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Introducing FirstHealth MyChart www.firsthealth.org
The health-wise wisdom of Mr. Franklin
I David J. Kilarski Chief Executive Officer FirstHealth of the Carolinas
t is a matter of some debate as to whether the proverb “Early to bed, early to rise makes a man healthy, wealthy and wise” was original to Founding Father Benjamin Franklin. A much earlier version seems to date from Aristotle. There is no questioning the wisdom of the healthy aspect of that familiar adage, however. A good night’s sleep combined with a balanced diet and a decent amount of physical activity is a generally accepted mainstay of a healthy lifestyle. As health care consumers have accepted this truth, they have also become better, and more informed, health care stewards, coming to accept the preventive as well as the curative nature of medicine and assuming a more active role in the status of their own health. FirstHealth of the Carolinas has long been recognized as an industry leader in the promotion of personal wellness. Note the following examples: • Medically supervised FirstHealth Fitness centers serving five very different communities work with their members to attain and maintain their health and wellness. • Cardiac, pulmonary and physical therapy rehab programs in some of those same locations help patients regain their health or manage their chronic illness so as to avoid additional hospitalizations. • Primary care practices throughout the FirstHealth service area are moving toward designations as “patient-centered medical homes” where providers incorporate disease prevention and wellness into regular encounters with established patients. They also collaborate with our fitness centers on this wellness goal via our successful Exercise is Medicine program. • FirstHealth Community Health, with its acknowledged talent for acquiring grant dollars, has established numerous programs that promote wellness throughout multiple generations of our population base. One of the latest examples is The Daily Mile walking trail program, which promotes the incorporation of physical activity – in addition to regular physical education and recess activities – into the daily academic curriculum. Still another aspect of this informed-consumer philosophy involves educating patients about the “appropriateness” of care. By establishing a network of convenient care clinics and increasing the number of primary care physicians in the area, FirstHealth has increased patient access to condition-appropriate services – directing, when “appropriate,” patients to outpatient instead of inpatient care and convenient care offices instead of emergency rooms, for example. Up-to-date technology is also critical to this patient wellness focus. This summer, the systemwide introduction of Epic information technology will greatly assist our efforts in engaging patients in their personal health management. Just turn the page for an introduction to Epic and the patient-centric FirstHealth MyChart patient portal. This is an exciting time for everyone connected with FirstHealth of the Carolinas – our physicians, staff and especially you, our patients. I think you’ll be interested in learning more about it.
(800) 213-3284 • www.firsthealth.org 1
the magazine from FirstHealth of the Carolinas
155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374 firsthealth.org FirstHealth is published by the Communications Department of FirstHealth of the Carolinas in conjunction with StayWell
Contributing Photographer Don McKenzie
Board of Directors FirstHealth of the Carolinas
Mr. Tom Pashley Mr. Gary VonCannon Raymond Washington, M.D. Mrs. Rusti Welch Ellen Willard, M.D.
Corporate Officers Chief Executive Officer, FirstHealth of the Carolinas President, FirstHealth Moore Regional Hospital. . . . . . Mr. David J. Kilarski Chief Financial Officer, FirstHealth of the Carolinas. Chief Medical Officer FirstHealth of the Carolinas .
. . Mrs.
. . . . . . . . . . . . . . . . . . . . . John
Lynn S. DeJaco F. Krahnert Jr., M.D.
President, FirstHealth Physician Group . . . . . . . . . . . . Daniel R. Barnes, D.O. President, Moore Regional Hospital-Hoke Campus. . Mrs. Susan K. Beaty, R.N. Vice President, Human Resources FirstHealth of the Carolinas . . . . . .
. . . . . . . . . . . . . . . . Mr.
Daniel F. Biediger
Chief Information Officer FirstHealth of the Carolinas .
. . . . . . . . Mr.
. . . . . . . . . . . . . . . . . . . . . Mr.
Vice President, Strategy & Innovation FirstHealth of the Carolinas . . . . . . . . .
Jeffrey A. Casey David B. Dillehunt
. . . . . . . . . . . . . Mrs.
President, FirstHealth Richmond Memorial Hospital and Sandhills Regional Medical Center . . . . . . . . . . . . . Mr. John J. Jackson Vice President, Quality FirstHealth of the Carolinas .
. . . . . . . . . . . . . . . . . . . . . Mrs.
Cindy McNeill-McDonald, R.N.
Chief Nursing Officer FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . Mrs. Karen Robeano, DNP, R.N. President, Foundation of FirstHealth . . . . . . . . . . . . . . Mrs. Kathleen Stockham President, FirstHealth Montgomery Memorial Hospital. . Mrs. Beth Walker, R.N. The not-for-profit FirstHealth of the Carolinas is headquartered in Pinehurst, North Carolina, and comprises Moore Regional Hospital, Montgomery Memorial Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus, Sandhills Regional Medical Center, The Foundation of FirstHealth, FirstCarolinaCare Insurance Company, and the FirstHealth Physician Group. Comments on FirstHealth magazine or changes of address should be directed to firstname.lastname@example.org or to (910) 715-4278.
StayWell 407 Norwalk St. Greensboro, NC 27407 (336) 547-8970 President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bill Moore Creative Director. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean Senior Editor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Richard Krisher Production Director. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh © Copyright 2017 by StayWell, an operating company of StayWell/MediMedia USA, and FirstHealth of the Carolinas, Inc. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from StayWell. Articles in this publication are written by professional journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are not necessarily those of StayWell or FirstHealth of the Carolinas. Models are used for illustrative purposes only.
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Introducing FirstHealth MyChart www.firsthealth.org
On the cover: On July 1, 2017, FirstHealth of the Carolinas will launch what has been described as the largest project in the organization’s history – the systemwide implementation of Epic Information Systems technology. While Epic will encompass a broad spectrum of organizational uses, the most important for FirstHealth patients will be the FirstHealth MyChart patient portal. For more information on Epic and MyChart, go to page 3.
Introducing FirstHealth MyChart
Making Decisions Before They Have to Be Made
Has Innovation Reached Its Limits? Far From It
Chief Operating Officer FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . Mr. Brian T. Canfield Vice President, Finance & Support Services FirstHealth of the Carolinas . . . . . . . . . . . . . .
Send a message to your doctor's office
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Mrs. Carolyn D. Helms, Chair Mr. Sherwood Blackwood, Vice Chair Mr. Jimmy Preslar, Treasurer Mr. Hew Fulton, Immediate Past Chair David M. Cowherd, M.D. John N. Ellis, M.D. Mrs. Nancy B. Kaeser Mr. David J. Kilarski Ms. Tracy A. Leinbach Mr. Brian McMurray
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10 What’s New at FirstHealth of the Carolinas? 12 The Technology of Telemedicine 13 A Non-Surgical Weight-Loss Option From FirstHealth Bariatrics 14 HELPing Patients Avoid Delirium For more information on any of the programs or services offered by FirstHealth of the Carolinas, please call (800) 213-3284 or visit www.firsthealth.org.
f you are a member of the FirstHealth of the Carolinas team – from hospital floors to administrative offices, Epic is already ingrained in your daily workplace experience. If you are a patient, Epic’s features – especially its user-friendly MyChart patient portal – will soon become the combination to an electronic safe housing your FirstHealth communications capability. On July 1, FirstHealth will go live with systemwide Epic information technology. From Pinehurst to Troy to Rockingham to Hamlet to Raeford and numerous locations between and beyond, the multicounty health care system will be bound by patient-centric software at the heart of a project generally acknowledged as the largest in FirstHealth’s history. The Epic evolution began about two years ago when FirstHealth’s longtime electronic medical record vendor served notice that it planned to “sunset” the product line (no longer make improvements to it). That initiated the search for a replacement system that would assist in a FirstHealth move toward aggressive population health management while also giving patients more tools to manage their own health care and allowing the organization to share its patient information with other providers more easily. “With Epic, FirstHealth’s clinical staff will have access to patient records whether they are seen at FirstHealth or other North Carolina Epic-based organizations, not to mention hundreds of others
across the country,” says FirstHealth CEO David J. Kilarski. “This will make life easier for patients and providers alike.” With the online MyChart patient portal, FirstHealth patients will be able to communicate safely and securely with their health care providers, pay their balances online, review their health history and schedule appointments. Instead of getting multiple billing statements for one FirstHealth encounter, they will get a single bill in an easy-to-understand format. In addition, the Healthy Planet population health application will better equip FirstHealth providers and staff to focus on their most at-risk patients. “Using all of the data in the system, we will be able to predict which patients are most likely to be admitted to the hospital and take measures to decrease their likelihood of an admission or readmission,” Kilarski says. (For an introduction to the FirstHealth MyChart patient portal, turn the page.)
(800) 213-3284 • www.firsthealth.org 3
Introducing FirstHealth 1
Understanding MyChart 1 Messaging ●● Inbox: Send and receive messages, letters and questionnaires; send non-medical messages to customer service staff.
2 Visits ●● View details about future appointments, including instructions and driving directions.
3 My Medical Record ●● View and update information in your medical record, including current health issues, medications, test results, allergies, immunizations, medical history and preventive care reminders. ●● After-visit and admission summaries: View and download details of past appointments and admissions. ●● Patient-entered data: Document details about your day-today health. ●● Questionnaires: Provide general and family history information, history of personal illness and other health information. ●● Content linking: Access educational links.
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Features Not Shown on the Home Page
Matt Mychart Log Out
●● Proxy access: The availability of proxy access allows parents, spouses or caregivers to view a patient’s MyChart account. A proxy’s access can be set to expire on a specific date or to grant a restricted set of features to some proxies, such as the parents of teenage children. ●● Demographics: You can review and update your address, phone number and insurance information on file.
●● Notifications: You can opt to receive a notification when new information is available in your account. ●● MyChart Mobile: MyChart for iOS and MyChart for Android are portable versions of MyChart you can use to view your health information. These mobile apps contain a set of select features that are also available in the full web-based version of MyChart. The apps are available at no charge.
4 Billing ●● View details of your health insurance, such as coverage and co-pays, and account information, such as individual statements. You can choose paperless billing and use a credit card to pay bills and co-pays.
5 Refill Your Medications ●● Ask for a prescription renewal: If you have integrated pharmacies, the refill is sent there directly for pickup.
6 Send a Message to Your Doctor’s Office
●● Get medical advice: Send photos and messages with non-urgent questions to providers to determine if an office visit is needed. ●● E-visits: Submit questionnaires, photos and symptoms as an electronic visit for physicians to review and follow up on.
7 Schedule an Appointment ●● Directly schedule, confirm and cancel appointments, and enter details about reasons for the visit.
(800) 213-3284 • www.firsthealth.org 5
before they have to be made The Palliative Care Services team, pictured on the campus of FirstHealth Hospice & Palliative Care, (back row, from left) Barbara Bane, patient care secretary; and Aaron Gavett, D.O., associate medical director; and (front row from left) Ashley Toscano, LCSWA, medical social worker; Ellen Willard, M.D., medical director; Donna Neal, R.N., CHPN, palliative care nurse; and Johnny Richard, MACE, spiritual care chaplain. This team is responsible for both inpatient and outpatient palliative care.
he concept of hospice dates from medieval program experienced even greater growth and the times as places where the sick, wounded or need for additional programs in a service area that dying – as well as weary travelers – could came to include Montgomery County as well as Moore. seek comfort. The modernOne of those needs, which Last fall, The Foundation day hospice concept as focused on grief counseling and of FirstHealth – with the end-of-life care is more recent but was support, prompted the opening recommendation of the FirstHealth practiced in Europe long before being of FirstHealth Hospice’s Grief introduced in the United States in the Resource & Counseling Center. Hospice Foundation Network latter half of the 20th century. Another need centered on – recommended a $234,875 Hospice in the FirstHealth of the palliative care. disbursement from the Hospice Carolinas community dates from the While all FirstHealth Endowment to expand palliative late 1970s, when a small group of Hospice patients get the ascare into the outpatient setting. A needed symptom and pain people – many of them with medical team has begun to visit FirstHealth management of palliative care, or spiritual backgrounds – began hospital campuses in Montgomery, FirstHealth’s current palliative to meet with the goal of bringing a hospice program to Moore County. care program operates separately Richmond and Hoke counties to Sandhills Hospice, which began educate physicians and nurses about from its hospice program. One accepting patients in 1980, resulted outpatient palliative care and how team offers palliative care in the from their efforts. hospital, and the other provides Telemedicine will help implement While FirstHealth always lent services in the Hospice House services outside of Moore County. financial and organizational assistance and patient residences. to the hospice program, its support The two services don’t became more critical as the local program grew. In April currently cross, but this will change with an expansion 1996, Sandhills Hospice merged with FirstHealth to of palliative care that will begin with a pilot program create FirstHealth Hospice (now FirstHealth Hospice & in local assisted living and skilled nursing facilities. Palliative Care). In these locations, another team will provide patient Under the FirstHealth umbrella, the hospice support before hospice care is needed – even during
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active and/or aggressive medical treatment. The goal is to capture patients who are newly diagnosed with life-limiting conditions but don’t need end-of-life care. “The education and support of this new approach will give patients and their families a clear perception about their goals of care, as well as information about disease progression, while the patient is still in a healthy frame of mind,” says Tina Gibbs, director of FirstHealth Hospice & Palliative Care. “This won’t speed up the need for hospice, but it will help identify the right timing for hospice so that this critical decision doesn’t have to be made during a time of last-minute crisis.” Dan Barnes, D.O., president of the FirstHealth Physician Group, expects that the expansion will have
a big impact on the FirstHealth community in terms of numbers of eligible patients and the kind of care they receive. “To this point, we have made a significant impact at Moore Regional Hospital,” he says, “but we can only serve patients in the hospital. Many times, the next contact is at a subsequent admission, and some of those admissions could be avoided with an outpatient presence. Palliative care can serve as a bridge to recovery or to hospice, depending on the patient’s underlying condition. Most important, patients and families can work on setting expectations and goals of care as the patient’s symptoms are controlled.”
Nurse navigators provide another valuable service Another FirstHealth program provides services to a very specific patient population – those who have been diagnosed with cancer. The aid and assistance provided by patient navigators Lynn Lanier, R.N., and Bobbi Clark, R.N., of FirstHealth Cancer Services can begin at any time during the always complicated and sometimes confusing journey through cancer care. Matt Sherer, administrative director of FirstHealth Cancer Services, calls their service a vital component of FirstHealth’s cancer program. As nurse navigators for FirstHealth Cancer Services, Bobbi Clark, “A navigator is like GPS on your smartphone,” Sherer says. R.N., (seated) and Lynn Lanier, R.N., provide a GPS-like service for cancer patients by serving as a constant point of contact for “You need help to find where you are going. The navigator’s role is information and support. just that. A patient can call them with any concern. The navigator may be able to resolve the issue immediately or will at least know how to direct the patient to the appropriate person or resource to help resolve the issue.” Lanier and Clark also help coordinate care and identify local resources and support that would be appropriate for their patients. Their assistance may involve a single contact or a continuing relationship. They may accompany a patient to multiple appointments involving a variety of medical disciplines – surgery, medical oncology and radiation oncology. Or they may be called upon to lend an occasional listening ear. “Every patient has a need,” says Lanier, who recently received her national certification as an oncology nurse navigator from the Academy of Oncology Nurse & Patient Navigators. Financial navigator Tenasha Goins complements the services provided by Lanier and Clark by linking underinsured or uninsured patients with available financial resources, including those provided by The Foundation of FirstHealth’s Cancer CARE Fund. Goins also works with patients who are having trouble accessing care because of problems related to transportation and medication costs.
(800) 213-3284 • www.firsthealth.org 7
THE PHYSICIAN’S PERSPECTIVE
Has innovation reached its limits? Far from it By Peter I. Ellman, M.D. Cardiovascular Thoracic Surgeon Reid Heart Center
be fresh “There cannot always knife; fields of conquest by the the there must be portions of ever remain human frame that will , at least sacred from its intrusions That we in the surgeon’s hands. , reached have already, if not quite n be little these final limits, there ca , the chest question. The abdomen rever shut and the brain will be fo e wise and from the intrusion of th humane surgeon.”
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he words to the left were uttered by English surgeon Sir John Erichsen in 1873. A world-renowned surgeon and innovator, he wrote important textbooks and operated on the Queen of England. Essentially, he was saying that there was no more room for innovation for surgery and that everything had been done – or almost. In the middle part of the 20th century, there were many feats of heroism that to this day seem the pinnacle not only of human achievement but are also among the greatest feats of what some consider the greatest generation. The ability for us to stop the human heart and keep someone alive on a bypass machine during lifesaving heart surgery would not have been possible if not for a select few surgeons, some maverick, who refused to accept Sir John’s claim that the chest was forever shut to human intrusion. I was attracted to heart and lung surgery, at least in part, because I was inspired by heroic figures who seemed to possess the qualities that I aspired to have. These were courageous innovators – men who would not stand for the status quo. They strove to make their art better, and this is a big part of the ethos of being a cardiothoracic surgeon. I wanted to help people, but I also wanted something that would fascinate and challenge me for the rest of my life mentally, emotionally and physically. The anatomy in the chest – the heart and the lungs – is beautiful in form and function, and I thought it would be a great privilege and joy to be able to work with it for a living.
For years, when people had lung cancer, they would have an operation that required a thoracotomy. With an incision in the side about 8 to 10 inches long, a thoracotomy requires dividing a large muscle in the back. There is no doubt this gives the surgeon the best exposure for working on the lungs, but it often requires cutting or breaking a rib and then placing a metal retractor between the ribs to spread the ribs wide enough apart for the surgeon to get his hands in the chest. This makes the operation easier for the surgeon, but it can be very painful for the patient – just after the operation and sometimes as a source of chronic pain. In the 1980s and early 1990s, the technology for the use of small incisions and videoscopes came into practice. Early adopters of laparoscopy in the abdomen were gynecologic surgeons and general surgeons. These operations are done with a video camera attached to a long metal tube with a lens on the end that works like a periscope. Instead of sticking a periscope up in the air to look around from a boat in the water, however, we put the scope inside the body so we can see without making a large incision. This technology, also used in the chest, is called videoassisted thoracoscopy surgery, or VATS. Many simpler lung operations now exclusively use VATS, because it avoids a thoracotomy. Over the past decade, however, many surgeons have moved to using it in more complicated cases, including cancer operations or lobectomies.
The lungs have parts called lobes – three on the right side and two on the left. The lobes have arteries bringing blue (low-oxygen) blood to the lung, veins bringing red (highoxygen) blood to the heart, and an airway to bring air from the mouth and trachea to the lungs for ventilation. To take these lobes out, we have to divide these structures. Dividing very thin vessels in very close proximity to the heart must be done with extreme care and precision. For the past two years, my colleague in cardiothoracic surgery, Art Edgerton, M.D., and I have used the VATS technique for lobectomies in patients who are good candidates for the nothoracotomy approach. We usually use three or four small incisions about the size of a nickel with one being just large enough for the specimen to be removed. This has been an incredible advance for our patients as the avoidance of a thoracotomy means much less postoperative pain. Patients usually go home a day or two earlier, and they get back to their regular activities much faster than if they had the traditional approach. One of our patients was even driving his car four days after surgery – somewhat against our wishes – but he said he felt so great that he just didn’t see why not. I am excited about the future here at FirstHealth Moore Regional Hospital, and I think this operation is a great advance for our patients. I am committed to bringing all of the newest and best technology to my patients as we continue to practice what I consider world-class medical care here in the heart of the Sandhills.
Love Your Heart You’ve only got one. And you don’t trust just anybody when it comes to taking care of your heart. We rely on your trust and that is why FirstHealth is recognized throughout North Carolina as having some of the best heart specialists in the state. We will love your heart as much as you do!
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at FirstHealth of the Carolinas?
FirstHealth becomes five-hospital system
Orthopaedic nursing unit
FirstHealth of the Carolinas added a fifth hospital campus with the Dec. 1, 2016, acquisition of Sandhills Regional Medical Center (SRMC) in Hamlet.
One of the busiest nursing floors at FirstHealth Moore Regional Hospital is getting a new look with the expansion/renovation of the renamed 3 Surgical (formerly 2C). Twenty-six rooms in the 44-bed unit have been completed with full completion scheduled for 2018.
With the acquisition, longtime FirstHealth administrator John Jackson assumed organizational responsibility for SRMC (and its medical affiliates) as president while continuing to serve in his previous role as president of FirstHealth Richmond Memorial Hospital in Rockingham. Both hospitals are located in Richmond County, North Carolina, and are part of a FirstHealth system also comprising the flagship Moore Regional Hospital in Moore County, Montgomery Memorial Hospital in Montgomery County and Moore Regional Hospital-Hoke Campus in Hoke County.
Clara’s House fifth anniversary In its five years of existence, the Clara McLean House has welcomed more than 6,000 guests from throughout the United States as well as from Canada, France, Argentina and the Philippines. Since it opened in April 2012, Clara’s House has offered patients and families a sanctuary with all the comforts of home – and more – as they have navigated hospital services, procedures and admissions to FirstHealth Moore Regional Hospital and FirstHealth Hospice & Palliative Care. The facility, which is named for a longtime FirstHealth benefactor, is located in FirstVillage directly across the street from Moore Regional’s main entrance.
100th successful TAVR case On Feb. 17, 2017, 66-year-old Lee County resident Dennis Morgan entered FirstHealth history as the 100th FirstHealth patient to successfully undergo a minimally invasive transcatheter aortic valve replacement (TAVR) for aortic stenosis. Interventional cardiologist Steven J. Filby, M.D.; cardiothoracic surgeons Peter I. Ellman, M.D., and Art Edgerton, M.D.; radiologist Michael Edwards, M.D.; and anesthesiologists from Pinehurst Anesthesia Associates comprise the multidisciplinary FirstHealth TAVR team.
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The design of each room incorporates a “Family Area” with sleeper sofa, USB port for family use, a second television and a “layflat” recliner. Each pod of six to eight rooms also includes an open nourishment alcove stocked with coffee, juice, sodas and snacks, also for family use.
New dental care centers A $630,000 grant from The Duke Endowment will allow the FirstHealth Montgomery School Health Centers to determine the best way to deliver school-based dental care to Montgomery County children on Medicaid. Partners in the FirstHealth School Health Centers Dental Program are The Duke Endowment, FirstHealth Montgomery School Health Centers and FirstHealth Dental Care. Current dental services will be relocated to facilities at East and West Montgomery middle schools in Biscoe and Mt. Gilead. The revised dental program will provide a comprehensive and consistent dental home for Montgomery County schoolchildren who do not currently have a dentist.
Convenient Care growth Steadily increasing volumes in FirstHealth’s three Convenient Care locations has prompted a look into further expansion of the program. Offices are currently located in Whispering Pines, Sanford and Hamlet (a recent relocation from the original Rockingham office). A fourth Convenient Care practice is expected to open within the next few months, and the model is being evaluated for expansion into additional communities as well. FirstHealth Convenient Care fills the void between the true emergency of emergency department care and the preventive/acute care of a primary care provider.
Top 100 Hospitals
Daily Mile walking trails
For the second consecutive year, Truven Health Analytics recognized FirstHealth Moore Regional Hospital as a Top 100 Hospital. FirstHealth’s flagship hospital, listed in the large community hospital category, was the only hospital in North Carolina to receive the award. As divisions of Moore Regional, Moore Regional Hospital-Hoke Campus and Richmond Memorial Hospital were included in the recognition.
Montgomery County Schools became the first U.S. school system to implement The Daily Mile with the opening of a Star Elementary School walking trail. In the program, all students in the school spend 15 minutes a day running, walking or jogging as part of their curriculum.
The Truven study identified its top 100 hospitals based on overall organizational performance. To compile the list, Truven (a health care data and analytics solutions service) analyzed the annual performance of hospitals on key quality measures from 2011 through 2015. According to the study, these hospitals demonstrated major improvements in the areas of inpatient mortality and complication rates, 30-day readmissions and lengths of stay. Most of them also maintained steady costs for treating an inpatient over the five-year study. Moore Regional also received Top 100 recognitions in 1995, 2003, 2004 and 2016.
Business North Carolina Business North Carolina magazine has once again recognized FirstHealth Moore Regional Hospital as one of North Carolina’s best hospitals and as a top hospital in patient satisfaction. Moore Regional ranked fifth in the “best hospital” listing (tied with Caromont Regional Medical Center in Gastonia) and second in the “patient picks” list. As divisions of Moore Regional, both Moore Regional Hospital-Hoke Campus and Richmond Memorial Hospital shared the designation. “Best hospital” criteria included patient satisfaction, readmission rates and infection rates, while “patient picks” were based on the percentage of patients who would recommend the hospital to others.
Funding for the Healthy People, Healthy Carolinians project came from a $450,000 Duke Endowment grant to the FirstHealth First-in-Health 2020 Task Forces in Montgomery and Richmond counties. All of the elementary schools in Montgomery and Richmond counties will eventually implement the program.
Geriatric Inpatient Medicine FirstHealth Moore Regional Hospital has addressed the special health care needs of the area’s growing elder population by developing the FirstHealth Physician Group Geriatric Inpatient Medicine Program. An outgrowth of Moore Regional’s Hospitalist Service, the program targets hospitalized geriatric patients by focusing on depression, delirium and dementia along with the coordinated management of orthopaedic and complex medical issues. The goal is to improve quality of life while helping patients maintain their independence for as long as possible by way of various types of health and social care services. Geriatric specialist Matthew L. Arroyo, M.D., heads the program.
Bariatric certification The FirstHealth Bariatric Center, a surgical weight-loss program at FirstHealth Moore Regional Hospital, has been accredited as a comprehensive center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, a joint program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery. Achieving this accreditation means that FirstHealth has demonstrated the ability to provide quality care and good outcomes for its surgical weight-loss patients. Standards ensure that these patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success.
Prediabetes programs FirstHealth of the Carolinas will focus on diabetes prevalence in Montgomery and Richmond counties by offering glucose screenings in non-traditional locations in a program funded by a Kate B. Reynolds Charitable Trust grant. Individuals with a prediabetes glucose result will be referred to a prediabetes education program developed by the Centers for Disease Control and Prevention in which a trained lifestyle coach will help them eat healthier, reduce stress and engage in more physical activity.
(800) 213-3284 • www.firsthealth.org 11
The Technology of Telemedicine
t’s not unheard of for neurohospitalist Sarah Uffindell, M.D., to be roused from a deep slumber by a late-night phone call from a FirstHealth emergency department. A patient is showing signs of stroke, the caller says, and Dr. Uffindell is needed for an immediate consultation. There was a time when Dr. Uffindell would get up, get dressed and head for the hospital – a pattern she still follows in many cases. In others, however, she slips a sweater over her pajamas, reaches for her smartphone and opens a mobile app that gives her face-to-face access – via a robot-transported monitor – to the ailing patient and attending ED staff. This physician-via-robot access known as Telestroke is now available at FirstHealth Moore Regional (a certified Primary Stroke Center) and the three outlying FirstHealth hospitals with an emergency department (Richmond Memorial, Montgomery Memorial and Moore Regional-Hoke Campus). “I beam in, evaluate the patient and give the staff instructions,” Dr. Uffindell says. “It’s a safe and secure way to be able to provide care to patients remotely when time is of the essence, as it is with strokes.” Dr. Uffindell is just one of the FirstHealth physicians using Telemedicine (also known as Telehealth) to deliver virtual medicine to patients in off-site locations. The technology lets health care providers evaluate, diagnose and treat patients without the need for an in-person visit. “Remote professional groups are frequently used to back up services that expand the hours of service availability,” says Deb Delong, administrative director of the FirstHealth Telehealth Team. Dan Barnes, D.O., president of the FirstHealth Physician Group, champions the team, which also includes representatives from FirstHealth’s Information Systems, Neurology, Behavioral Health, Home Care and Hospitalist Service departments. Home Care introduced Telemedicine technology about a decade ago with its remote home monitoring of patients. FirstHealth’s use has
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since evolved to include Telepsych, Telestroke and Teleneurology, as well as Telecode/ RRT by which remote physicians direct the efforts of bedside lifesaving teams of specially prepared nurses and respiratory therapists to revive patients in cardiac or respiratory arrest in locations lacking around-the-clock physician coverage. On the Telemedicine horizon are applications for geriatrics, critical care, health care coaching and diabetes education, and infectious diseases. Depending on the medical specialty, the equipment can vary from the homemonitoring tablets of Home Care, to TVlike audio-video equipment located in all emergency departments and some physician practices, to the InTouch robots of specialties requiring face-to-face time. “It has audio and video capabilities as well as a recording device,” DeLong says. According to Dr. Uffindell, patient response has been surprisingly positive, Robot technology gives FirstHealth physicians, including even among the sometimes neurohospitalist Sarah Uffindell, technology-resistant senior M.D., (shown on monitor) real-time, population. face-to-face contact with remote patients. Foundation of FirstHealth “They feel they get even funding in the amount of $242,138 more of the physician’s piloted the FirstHealth Telemedicine attention,” she says. “Because program by offsetting equipment costs for robots at all five FirstHealth both physician and patient hospitals. are looking directly into the camera, they feel like they get more face-to-face contact.”
A non-surgical weight-loss option from FirstHealth Bariatrics When inflated with saline, the ORBERA device is about the size of a grapefruit.
s anyone who has experienced the the point that they frustrations of trying to lose weight can require more invasive attest, losing weight – and keeping it treatment,” says David off – is never easy. Grantham, M.D., of While diet and exercise are helpful to FirstHealth Bariatrics. many, and weight-loss surgery works for those with During the more serious chronic health issues, a new procedure procedure, for which now available through the bariatric program at the patient is sedated, FirstHealth Moore Regional Hospital provides a nona thin, deflated balloon surgical option for people who have difficulty with the is passed through the diet-and-exercise regimen but haven’t reached the level patient’s mouth, down the The FirstHealth Bariatrics team: (clockwise from top left) David of surgical intervention. esophagus and into the Grantham, M.D., bariatric surgeon; Raymond Washington, M.D., medical The ORBERA Intragastric Balloon procedure stomach, where it is filled director, FirstHealth Bariatrics; Melissa involves the minimally invasive placement of a balloon with saline until it is about Herman, R.D., LDN, program manager; in a patient’s stomach to reinforce portion control. the size of a grapefruit. The Christi Embler, R.N., nurse education liaison; and Alexis Elliott, LCSW, CDE, Appropriate patients are adults who typically have procedure usually takes behavioral health coach. a body mass index of 30 to 40 (although this can be 20 to 30 minutes, and the flexible) and who want to lose weight and maintain their patient generally goes home the same day. weight loss while participating in a medically supervised After six months, the deflated balloon is removed program. the same way it was placed. For six months afterward, The 12-month ORBERA program combines the the patient must follow a healthy diet and exercise temporary balloon with nutritional and behavioral prescription to maintain his or her weight loss. coaching and an exercise program. The balloon is “While the balloon helps you get started, the removed after six months, but the habits you form during the 12-month coaching continues for another six program are the tools to keep a healthy months. weight,” says Raymond Washington, For more information “This non-surgical M.D., medical director of about the ORBERA Intragastric treatment can help transform FirstHealth Bariatrics. “With Balloon procedure, the lives of patients before the balloon, you get a tool and visit www.firsthealth.org/orbera their obesity, which we a chance to learn a new way to or call (910) 715-1919. consider as a chronic feel about food.” disease, progresses to
(800) 213-3284 • www.firsthealth.org 13
HELPing patients avoid delirium
s a neurologist with Hospitalist Services at FirstHealth Moore Regional Hospital, Steven Lewis, M.D., frequently sees patients who have become confused during their inpatient hospital stay. Many times, he finds that their confusion has been caused by delirium, a disturbance in mental abilities that can result in confused thinking and reduced awareness of the patient’s environment. Often traced to contributing factors that can include dehydration, poor nutrition, changed medication schedules, abnormal electrolytes and pain, delirium can have serious consequences, especially among the elderly. Instead of merely treating delirium, however, Dr. Lewis began to investigate ways to prevent it. That’s how he found HELP (Hospital Elder Life Program). “I reviewed the medical literature and found several programs that have been studied,” he says. “HELP had the most scientific evidence supporting its use.” Designed by the Yale University School of Medicine, HELP is an innovative approach to improving hospital care for older patients. It has four primary goals: • Maintaining physical and cognitive functioning of high-risk older adults throughout their hospitalization • Maximizing independence at discharge • Assisting with the transition from hospital to home • Preventing unplanned hospital readmissions During his search for an appropriate prevention program for Moore Regional, Dr. Lewis learned that
14 Spring/Summer 2017
The Moore Regional Hospital HELP team – Elder Life Nurse Specialists Terrie Ebel, R.N., and Mandi Steed, R.N.; and Clinical Director Steven Lewis, M.D. – with Ellen Airs, one of the program’s 15 specially trained volunteers
other members of the hospital’s staff had begun to look at geriatrics issues. One was Deana Kearns, R.N., administrative director of Medical Nursing/Clinical Practice, who was putting together a committee on geriatric care. She believes the HELP program addresses a critical need. “Advances in care for elderly patients have led to a longer life expectancy and a special set of problems,” she says. “As we move toward a more specialized approach to the elderly population, the HELP program takes that first step in preventing hospital-induced delirium.” To be considered for HELP at Moore Regional, patients must be 70 years or older and live at home or in a retirement facility. They must also have one risk factor for functional decline or delirium such as cognitive impairment, mobility or ADL (activities of daily living) impairment, vision or hearing impairment, or dehydration. Only the second such program in North Carolina, HELP was introduced at Moore Regional last year as a
pilot on the hospital’s 4Medical nursing unit and later expanded to 3Medical. The 2Neurology staff is now undergoing training, and Inpatient Oncology will be added to the program later this year. The eventual goal is to take the program hospital-wide. Dr. Lewis serves as clinical director of a HELP team also comprising Elder Life Nurse Specialists Mandi Steed, R.N., and Terrie Ebel, R.N., and chairs a HELP Committee that includes physicians, an occupational therapist, dietitians, a pharmacist, discharge planners, social workers and volunteers. (See the accompanying story for more information on HELP volunteers.) Steed, the gerontology-certified program coordinator, shadowed another program and attended a HELP conference in Pennsylvania before working with Dr. Lewis to establish the model for Moore Regional. Patients who fit HELP criteria get a geriatric assessment that looks at their medical history, home and hospital medications, and invasive procedures, as well as their need for occupational or physical therapy. Steed and Ebel then make recommendations regarding treatment.
Once selected for assistance, patients are assigned a volunteer who has been specially trained in HELP interventions that can range from one-on-one communication to therapeutic activities, range-ofmotion exercises and feeding assistance. “We do things that help patients cognitively,” Steed says, “and we want to get them up and moving.” The goal is to reach the patient as soon as possible during his or her hospitalization in order to avoid or at least shorten the period of delirium, which can lead to more serious complications and lengthen the inpatient stay. There is no charge for HELP participation. “We look at what we can do on the nurse/medicine side to prevent delirium,” Steed says. According to Dr. Lewis, the program enrolls patients who are at highest risk for delirium and has been remarkably successful in preventing it. “I have seen a significant reduction in the number of cases of delirium,” he says, “and our data shows that the program has kept this high-risk population nearly free of the condition.”
The importance of HELP volunteers Both Clinical Director Steven Lewis, M.D., and Elder Life Specialist Mandi Steed, R.N., say that the HELP program at FirstHealth Moore Regional Hospital works because of its volunteers. “I would like to point out how important the volunteers are to the program,” Dr. Lewis says. “Unlike most hospital interventions, we do not use medications or procedures. The key to this program working are the people, the volunteers, doing the interventions.” Steed agrees. “We are not a program without volunteers,” she says. “We need that commitment.” Moore Regional has 15 specially trained HELP volunteers. One is Pinehurst resident Ellen Airs, who was approached by Cindy Strother, administrative director of Guest Services at Moore Regional, about volunteering on Fridays, which had no volunteers at the time. Airs agreed to take both Friday shifts. “I know the importance of it, having been a caregiver for my husband, who had hospital stays during his last 12 years,” Airs says. “It’s just right up my alley.” Although she enjoys all of her HELP patients, Airs admits a special bond with a certain group of patients. “So many people don’t have loved ones who are nearby who can come visit with them,” she says. “Those who don’t have family members showing up are most appreciative and, yes, it’s nice when
they thank me for coming.” Much of Airs’ HELP contact involves chatting with patients to keep them “in the here and now.” “We want to engage them and make sure they’re not confused,” she says. “I love the program, because it’s an umbrella over the patient’s care. I love the extra layer of protection of healthy outcomes that HELP provides.” Moore Regional’s HELP volunteers include retired nurses, retired teachers, a husband-and-wife team and one military vet. Each completed 16 hours of general and service area orientation before being assigned to patients. All report a high degree of satisfaction with their work. “All of the volunteers have loved it,” Steed says. “I still have the original five volunteers, and they’re awesome.”
If you are interested in volunteering with the HELP program for hospitalized older adults at FirstHealth Moore Regional Hospital, contact the Volunteer Services program of Moore Regional Hospital Guest Services at (910) 715-1268.
(800) 213-3284 • www.firsthealth.org 15
N E W P ROV I DE R S Cardiology
Heidi Marie Templin, ANP; FirstHealth Cardiology; Reid Heart Center; Moore Regional Hospital
Cardiac & Thoracic Surgery
Thomas P. Spiegel, PA-C; FirstHealth Cardiovascular & Thoracic; Moore Regional Hospital
Brianne Evans, PA-C; FirstHealth Family Medicine, Long Drive, Rockingham
16 Spring/Summer 2017
General and Colorectal Surgery
Reid C. Vegeler, M.D.; Pinehurst Surgical, FirstHealth General & Colorectal Surgery; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional HospitalHoke Campus
Pawan A. Dhawan, M.D.; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Monica E. Gensic, PA-C; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Catherine J. McInnis, PA-C; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Marla E. Mills, PA-C; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional HospitalHoke Campus
Jennifer A. Muzzy, AGPCNP; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Japonica D. Owens, FNP; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Kishore Reddy Rasamallu, M.D.; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus, Sandhills Regional Medical Center
Jennifer M. Swierz, PA-C; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Do you need help in finding a primary care provider or medical specialist? If so, visit Brad J. Young, PA-C; FirstHealth Hospitalist Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional HospitalHoke Campus
Anthony A. Mazzarulli, M.D.; FirstHealth Behavioral Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
From the Cleveland Clinic to Moore Regional Hospital Debra Jenkins Parsons, GNP; FirstHealth Internal Medicine, Rockingham; Richmond Memorial Hospital
Amanda E. Picerno, PA-C; FirstHealth Neurosurgery; Moore Regional Hospital
Corinne S. Medina, M.D.; FirstHealth Behavioral Health Services; Moore Regional Hospital, Richmond Memorial Hospital, Moore Regional Hospital-Hoke Campus
Physical Medicine & Rehabilitation
Jairon Downs, M.D.; Carolina Rehabilitation & Surgical Associates; Moore Regional Hospital
I have been a patient of Dr. Gregory Collins since February 2015. As you know, he was a world-renowned physician at the Cleveland Clinic in Cleveland, Ohio. The Lou Ruvo Center for Brain Health in Las Vegas, Nevada, had partnered with the Cleveland Clinic and a friend there referred me to the Cleveland Clinic. I was Gregory Collins, M.D. recommended for a VIP status, which enabled me to become a patient of Dr. Collins. Dr. Collins was able to diagnose my disorder very quickly. He started me on a treatment program that was very effective and has helped me enormously to lead a healthier life. In fact, when Dr. Collins moved to Pinehurst (and FirstHealth Moore Regional Hospital), I decided that I wanted to stay under his care. Dr. Collins is an exceptional doctor. He is very kind, caring, compassionate and committed to the betterment of his patients. I am very privileged to be his patient. I feel that FirstHealth Moore Regional Hospital is very fortunate to have such an extraordinary doctor. Karen Cashman Las Vegas, Nevada
(800) 213-3284 â€˘ www.firsthealth.org 17
Thank you for the help with health and fitness
George Hall (on treadmill) had his long-term health and a diabetes diagnosis in mind when he started working with fitness coach Randy Ballard at FirstHealth Fitness-Pinehurst. The result has been life-changing.
I am sending this note because I’d like to express my sincere appreciation and recognize the incredible job that Randy Ballard has done for me and my overall health condition in a very short period of time. My wife and I are new to the Pinehurst area, moving here from Virginia in June. In August, we both joined FirstHealth Fitness, and I was assigned to Randy as my fitness coach. I suffer from Type 2 diabetes (attributed 100 percent to weight). As I mentioned to Randy during our intake session, weight management was not only my number one priority, but it was essential to my long-term health prospects. Randy created an exercise program not only with a significant cardio component but, because I am a golfer (and an older one at that), a weight-lifting component as I have lost some muscle density, too. I saw my new Pinehurst doctor in September, at which time he did a complete blood panel. My A1C was 9.0 percent, out of control along with other results that were about as flattering. Randy continued working weekly with me, ensuring that I was doing OK on the program and increasing the intensity of my workouts as I was able. When I returned to the doctor for my three-month follow-up, I had lost 15 pounds and my A1C dropped from 9 to 6.6, a 26 percent decrease in just three short months. Furthermore, not one of the other measurements in the blood panel was high or rated as abnormal, i.e., blood pressure, cholesterol, etc. Randy and I continue to speak regularly and monitor my progress during those discussions. I am 100 percent convinced that had it not been for Randy’s interest in my health and well-being and those weekly “check-in” conversations, my three-month checkup results would have been very different. I continue to be very optimistic and hope, with Randy’s help, I can get off my diabetes medication for good. Make no mistake about it, this story probably would have a different ending without the dedication and commitment of one Randy Ballard. George Hall Pinehurst, North Carolina
18 Spring/Summer 2017
From ER to hospice, FirstHealth care was “phenomenal” As a nurse, it is not often that I am impressed, but the care my father received from FirstHealth was phenomenal. Daddy had Stage 4 pancreatic cancer and came in through the ER one evening. He was admitted and stayed in Moore Regional for two-and-a-half weeks before being moved to the Hospice House, where he passed away peacefully. All the staff I encountered went above and beyond. Living out of town, I spent several nights in the Clara McLean House. What a wonderful place just to go take a shower and sleep knowing I was near my dad. When Dad moved to the Hospice House, I went with him. I now know there truly are angels on this earth, because I met them there. Their kindness, love and respect for my father will never be forgotten. Kristi Medlin Richfield, North Carolina
According to his daughter, David Linton Kidd loved the sand and spent hours sculpting “anything but a sandcastle” during family beach vacations. Kristi Medlin says she and her father “spent three hours crawling around” to make a cancer awareness ribbon in summer 2015, his “last good summer” before he succumbed to pancreatic cancer in the FirstHealth Hospice House.
Mammogram was “positive experience” Just before Dec. 25, I visited FirstHealth for my annual mammogram screening. This was only my second time to FirstHealth, and I want to express how pleased I was the second time around as I was for my first visit. My first positive experience was with two wonderful ladies in the area where I checked in. Their names are Jennifer LeGrand and Cynthia Farmer. These ladies were so refreshing and so much fun in my short time with them. When I left, they handed me an envelope. I put it in my purse and didn’t look at it until I got home. The envelope consisted of a Christmas card personally signed by both ladies and a handcrafted bookmark. This had a huge impact on me, because not only was it Christmastime, but also because these ladies enjoyed their jobs and were happy to be there and loved spreading joy to others. My second interaction was with the woman who did my screening. Her name eludes me, but I still want to say how wonderful she was. My mother is a breast cancer survivor so each screening is a worry for me. My mammography technologist was great. She made me feel at ease and, for the second time in a row, I have not had to return to have my screening done a second time. I just wanted to take a moment to say “kudos” to Cynthia and Jennifer and my mammography technologist. Thank you for providing such essential and quality health care. Kelly Stevens Pinehurst, North Carolina
(800) 213-3284 • www.firsthealth.org 19
MULTI-LANGUAGE INTERPRETER SERVICES English ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (910) 7151000 (TTY 711). Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (910) 715-1000 (TTY 711).
A “fantastic”emergency department I’m an emergency room registered nurse in the state of Alabama. I made an emergency trip to North Carolina recently. The day of my visit, I became ill and had to visit the emergency department at FirstHealth Moore Regional Hospital. The first encounter of knowing I was in the right place occurred when an ED tech asked if I was OK and provided a wheelchair, which I didn’t use. The second encounter was the triage R.N., who was really concerned about my illness. The third encounter was with a registration tech and registered nurse. The tech was extremely courteous and professional. The R.N., wow, I cannot express the super, super treatment I received. She understood exactly what kind of care I needed and even listened to my input. I was most surprised by the facility. The ED, in most cases, is the first impression of the hospital. When the nurse gave me the call button and said if I needed her, to call, and the TV button for my comfort, I was truly taken. Sure, we all have the call button, but television, hmmm, a TV in your room … in the ED. This ED is the epitome of what we all should experience. I could ramble on and on, but I wanted to let you know what a fantastic facility this is and what an extremely high-skilled and caring staff you have. Michael Bailey Oxford, Alabama
“Above and beyond”care from bright young nurses I was recently a patient in the Cardiac Specialty Unit (at Moore Regional Hospital). My nurses were Kari Stewart and Amanda Wilson. I worked for 38 years as an anesthetist in four medical school-affiliated hospitals after graduating from Emory Medical School. There have been many very knowledgeable and dedicated nurses that I worked with over those years. I feel that Kari and Amanda deserve to be included in the best of those nurses. They helped me to understand how my cardiac problems were being treated and what to expect from some of the new medications that I wasn’t familiar with. At the same time, they provided exceptional nursing care without interfering with much-needed rest. That is above and beyond what my previous experience in intensive care units delivered. I am grateful to both of these bright young nurses. Terry Thrasher West End, North Carolina
20 Spring/Summer 2017
繁體中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言 援助服務。請致電 (910) 715-1000 (TTY 711)。 Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (910) 715-1000 (TTY 711). 한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-(910) 715-1000 (TTY 711)번으로 전화해 주십시오. (Arabic) اﻟﻌرﺑﯾﺔ Français (French) اﻟﻣﺳﺎﻋدة ﻓﺈن ﺧدﻣﺎت، إذا ﻛﻧت ﺗﺗﺣدث ﺑﺎﻟﻠﻐﺔ اﻟﻌرﺑﯾﺔ:ﻣﻠﺣوظﺔ ATTENTION Si vous parlez des services d'aide (910) :715-1000 ﺑرﻗمfrançais, اﺗﺻل.ﺑﺎﻟﻣﺟﺎن ﺗﺗواﻓر ﻟك اﻟﻠﻐوﯾﺔ linguistique vous sont proposés gratuitement. Appelez le (711 :TTY اﻟﺻم واﻟﺑﻛم )رﻗم ھﺎﺗف (910) 715-1000 (ATS 711).
Hmoob (Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (910) 715-1000 (TTY 711). Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (910) 715-1000 (телетайп: 711). Tagalog (Tagalog – Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (910) 715-1000 (TTY 711). ગુજરાતી (Gujarati) સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલક ્ ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો (910) 715-1000 (TTY 711). មែរ (Cambodian) ចំណាំ: បើអ្នកនិយាយភាសាខ្មែរ អ្នកអាចរកសេវាជំនយ ួ ផ្នែកភាសា ដោយឥតគិតថ្លៃបាន។ ចូរហៅទូរសព្ទទៅលេខ (910) 715-1000 (TTY 711) Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (910) 715-1000 (TTY 711). हिन्दी (Hindi) ध्यान दे:ं यदि आप हिन्दी बोलते हैं तो आपके लिए मुफत ़् में भाषा सहायता सेवाएं उपलब्ध है।ं (910) 715-1000 (TTY 711) पर कॉल करे।ं (Lao) ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົາ້ ພາສາ ລາວ, ການບໍລກ ິ ານຊ່ວຍເຫຼອ ື ດ້ານພາສາ, ໂດຍບໍເ່ ສັຽຄ່າ, ແມ່ນມີພອ ້ ມໃຫ້ທາ່ ນ. ໂທຣ (910) 715-1000 (TTY 711). 日本語 (Japanese) 注意事項：日本語を話される場合、無料の言語支 援をご利用いただけます。(910) 715-1000（TTY:711） まで、お電話にてご連絡ください。
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