need a referral for preventive screening tests. If you have a clinic appointment for any health issue, the Patient Centered Medical Home discharge process will identify any preventive screenings you will need and assist you in scheduling them before you leave your clinic visit.
Directions to the closest Hospital Emergency Room from Dunham Clinic?
Carlisle Regional Medical Center 361 Alexander Spring Road Carlisle, PA 17105 (717) 249-1212
Directions: (3.98 Miles- Approx 11 minutes from Dunham): From the Clinic- EXIT the Ashburn Gate. Turn left onto Ashburn Drive, Go approx 0.4 miles and turn Left onto North Hanover Street/US 11. Continue to follow North Hanover Street for 1.4 miles. Turn right onto West Willow Street for 0.2 miles. Turn slight left onto Walnut Bottom Road. Drive 1.1 miles turn right onto Alexander Spring Road. Drive 0.8 miles Carlisle Regional Center will be on your right.