Generic Prescription Medications & OTC Drugs $7 or Less Antibiotics Mental Health Cholesterol Diabetes Health Card Arthritis & Pain Skin Conditions Gastrointestinal Health Service Listing Heart Health & Blood Pressure Diabetes Vitamins & Nutritional Health
Routine health & wellness for you and your family
Fungal Infections Women’s Health
• Routine health & wellness Other Medical Conditions Gastrointestinal Health
• Routine diagnostic Mental Health
• Annual screenings Glaucoma & Eye Care $15 or Less
• Routine vision Allergies, Cold & Flu Skin Conditions
• Routine dental Antibiotic
• Women’s services Heart Health & Blood Pressure Thyroid Conditions
• Prescription & OTC Women’s Health
Arthritis & Pain Routine Health & Wellness Routine Vision Services Physicals and Primary Care Clinic Visits
Basic eye exam for eye glasses ……………….….……….……….……… $25
Annual comprehensive physical ………….……….………………. $150
Single vision glasses (with standard non-brand frame)…….…………….….……. $69
(includes CBC, CMP, Lipid profile, chest x-ray, EKG)
Bifocal glasses (with standard non-brand frame)…………….………….….………… $99
Annual women’s health physical …………………….………………… $90
(includes pelvic, PAP smear, clinic breast exam)
Annual DOT physical ……………….….…………….…….…………. $75 Routine physical exam (illness/sickness visits)……….….….………. $45
Surgical consult …………………………………………………….…….…. $75
Routine Dental Services Routine Diagnostic Screenings—Imaging
Mammogram ………………………………………….…………………. $76
Dental Exam …………………………………………….………….…….….… $20
Dexa scan (whole body bone density)……………………………………. $100
Adult Prophy (cleaning) ………………………………….…. $40
Chest x-ray ……………….…………………………………………….…… $40
Child Prophy (cleaning) …………………………………….………….….……. $25
X-ray of extremities (hands, wrists, ankle, or feet)……………………….….…. $40
Fluoride treatment …….…………….………….….……… $8
Abdomen Series (complete) ………………………………….……….…… $65
Panoramic X-ray …….………….………….….……. $30
Sealants (children only, fee per tooth)……….….…. $20
Routine Diagnostic Screenings—Laboratory
Simple extraction ……………………….….….… $50
Basic metabolic panel (BMP)………….………………………….……… $8
Silver filling (Amalgam) one surface…….….….……. $40
(includes Glucose, BUN, Creatinine, Na, K, C1, CO2, Calcium)
Clotting Time (PT with INR) …………….………………………….………. $5
Silver filling (Amalgam) each additional surface……. $20
Complete blood count (CBC) ……….………………………….………. $5
White filling (Composite) one surface………….….… $45
Comprehensive metabolic panel (CMP)……………………….……. $10
White filling (Composite) each additional surface….… $20
(includes all tests in BMP plus Albumin, Total Bili, Alk Phos, AST & ALT)
Lipid Panel …………………………………….……………………….………. $6
PSA (screening)….…………………………………….…………………. $25
Urinalysis …………………………………….……………………….……… $5
A physician’s order is required for most ser-
v ices, except vaccines and blood pressure
Urine drug screen (chain of custody) ………………………………………. $30
screenings. Appointments are required for
Other Diagnostic & Preventive Services
Blood Pressure screenings (1st Thurs of month from 1 pm—3 pm) ……….….…. Free
All services require presentation of TLC
Electrocardiogram (EKG) .……….……………………………………. $50
Flu vaccine ……………….………………………………………….……… Free
Pneumococcal vaccine …………….…………………………….……. Free
This is a sample listing only; a full list is avail-
(including interpretation) …………………………….……….…. $10
Tetanus vaccine ….………………………………………………………. $15
1. Last Name First Name DO NOT WRITE IN THIS SPACE N.C. Department of Health and Human Services State Laboratory of Public Health 2. Patient Number Submitter Laboratory/Medical Record #: _____________________ 3. Address _ t _ e _ _ o _ f PLEASE GIVE ALL Month Day Year INFORMATION REQUESTED 5. Race 1. White 2. Black 3. American Indian 4
Secondary prevention of further episodes of ARF is a priority. Secondary prophylaxis with regular benzathine penicil in G (BPG) is the only RHD control strategy shown to be effective and cost-effective at both community and population levels. This quick reference guide is derived from the Australian guideline for prevention, diagnosis and management of acute rheumatic fever and Although ARF