Immediate Healthcare Your same day or next day appointment can be scheduled to assist you in the immediate health care needs you may have. To be seen for a laceration, sprain, sore throat, cough, or other urgent need please call.

Preventive Care 19 to 39 years
Preventive Care 40 to 64 years
Preventive Care 65 years and Older
Who should receive a flu shot?

Preventive Care 19 to 39 years

Health Care Services	When
Physical exam	Ages 19 to 21: One visit every two to three years; annually if desired Ages 22 to 39: One visit every 24 months; annually if desired
Clinical Screenings	When
Depression screening	During physical exam
Tobacco/drug use	During each visit
Alcohol misuse	During each visit
Chlamydia and gonorrhea screening (STIs)	All sexually active women to be screened for STIs
HIV screening	Annually for adolescents and adults at high risk
Cervical cancer screening (women)	Start screening within three years of beginning sexual activity or at age 21, whichever is first. Annual screening up to age 30. For ages 30 and older, screening every two to three years.
Height, weight, BMI and blood pressure	During physical exam; nutrition and physical activity counseling for those identified as high risk
Dyslipidemia screening (risk assessment based on family history and physical exam)	Assessment annually through age 21. For all adults ages 20 and older, a fasting lipoprotein profile (total cholesterol, LDL, HDL and triglyceride) should be obtained once every five years.
Hemoglobin and hematocrit	Once every two years
Tuberculin skin test (PPD)	For those identified as high risk
Family and intimate partner violence, breast self exam, etc.	Anticipatory guidance at physician discretion
Immunizations	When
Td/Tdap Tetanus, diphtheria and pertussis	Every 10 years One dose of Tdap if pertussis booster was not received previously
MMR Measles, mumps and rubella	One to two doses if not vaccinated previously or no history of disease
HepA Hepatitis A	For high risk groups
HepB Hepatitis B	For high risk groups
Var Varicella (chickenpox)	Two-dose series at least 4 weeks apart if no history of varicella and no previous vaccination
Flu Influenza	Annually
Pneumonia Pneumococcal	For high-risk groups
Meningococcal	Ages 19-24: One dose if not vaccinated previously.
HPV Human papillomavirus	Three-dose series for ages 19-26 on a zero, two-months and six-months schedule if no previous vaccination. Minimum spacing: 4 weeks between #1 and #2; 12 weeks between #2 and #3. Must be 24 weeks between doses #1 and #3.

Preventive Care 40 to 64 years

Health Care services	When
Physical exam	One visit every 24 months; annually if desired
Clinical Screenings	When
Depression screening	During physical exam
Tobacco use	During each visit
Alcohol misuse	During each visit
Height, weight, BMI and blood pressure	During physical exam; nutrition and physical activity counseling for those identified as high risk
Diabetes screening	Fasting plasma glucose test every 3 years in adults with hypertension or hyperlipidemia beginning at age 45
Dyslipidemia screening	For all adults, a fasting lipoprotein profile (total cholesterol, LDL, HDL and triglyceride) should be obtained once every five years.
Tuberculin skin test (PPD)	For those identified as high risk
Hemoglobin and hematocrit	Once every two years
Mammogram (women)	Ages 40 to 49, every one to two years; ages 50 and older, annually
Cervical cancer screening/pap test (women)	Every two to three years
Chlamydia and gonorrhea screening (STIs)	All sexually active women to be screened for STIs
HIV screening	Annually for adults at high risk
Colorectal cancer screening	Beginning at age 50, one of the following screening options: Fecal occult blood test annually Flexible sigmoidoscopy every five years Fecal occult blood testing annually and flexible sigmoidoscopy every five years Colonoscopy every ten years Those with a family history (first degree relative) of colorectal cancer, or adenomatous polyps: Begin screening at age 40, or 10 years before the youngest case in the immediate family. Colonoscopy every five years.
Osteoporosis risk factor assessment (women)	Once every two years as part of the physical exam (does not include bone density test)
Menopause counseling	Anticipatory guidance at physician discretion
Breast self exam	Anticipatory guidance at physician discretion
Intimate partner violence	Anticipatory guidance at physician discretion
Immunizations	When
Td/Tdap Tetanus, diphtheria and pertussis	Every 10 years (Give one dose of Tdap if pertussis booster was not received previously.)
HepA and HepB Hepatitis A and Hepatitis B	For high risk groups
Var Varicella (chickenpox)	Two-dose series at least four weeks apart if no history of varicella or previous vaccination
Flu Influenza	Annually
Pneumococcal Pneumonia	For high risk groups
Zoster Shingles	One dose at age 60 and older
Meningococcal	For high risk groups
MMR	For high risk groups

Preventive Care 65 years and Older

Health Care services	When
Physical exam	One visit every 24 months; annually if desired
Clinical screenings	When
Depression screening	During physical exam
Tobacco use	During each visit
Alcohol/drug misuse	During each visit
Height, weight, BMI and blood pressure	During physical exam; nutrition and physical activity counseling for those identified as high risk
Lipoprotein screening	For all adults, obtain a fasting lipoprotein profile (total cholesterol, LDL, HDL and triglyceride) once every five years.
Diabetes screening	Screening once every three years (e.g. fasting plasma glucose test)
Tuberculin skin test (PPD)	For those identified as high risk
Hemoglobin and hematocrit	Once every two years
Mammogram (women)	Annually
Cervical cancer screening (women)	Every two to three years. Suggest stopping at age 70 if three or more normal Pap tests in a row, no abnormal Pap test in previous 10 years and not at high risk.
Chlamydia screening and gonorrhea screening (STIs)	All sexually active women to be screened for STIs
HIV screening	Annually if you are at high risk
Colorectal cancer screening	One of the following screening options: Fecal occult blood test annually Flexible sigmoidoscopy every five years Fecal occult blood test annually and flexible sigmoidoscopy every five years Colonoscopy every ten years Consider stopping screening at age 75. Use individual consideration between ages 75-85. Screening is not recommended for individuals older than age 85.
Osteoporosis risk factor assessment (women)	Routine beginning at age 65 (does not include bone density test)
Abdominal aortic aneurysm screening (men)	Between ages 65 and 75 who have ever smoked, a one-time screening for abdominal aortic aneurysm.
Immunizations	When
Td/Tdap Tetanus, diphtheria and pertussis	Every 10 years (Give one dose of Tdap if pertussis booster was not received previously.)
HepA Hepatitis A	For high risk groups
HepB Hepatitis B	For high risk groups
Var Varicella (chickenpox)	Two-dose series at least four weeks apart if no history of varicella or previous vaccination.
Flu Influenza	Annually
Pneumoccal Pneumonia	Once after age 65
Zoster Shingles	One dose at age 60 and older
Meningococcal	If high risk
MMR	If high risk

Who should receive a flu shot?

Age	Seasonal Flu	H1N1 Flu
Children 6 - 12 months	Recommended	Recommended
Children 1 - 4 years	Recommended	Recommended
Children 5 - 18 years	Recommended; strongly recommended if any underlying chronic health condition	Recommended
Young adults 19 - 24 years	If desired	Recommended
Adults 19 - 64 years with underlying chronic health conditions (examples: asthma, diabetes)	Recommended	Recommended
Pregnant women	Recommended	Recommended
Household contacts of children under 6 months of age	Recommended	Recommended
Health care workers and emergency medical services personnel	Recommended	Recommended
All other adults 25 - 49 years	If desired	If desired, based on vaccine availability*
All other adults 50 and older	Recommended	If desired, based on vaccine availability*
*In case of a shortage of the H1N1 vaccine, the vaccination may not be available to this group. Talk to your provider if you have questions.

Update on Vitamin D

It is remarkable that there can be a vitamin that is so important in so many ways! Vitamin D might just be the answer to significant health problems. In the past 2 years, many health care providers have been testing people for Vitamin D deficiency. This simple blood test gives an upper limit normal of 100ng/ml, the common finding among the population in this area is ‹22 ng/ml. The major biologic function of Vitamin D is to maintain normal blood levels of calcium and phosphorus. Populations who may be at a high risk for vitamin D deficiencies include individuals over age 50, people with dark skin, exclusively breastfed infants and those who have limited sun exposure, people with fat mal-absorption such as some forms of liver disease, cystic fibrosis, and Crohn's disease, and people who are obese or who have undergone gastric bypass surgery. Our community has minimal sun exposure and therefore inadequate exposure to the sun to assist in absorbing Vitamin D.

Very few foods in nature contain Vitamin D. The flesh of fish such as salmon, tuna and mackerel are among the best sources. The American diet has many foods fortified with Vitamin D including milk, cereal flours, orange juice, yogurt and margarine. Most people meet their vitamin D needs through exposure to sunlight. Seasons, geographic latitude, time of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis.

Vitamin D is important in prevention of bone disorders like rickets, and together with calcium, Vitamin D helps protect older adults from osteoporosis. There are studies looking at the expected benefits of Vitamin D on cancer prevention. Vitamin D emerged as a protective factor in one study as a preventative against colon cancer. Vitamin D might play some role in the prevention and treatment of type 1 and type 2 diabetes, hypertension, glucose intolerance, multiple sclerosis, and other medical conditions.

Don't hesitate to spend 10 minutes in the sun, without sunscreen twice a week. If you can do this you may not need a supplement. However, discuss with your medical provider the need for a Vitamin D 25-OH test to determine your baseline level, then you will be able to provide the supplement you need.