We take our sleep seriously, and with our Polysom Techs to help, we can find effective ways to help others. You will be providing direct care to patients while safely operating sophisticated medical equipment to record sleep/wake stages, respiratory events, cardiac events and other clinical events.
What you will do:
- Provides for the assessment and evaluation of the appropriateness and effectiveness of diagnostic testing based on patients’ age, cognitive and physical abilities, and/or developmental needs. Is responsible for communication to the physician of pertinent patient data.
- Initiates and monitors overnight testing procedures in accordance with American Academy of Sleep Medicine.
- Communicates a professional attitude with patients, visitors and other hospital personnel. Practices strict ethical enforcement of protected medical and employee confidentiality.
- Assists coordinator with quality assurance programs for the department and makes recommendations as needed.
- Operates in full compliance with organization’s safety program. Responds to all emergency preparedness situations as appropriate. Utilizes standard precaution and assures unit’s equipment is ready for safe operation.
- Performs duties in documented accordance with requirement of all regulating/governing bodies.
- Assumes responsibility for personal and professional growth through participation in department meetings, in-service programs and continuing education programs. Fulfills yearly education requirements as stated by policy.
- May participate in on call rotation for staffing.
**Eligible for $5,000 Sign-On Bonus and $10,000 Education Assistance!**
We take our sleep seriously, and with our Polysom Techs to help, we can find effective ways to help others. You will be providing direct care to patients while safely operating sophisticated medical equipment to record sleep/wake stages, respiratory events, cardiac events and other clinical events.
What you will do:
- Provides for the assessment and evaluation of the appropriateness and effectiveness of diagnostic testing based on patients’ age, cognitive and physical abilities, and/or developmental needs. Is responsible for communication to the physician of pertinent patient data.
- Initiates and monitors overnight testing procedures in accordance with American Academy of Sleep Medicine.
- Communicates a professional attitude with patients, visitors and other hospital personnel. Practices strict ethical enforcement of protected medical and employee confidentiality.
- Assists coordinator with quality assurance programs for the department and makes recommendations as needed.
- Operates in full compliance with organization’s safety program. Responds to all emergency preparedness situations as appropriate. Utilizes standard precaution and assures unit’s equipment is ready for safe operation.
- Performs duties in documented accordance with requirement of all regulating/governing bodies.
- Assumes responsibility for personal and professional growth through participation in department meetings, in-service programs and continuing education programs. Fulfills yearly education requirements as stated by policy.
- May participate in on call rotation for staffing.
mclabnebraska
Job Summary:
Performs diagnostic sleep procedures for patients as ordered by a physician, and in accordance with established protocols, standards and practices.
Essential Duties:
Ensures patients are set up for sleep studies by directly applying or overseeing the application of recording devices to the patient in accordance with department standards and procedures.
Records/monitors polysomnogram and/or electroencephalograms.
Responds with appropriate interventions to ensure patient safety.
Identifies normal and abnormal cardio-respiratory, neurological, and sleep physiology; recognizes and reports pathology that requires treatment.
Administers oxygen and nasal continuous positive airway pressure and employs ventilator assist devices in accordance with established protocols.
Performs special procedures such as multiple sleep latency testing and patient education, EEG recording to include wake and sleep, nasopharyngeal, bedside, isolation, and electro-cerebral inactivity evaluations.
Scores data and generates reports that accurately and concisely summarize the patient’s sleep / wake stages, respiratory events, cardiac events, limb movement, arousal analysis, and other clinical events; sends to the physician for interpretation.
Performs maintenance and minor repair of laboratory equipment and reports needs for major repairs.
Cleans/sanitizes equipment.
$10,000 Sign On Bonus!
A Polysomnographic Technologist works under the general supervision of the clinical director (M.D., D.O., PhD) or designee to provide comprehensive evaluation and treatment of sleep disorders. This may involve polysomnography, diagnostic and therapeutic services or patient care and education. A Polysomnographic Technologist can perform the duties defined for a Polysomnographic Technician and may provide supervision of other staff.
ESSENTIAL FUNCTIONS:
- Gather and analyze patient information. Verify documentation and physician orders.
- Prepare and calibrate equipment required for testing to determine proper functioning and make adjustments, if necessary.
- Apply electrodes and sensors according to accepted published standards.
- Performs diagnostic and therapeutic (CPAP, BIPAP) polysomnography, MSLT and MWT.
- Performs CPAP downloads for all clinic visits and when directed by physician.
- Performs polysomnographic data acquisition while monitoring study-tracing quality to ensure signals are artifact-free and make adjustments, if necessary.
- Performs routine PAP mask fitting.
- Documents routine observations, including sleep stages and clinical events, changes in procedure, and other significant events in order to facilitate scoring and interpretation of polysomnographic results.
- Performs routine maintenance and upkeep of all computerized sleep systems.
- Performs polysomnography record scoring and report generation.
- Oversees and performs difficult and unusual procedures and therapeutic interventions.
- Manages own patient schedules and works with patients to troubleshoot issues and concerns.
- Educates patient on equipment (i.e., actigraphy, home study and oximetry), tracks equipment and produces report for physicians; cleans and prepare equipment for next use.
- Meets with patients after physician appointment to review equipment order, troubleshoot and answer any patient questions.
- Trains and mentors staff Polysomnography Technicians and students.
- Follows all procedure protocols.
#missioncritical
GENERAL SUMMARY:
$10,000 Sign On Bonus!
A Polysomnographic Technologist works under the general supervision of the clinical director (M.D., D.O., PhD) or designee to provide comprehensive evaluation and treatment of sleep disorders. This may involve polysomnography, diagnostic and therapeutic services or patient care and education. A Polysomnographic Technologist can perform the duties defined for a Polysomnographic Technician and may provide supervision of other staff.
ESSENTIAL FUNCTIONS:
- Gather and analyze patient information. Verify documentation and physician orders.
- Prepare and calibrate equipment required for testing to determine proper functioning and make adjustments, if necessary.
- Apply electrodes and sensors according to accepted published standards.
- Performs diagnostic and therapeutic (CPAP, BIPAP) polysomnography, MSLT and MWT.
- Performs CPAP downloads for all clinic visits and when directed by physician.
- Performs polysomnographic data acquisition while monitoring study-tracing quality to ensure signals are artifact-free and make adjustments, if necessary.
- Performs routine PAP mask fitting.
- Documents routine observations, including sleep stages and clinical events, changes in procedure, and other significant events in order to facilitate scoring and interpretation of polysomnographic results.
- Performs routine maintenance and upkeep of all computerized sleep systems.
- Performs polysomnography record scoring and report generation.
- Oversees and performs difficult and unusual procedures and therapeutic interventions.
- Manages own patient schedules and works with patients to troubleshoot issues and concerns.
- Educates patient on equipment (i.e., actigraphy, home study and oximetry), tracks equipment and produces report for physicians; cleans and prepare equipment for next use.
- Meets with patients after physician appointment to review equipment order, troubleshoot and answer any patient questions.
- Trains and mentors staff Polysomnography Technicians and students.
- Follows all procedure protocols.
#missioncritical
JOB SUMMARY
A Polysomnographic Technologist works under the general supervision of the clinical director (M.D., D.O., or PhD) or designee to provide comprehensive evaluation and treatment of sleep disorders. This may involve polysomnography, diagnostic and therapeutic services or patient care and education. A Polysomnographic Technologist can perform the duties defined for a Polysomnographic Technician and may provide supervision and education for other staff.
ACCOUNTABILITIES
- Gather and Analyze Patient Information
a. Collect, analyze and integrate patient information in order to identify and meet the patient-specific needs (Physical/mental limitations, current emotional/physiological status regarding the testing procedure, pertinent medical/social history), and to determine final testing parameters/procedures in conjunction with the ordering physician or clinical director and laboratory protocols.
b. Complete and verify documentation.
c. Explain pre-testing, testing, and post-testing procedures to the patient.
- Testing Preparation Procedures
a. Prepare and calibrate equipment required for testing to determine proper functioning and make adjustments if necessary.
b. Apply electrodes and sensors according to accepted published standards.
c. Perform appropriate physiologic calibrations to ensure proper signals and make adjustments if necessary.
c. Perform positive airway pressure (PAP) mask fitting.
- Polysomnographic Procedures
- Follow procedural protocols such as Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Test (MWT), parasomnia studies, PAP, oxygen titration etc. to ensure collection of appropriate data.
b. Follow “lights out” procedures to establish and document baseline values (such as body position, oxyhemoglobin saturation, respiratory and heart rates, etc.)
c. Perform Polysomnographic data acquisition while monitoring study-tracing quality to ensure signals are artifact-free and make adjustments, if necessary.
d. Document routine observations including sleep stages and clinical events, changes in procedure, and significant events in order to facilitate scoring and interpretation of polysomnographic results.
e. Implement appropriate interventions (including actions necessary for patient safety and therapeutic intervention such as continuous and bi-level positive airway pressure, oxygen administration, etc).
f. Follow “lights on” procedures to verify integrity of collected data and complete the data collection process (repeats the physiological and instrument calibrations and instructs the patient on completing questionnaires, etc.)
g. Demonstrate the knowledge and skills necessary to recognize and provide age specific care in the treatment, assessment, and education of neonatal, pediatric, adolescent, adult, and geriatric patients.
h. Oversees and performs difficult and unusual procedures and therapeutic interventions.
- Polysomnographic Record Scoring
a. Score sleep/wake stages by applying professionally accepted guidelines.
b. Score clinical events (such as respiratory events, cardiac events, limb movements, arousals etc.) according to center specific protocols.
c. Generate accurate reports by tabulating sleep/wake and clinical event data.
- Service Management and Professional Issues
a. Comply with applicable laws, regulations, guidelines and standards regarding safety and infection control issues.
b. Perform routine and complex equipment care and maintenance.
c. Evaluate sleep study related equipment and inventory.
d. Maintain current CPR or BCLS certification.
e. Demonstrate effective written and spoken communication skills.
f. Demonstrate appropriate social skills.
g. Respond to study participant's procedural-related inquiries by providing appropriate information.
h. Demonstrate the ability to analyze complex situations and apply policy.
i. Comply with the ABSM Standards of Conduct.
6. Performs other duties as assigned to meet the organization`s needs.
#missioncritical
JOB SUMMARY
A Polysomnographic Technologist works under the general supervision of the clinical director (M.D., D.O., or PhD) or designee to provide comprehensive evaluation and treatment of sleep disorders. This may involve polysomnography, diagnostic and therapeutic services or patient care and education. A Polysomnographic Technologist can perform the duties defined for a Polysomnographic Technician and may provide supervision and education for other staff.
ACCOUNTABILITIES
- Gather and Analyze Patient Information
a. Collect, analyze and integrate patient information in order to identify and meet the patient-specific needs (Physical/mental limitations, current emotional/physiological status regarding the testing procedure, pertinent medical/social history), and to determine final testing parameters/procedures in conjunction with the ordering physician or clinical director and laboratory protocols.
b. Complete and verify documentation.
c. Explain pre-testing, testing, and post-testing procedures to the patient.
- Testing Preparation Procedures
a. Prepare and calibrate equipment required for testing to determine proper functioning and make adjustments if necessary.
b. Apply electrodes and sensors according to accepted published standards.
c. Perform appropriate physiologic calibrations to ensure proper signals and make adjustments if necessary.
c. Perform positive airway pressure (PAP) mask fitting.
- Polysomnographic Procedures
- Follow procedural protocols such as Multiple Sleep Latency Test (MSLT), Maintenance of Wakefulness Test (MWT), parasomnia studies, PAP, oxygen titration etc. to ensure collection of appropriate data.
b. Follow “lights out” procedures to establish and document baseline values (such as body position, oxyhemoglobin saturation, respiratory and heart rates, etc.)
c. Perform Polysomnographic data acquisition while monitoring study-tracing quality to ensure signals are artifact-free and make adjustments, if necessary.
d. Document routine observations including sleep stages and clinical events, changes in procedure, and significant events in order to facilitate scoring and interpretation of polysomnographic results.
e. Implement appropriate interventions (including actions necessary for patient safety and therapeutic intervention such as continuous and bi-level positive airway pressure, oxygen administration, etc).
f. Follow “lights on” procedures to verify integrity of collected data and complete the data collection process (repeats the physiological and instrument calibrations and instructs the patient on completing questionnaires, etc.)
g. Demonstrate the knowledge and skills necessary to recognize and provide age specific care in the treatment, assessment, and education of neonatal, pediatric, adolescent, adult, and geriatric patients.
h. Oversees and performs difficult and unusual procedures and therapeutic interventions.
- Polysomnographic Record Scoring
a. Score sleep/wake stages by applying professionally accepted guidelines.
b. Score clinical events (such as respiratory events, cardiac events, limb movements, arousals etc.) according to center specific protocols.
c. Generate accurate reports by tabulating sleep/wake and clinical event data.
- Service Management and Professional Issues
a. Comply with applicable laws, regulations, guidelines and standards regarding safety and infection control issues.
b. Perform routine and complex equipment care and maintenance.
c. Evaluate sleep study related equipment and inventory.
d. Maintain current CPR or BCLS certification.
e. Demonstrate effective written and spoken communication skills.
f. Demonstrate appropriate social skills.
g. Respond to study participant's procedural-related inquiries by providing appropriate information.
h. Demonstrate the ability to analyze complex situations and apply policy.
i. Comply with the ABSM Standards of Conduct.
6. Performs other duties as assigned to meet the organization`s needs.
#missioncritical
Great opportunity to work REMOTELY!
CHI Health Partners (CHP) is a physician-driven, clinically integrated network initiative that builds on the strengths of participating providers to improve patient health, increase efficiency and enable physicians to succeed in today’s changing health care payment and delivery environments. To learn more about CHI Health Partners, please visit our website at https://www.chihealthpartners.org/
This position compiles financial and clinical quality data from multiple disparate sources to perform complex qualitative and quantitative analysis. The position will synthesize these results into meaningful reporting to assist CHP Leadership with decision making, identification of trends, and other value based contract financial initiatives. This job function requires an appreciable background working within healthcare reimbursement structures. Some of the key functions that this role will perform are:
- Responsible for designing, developing and maintaining reporting solutions and systems to accommodate current and evolving analysis in support of Clinically Integrated Network objectives
- Leverages existing understanding on industry standard elements such as provider coding schemes (e.g. CPT, DRG, Rev, ICD), provider fee schedule types, and claims processing to drive analytical insights.
- Prepares routine and adhoc reports in order to ensure that the Clinically Integrated Network is meeting its strategic objectives related to the contractual financial and clinical quality objectives
- Provides analytical narratives and comments in reports to provide insights and information to end users rather than just data.
- Creates data visualizations and dashboard reporting utilizing products such as Power BI or Sisense.
- Creates, produces, and publishes all reports in a timely manner, monitoring and interpreting for any notable trends and/or outliers
- The data analysis projects provided will require summarization, presentation and explanation to enhance the stakeholder’s knowledge of underlying trends, results and implications of the analysis. All summary and analysis reporting projects must be theoretically, statistically and accurately composed and presented.
Job Summary / Purpose
Reporting to the System Director of Data Driven Clinical Strategy with a matrix reporting to the System Director of Post Acute Care, this position is responsible for the development and management of analytic solutions designed to drive clinical, quality, and financial operational efficiencies with population health programs with a strong focus on post-acute care and transitions of care.
Essential Key Job Responsibilities
• Collects, analyzes, maintains, and communicates data (claims, clinical, quality) to Post Acute leadership, Care Coordination nurses, and Population Health Leadership to support post acute program initiatives using a variety of tools (claims data warehouse, population health tools, electronic health record, and other reporting systems). Translates program elements from clinical and operational stakeholders into analytics solutions. (60%)
• Analyzes and reconciles data for Centers for Medicare and Medicaid Services (CMS) bundled payments program and Medicare Shared Savings Program (MSSP). (20%)
• Daily consolidates Emergency Department and Inpatient discharge data from multiple different sources to be merged and sent to post acute and care coordination team to conduct patient outreach activities. (5%)
• Provides support for data integrity and data validation. (5%)
• Partner and interact closely with many different types of stakeholders. (5%)
• Lead and manage complex projects that are strategic in nature and scope. (5%)
Position Summary:
The Post Acute Care (PAC) Transition Nurse is an integral part of the Population Health Care Coordination Team, responsible for managing length of stay within a PAC facility as well as appropriate transition through the continuum of care on assigned patients. The PAC Transition Nurse performs this role in such a manner as to meet the individual’s health needs while promoting quality and cost effective outcomes.
The PAC Transition Nurse evaluates and identifies knowledge gaps of disease process and treatments, determines appropriate resources or services required to meet an individual's health needs, provides education/coaching on disease self-management for health promotion and maintenance, monitors patient's progress, promotes quality cost effective outcomes with the goal of improved care coordination amongst providers and increased involvement of the individual/family/caregiver in the decision making process to reduce hospitalizations, readmissions and ER visits.
This position will involve direct patient contact, in post-acute facility settings. They will collaborate with acute care coordination, ambulatory care coordination, physicians, post-acute program managers, and post acute service providers to ensure elements of optimal transition are considered and are in place (e.g. followup appointments made, DME ordered/received,social determinants addressed, etc.).
The PAC Transition Nurse will advocate for the patient and family by identifying and valuing patient goals of care, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the PAC Transition Nurse will protect confidentiality while striving to achieve high levels of patient satisfaction.
Position Summary:
The Post Acute Care (PAC) Transition Nurse is an integral part of the Population Health Care Coordination Team, responsible for managing length of stay within a PAC facility as well as appropriate transition through the continuum of care on assigned patients. The PAC Transition Nurse performs this role in such a manner as to meet the individual’s health needs while promoting quality and cost effective outcomes.
The PAC Transition Nurse evaluates and identifies knowledge gaps of disease process and treatments, determines appropriate resources or services required to meet an individual's health needs, provides education/coaching on disease self-management for health promotion and maintenance, monitors patient's progress, promotes quality cost effective outcomes with the goal of improved care coordination amongst providers and increased involvement of the individual/family/caregiver in the decision making process to reduce hospitalizations, readmissions and ER visits.
This position will involve direct patient contact, in post-acute facility settings. They will collaborate with acute care coordination, ambulatory care coordination, physicians, post-acute program managers, and post acute service providers to ensure elements of optimal transition are considered and are in place (e.g. followup appointments made, DME ordered/received,social determinants addressed, etc.).
The PAC Transition Nurse will advocate for the patient and family by identifying and valuing patient goals of care, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the PAC Transition Nurse will protect confidentiality while striving to achieve high levels of patient satisfaction.
Whether your surgery is outpatient or inpatient, you can be assured to receive the latest standard of care, delivered by board-certified physicians and an expert, specially trained surgical team. CHI St. Luke’s surgeons specialize in all body systems and perform procedures from microsurgery to joint replacement.
Job Responsibilities
As a Registered Nurse in the PACU, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this health care role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
As a Registered Nurse you will be responsible for the delivery of excellence in patient care through assessing, formulating nursing diagnoses and establishing goals, planning and implementing intervention and evaluating patient care outcomes. With the staff nurse's professional practice he/she responsible for participating in and maintaining quality, cost effectiveness and guest relations. Provide patient care in compliance with hospital policies and procedures and the standards of professional nursing practice as defined by the Board of Nurse Examiners for the State of Texas.
Our world needs compassion like never before. Our communities need caring, and our families need protection. With our combined resources, we are committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community. This role will allow you to give back to our community and broaden your healthcare skills.
related skills: Registered Nurse, RN, Nurse, ADN, BSN, ACLS, NIH, Medical Surgical, EPIC, inpatient, hospital , acute care, clinic, hospital, compassion, patience, kindness, respect
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this Post Surgical Unit RN role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
Eligible for $10,000 Sign-on Bonus & $10,000 Educational Assistance *
* Speak to a recruiter regarding incentive eligibility, requirements and restrictions for new hire employees and current employees accepting a promotion.
All new grad RNs will be enrolled in the Nurse Residency Program.
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this health care role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
Eligible for $10,000 Sign-on Bonus & $10,000 Educational Assistance *
* Speak to a recruiter regarding incentive eligibility, requirements and restrictions for new hire employees and current employees accepting a promotion.
All new grad RNs will be enrolled in the Nurse Residency Program.
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this health care role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this RN role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
As a Registered Nurse, you will be responsible for delivering the highest quality patient care according to the specific orders of each patient’s individual physician. This will involve, utilizing your knowledge and skills to educate patients and their families on prevention and healthy habits.
Additional responsibilities for this RN role include:
- Monitoring patients’ conditions and assessing their needs
- Collaborating with physicians and nurses to devise individualized care plans for patients
- Administering patients’ medications and providing treatments according to physicians’ orders
- Fostering a supportive and compassionate environment to care for patients and their families
EVENING AND WEEKEND SHIFT DIFFERENTIAL!!!
**Must have a Stationary Engineer License**
- Operates high-pressure boilers.
- Operates chillers and absorbers.
- Compiles water treatment reports.
- Performs maintenance on boilers, chillers, pumps, steam pipes, and related machinery.
- Operates automated building control computer and makes corrections as required.
- Operates/adjusts air handling equipment.
- Performs preventive maintenance on kitchen and laundry equipment.
- Performs routine inspections of mechanical rooms.
- Performs building maintenance.
- Maintains established department policies, procedures and objectives, concerning quality assurance, safety, environmental conditions and infection control.
- Assumes responsibility for personal and professional growth through participation in department meetings, inservice programs and continuing education programs. Fulfills yearly education requirements as stated by policy.
- Maintains professional attitude with patients, visitors and other hospital personnel while assuring confidentiality of patient and other hospital information.
- Participates in all safety, security and infection control programs that are mandatory as well as those required and provided by the department
- Demonstrates work practices consistent with Alegent Health and department-specific safety, security and infection control policies.
- Must have ability to work effectively and collaboratively in a diverse and multi-cultural environment.
#missioncritical
#stationaryengineer
#operatingengineer
Expectations:
- Anticipate and plan for future changes.
- Make recommendations to improve customer service as appropriate.
- May support 1 – 5 providers at any given time.
- Responsible for employee performance management by completing performance appraisals and setting individual goals as outlined in policies and procedures.
- Effectively lead and develop a team of employees including hiring, training and development, salary recommendations, etc.
- Prepare, recommend, and monitor clinic budget, goals, and objectives taking into consideration input from clinic staff.
