little company of mary
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11
Little Company of Mary Hospital
Direct Patient Care For
Student Nurses and Faculty
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You are a Valuable Member of Our Team
Thank you for entering
health care!
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Mission
In solidarity with the Sisters of the Little Company of Mary we are entrusted to serve the community through our ministry of Catholic Health Care
We are the empowered laity – the Greater Company of Mary
Rooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity.
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Professionalism: take pride in your quality based, respectful care
Compassion: respect patients and families by listening to and assisting with their needs
Quality: promote highest level of safety in your care for quality patient outcomes. Anticipate patient needs
Responsibility: patient care, environmental and financial resources are in your hands
Core Values
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Attitude Maintain a professional attitude
Sense of Ownership Take pride in your work
Commitment to Co-Workers Treat co-workers with respect
Appearance Dress appropriately for the clinical setting
Communication Keep communication open among nursing staff, students and instructors
Customer’s Rights Give respectful care
Safety & Awareness Be aware of your environment
Elevator Etiquette Allow everyone to get off the elevator before you get on Do not block people exiting the elevator Do not discuss patients, patient’s families or co-workers on the elevator Keep voice down when with a group
Standards of Performance
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Is a Service Recovery ProcessFor ACTing on patient complaintsIt allows us to take corrective action to prevent the
problem from occurring againWe:
A: Apologize for mistake
C: Correct the problem promptly
T: Take action so problem will not occur again
Gift Program
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Introduce yourselfBe polite, listen attentively to your patientMake eye contactExplain why you are thereFirst impressions count!
“In the first 8-30 seconds after a customer talks with or sees you an opinion of you and your facility has been formed”
(Personal Growth January 2009)
What you do, does make a difference!
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Hourly Rounding at LCM Occurs on all patients
Every hour from 6am-10pm Every two hours from 10pm-6am
Focus on the 4P’s Pain – using the 1-10 scale
Positioning – is the patient in a comfortable position Toileting (potty) – does the patient need to go to the bathroom Placement – move items within reach (table, call light, tissue, phone, water, urinal)
A scan of the environment To be sure that all items are within reach To insure safety measures are in place To deliver the care patients need and expect
All above documented on Inpatient Hourly Rounding Log The white board in the patients room will be updated at the beginning of tour of duty:
With patients goal Ask the patient, “The one most important thing I can do for your care?”
Names of caregivers
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The Employee Parking lot is located on the east side of California at 95th Street.
Park on east portion of lot closer to Office Max
Enter the hospital through the revolving door at the front entrance
Other designated parking areas Blue - Employee/Volunteer Green - Physician Yellow - Patient/Visitor Red- Unavailable
LCMH is undergoing a campus transformation
Parking will be restricted **Students are to park at a
remote location Evergreen Bath &
Tennis 91st and California West end of parking lot
Check with your instructor for up to date information
Parking at LCMH
East
Parking
Lot
Student ParkingEvergreen Bath and Tennis91st California
95th Street
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91st Street
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In order to maintain safety it is required that students and instructors :
Wear their school picture ID in clear badge holder ID must be worn at chest level
Must wear your school uniform and ID during clinical Must wear professional dress with lab coat and ID if in hospital other than clinical
No Cut offs Flip flops Tank tops Jeans
If the hospital provided you with the clear badge holder please return it to your faculty at end of clinical.
Student Identification
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Smoking is not allowed in the hospital, or in areas surrounding the hospital including sidewalks and parking lots
Tobacco-Free
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HIPAA protects the privacy of individually identifiable health information
When working in the clinical setting ask your self Do I need to know this to complete my patient
care???? If you answer “no”, then stop
If you answer “yes”, follow the HIPAA TIPS ……………
Health Insurance Privacy And Portability Act (HIPAA)
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HIPAA TIPS
Don’t talk about a patient’s condition in front of others
Keep patient information safe Close off the computer Put charts away
Copying of any portion of the medical record is a HIPAA violation and can be prosecuted by law
If patient information is necessary for your learning process and to deliver patient care
Keep the information within the learning environmentShare pertinent information with the staff to provide quality care for the patient
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HIPAA Guidelines: Releasing Information Over the
TelephoneAt LCMH on admission the patient and his/her
personal representative will be given a paper with a four digit identification number The last four digits of the current visit number
Any calls received requesting patient information will only be honored if the caller knows the identification number
For unresponsive patients having no family request assistance from Case Management
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In an effort to maintain patient safety ALWAYS verify:
Patient’s name Patient’s date of birth1. By having the patient verbalize this information 2. Verifying the information with the patient’s ID band.
Patient Identification
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Cell Phones
Cell phones are not to be used in the clinical area! For any reason!
Cell phones can only be used in public areasThe lobby The cafeteria
Staff nurses will use hospital issued cell phones for communication with physicians and families
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All hospital policies can
be found on Meditech-LCHM’s computer system Under “Patient Care Services Policies and Procedures”
Your instructor will have access to LCMH’s library
Hospital Policies
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Get report.Let RN and Care Partner know what you will be doing for
your patientLet RN and Care Partner know when you are leaving the
unitsReport off to RN when clinical completed
Communication
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When a patient is identified to be at risk for fall. Fall Protocol is initiated
Follow the information provided in the Fall Prevention Protocol Packet
Found on MDC cart Fall protocol (yellow) ID band is placed on patient. Fall protocol signage is placed outside the patient’s
door and on the front of the patient’s chart Before leaving the patient’s room
Meet patient’s toileting needs Place the bed in the low position De-clutter the walk way Place the phone within reach Place the call light within reach Ask “Is there anything else I can do for you
before I leave your room?”
Fall Prevention Protocol
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At LCM we reduce the use of restraints as much as possible We use the least amount of restriction for the least amount of time The dignity and rights of our patients MUST be maintained at all times At lease every two hours we meet the patient’s needs of:
Nutrition Toileting Repositioning
We follow the the “Three Ps” Potty Pain Positioning
When a patient is in Medical Restraints staff will document every two hours
Restraint Policy at LCMH
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Restraints at LCMHBehavioral Restraints
Are applied when a patient is at risk to harm self or others
Students usually do not take care of these patients
Must have a 1:1 sitter at all times
Medical Restraints Are applied when a patient is
interfering with their healthcare The need for medical restraints
is reevaluated frequently and a doctors order is required
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Latex AllergyAlways be aware of allergies
identified by the patientLatex-free gloves are on the units for use with patients
having a latex allergy or if you have a latex allergyLatex-free equipment is available for those patients with a
latex allergyMDC has a list of all available latex free equipment
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Call Light Used At LCMHVolume Control on the side
Nurse Call Button
|
TV Control
|
Nurse Call Button
|
TV Control
Volume Control on the side
This call light is used in some of the patient rooms
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Pain is observed in patients of all ages When accessing pain use the age appropriate pain tools
Available for newborns to the elderly Our Pain Scale at LCMH
0 – 10 with verbiage and Smiley Faces 0 being no pain 10 being the worst possible pain
A Patient’s self-report is the only reliable report of pain Report patient’s self-report of pain to the nurse At LCMH a pain score of equal to or greater than a 4 requires intervention
It can interfere with activities of daily living and hinder recovery LCMH Care Partners can document the patient’s self report
Pain Across the Continuum
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Patient Handout on Pain Assessment at LCMH
LCMH’s platform of care: “In Pursuit of Pain-Free Health Care”
A copy of Our “Commitment to Pain” sheet Is given to all patients on admit
Is available, on every unit, in many different languages
Explains LCMH’s philosophy on pain relief
Explains how they will rate their pain
Explains what the patient can expect fro us
Explains how the patient can help manage their pain
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At LCMH care is provide taking into consideration The growth and development the physiological changes that
occur with the aging process
Age Appropriate Care
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Wash your hands!! Wash your hands!!! Signage will be placed outside the patient’s room indicating the
type of isolation precaution the patient is on Wear the appropriate personal protective equipment (PPE)
NEVER ENTER AN ISOLATION ROOM WITHOUT THE APPROPRIATE PPE
Antibacterial soap & alcohol based cleanser are available in every patient room
Red garbage cans are placed in each patient room for biohazard waste
Infection Control Issues
Isolation gowns are NOT DISPOSABLE
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Artificial nails spread infection and are not allowed
Natural nails should be < ¼ inch long
Always check signage outside the
patients room for PPE to be used
If the patient has C-Diff
They will be on Contact “Plus” Isolation
Wash hands with soap and water
This is the ONLY way to kill C-Diff
Alcohol gels DO NOT kill C-Diff”
Infection Control Tips
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Infection Control Guidelines• Health care institutions are mandated by
regulatory agencies • These mandates require students have specific immunizations for
their protection
• If you are sick DO NOT come to the clinical setting• A make up day can be arranged with your faculty if school
policy allows• Though not required consider getting the flu vaccine
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• The N95 Respirator is a special fit-tested mask • Worn when caring for patients on Airborne isolation-in negative air flow rooms
• Staff are trained on the proper use of the N95 Respirator• Students will not care for patients in negative air flow rooms
• Commonly seen conditions requiring Airborne Precautions include suspected or confirmed:
• MTB (mycobacterium tuberculosis)• Positive AFB (acid fast bacilli)
until MTB is ruled out• Varicella/Chickenpox• Varicella/Shingles
• If disseminated• More than 25 vesicles
N95 Respirator
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Exposure to blood and body fluids is taken very seriously at LCMH
Take all precautions to reduce exposure to blood or body fluids
If exposed to blood or body fluids
Report it to your faculty and charge nurse immediately
Wash exposed area with soap and water for 3-5 minutes Rinse splashes to eyes or mouth with water or sterile saline for 10 minutes Wash puncture wounds with soap and water for 3-5 minutes Report to the Emergency Room
Treatment needs to be completed within 2 hours
You are financially responsible for treatment you receive. Uniforms soiled with blood or body fluids will be cleaned by the hospital
Notify the charge nurse You will be given scrubs in exchange for your soiled uniform Your cleaned uniform will be returned when you return the scrubs
Exposure Incidents
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Occurrence Reports
If involved in an occurrence with potential to cause harm to anyone an occurrence report needs to be filled outOccurrence Reports are on the Meditech computer systemReport the occurrence to your instructor and the nurse managerDocumentation of the occurrence is only in the Occurrence
Report computer module
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Linen Utilization
LCMH has initiated a linen campaignTo ensure proper and efficient use of linen items for
patient comfort and safetyTo limit the misuse and the unnecessary
contamination of linen LCMH spends more than
$500,000 annually on linen processing $400,000 annually in linen replacement
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Linen “As Needed” Bed Change
Changing the linen “as needed”
Is a new conservative program at LCM H
It is easy on the environment by
Protecting our natural resources
Conserving water
Exposing fewer chemicals into the environment
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“As Needed” Bed Change Guidelines
Straighten bed linens every day
Change the patient’s bed linens with what is needed when needed
When the bed is visibly soiled
When the bed is damp
When the Physician’s request or care giver requests the
bed linens be changed
When the patient requests or a family member requests
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Steps to follow to go“Easy on the Environment”
Maintain LCMHs commitment to outstanding patient care while being “easy on the environment” Enter the patient’s room Exchange only what is needed Explain the process Educate the patient on how
they are helping to protect
the environment
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What to do With Soiled Linen
All soiled linen is to be put in BLUE plastic bags while still in the patient’s room
Any linen that is brought into a patient’s room is considered contaminated and must be placed in BLUE plastic bagsOnly linen that will be used should be brought into
the patient room
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Do Not Resuscitate A DNR means the patient has chosen to have no intervention or
partial interventions if they become unresponsive without a pulse A doctor’s order MUST be on chart if patient has a “Do Not
Resuscitate” status Always know your patient’s code status
A sticker is placed on on front of chart to indicate the patients code status
No Code Status Partial Code Status
DNR Status
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Rapid Response Is activated when a patients condition is deteriorating
Anyone can activate a Rapid Response Families, patients and visitors are educated on
Rapid Response Activate by dialing 5960
Announce Rapid Response and your location Code 70
Is activated when a patient is unresponsive without a pulse Code Brain
Is activated when a patient has an acute ischemic stroke and requires TPA
Code Purple The Perinatal Hemorrhage Rapid Response Team
Emergency Codes
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Emergency Codes Code 99
Is activated in fire situations Activate by pulling the nearest fire alarm
Know the locations of the fire alarms Code 33 Yellow
Is activated in a disaster Standby Wait for direction from your instructor
Code 33 Red Is activated in a disaster
Wait for direction from your instructor Code 33 Orange
Is activated in a hazardous material or Bioterrorism situation If you discover a Hazmat incident
Activate by calling Security 5313 Announce Code 33 orange and your location
Wait for direction from your instructor
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Emergency CodesCode 66
Water sprinkler activation Activate by calling Security 5313
Announce Code 66 and your locationCode Gray
Is activated in a sever weather watch Wait for direction from your instructor
Code Black Is activated in a sever weather warning
A tornado or severe thunderstorm has been sighted in Southern Cook County
Wait for direction from your instructor
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Emergency Codes Code Kid
Is activated in an infant abduction Activate by dialing 5960
Announce Code Kid and your location Be alert to any unusual activity
Report unusual activity to security 5313 Code Dr. Blue
Is activated for security assistance if you feel threatened and the offender is present or if you see a suspicious person Activate by calling 5313
Announce Dr. Blue and your location Code Silver
Is activated when there is an armed intruder Activate by calling Security 5313
Announce Code Silver and your location If you hear a Code Silver called DO NOT go to that area
Crisis Intervention Team Is activated for violent patient situations
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Know your patient’s code status! If you find someone
unresponsive and without a pulse Activate a Code 70
Activate by dialing 70 and announce Code 70 and your location Begin CPR Compressions only until Code 70 team arrives
Code 70
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Fire situations• Fire Plan: R – Rescue patient from room
A – Alarm, know where they are C – Contain, close door
E – Extinguisher to room • Fire Extinguisher Plan: P – Pull the pin A – Aim at base of fire S – Squeeze the trigger S – Sweep base of fire
Code 99
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Code Brain A Code Brain
Is activated when a patient with acute ISCHEMIC stroke meets the criteria for thrombolytic therapy (TPA) (Tissue Plasminogen Activator) treatment
A MD order has been received for TPA administration
Process Activate by calling 5960
Announce Code Brain and your location
Included in the “Code Brain” batched page will be The house MD The Nursing Supervisor The stroke coordinator
http://www.health.com/health/static/hw/media/medical/hw/h5551195.jpg
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Symptoms of a Possible Stroke Acute stroke signs and symptoms
SUDDEN ONSET F = FACE
Uneven smile Facial droop/numbness Vision disturbance in one or both eyes Double, blurred or blackened vision
A = ARM Weakness, numbness difficulty walking Balance or coordination difficulties
S = SPEECH Slurred speech Inappropriate words Mute Difficulty understanding words Confusion
T = TIME This is a MEDICAL EMERGENCY – Call 911
Other Headache May be sudden and severe in nature
http://braininjurypeervisitor.org/web_images/act_fast.jpg
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What To Do If You Recognize Signs and Symptoms of a Possible Stroke
For Patients on Medical/Surgical Units Activate the “Rapid Response Team”
Dial 5960 and announce Rapid Response and your location ICU RN will
Access the patient Order ACUTE STROKE PROTOCOL diagnostics Accompany the patient for STAT Acute Stroke Protocol Plain Brain CT Transfer the patient to ICU if needed
For Visitors and Patients Outside Inpatient Units Activate by dialing 70 and announce Code 70 and your location
Code team will transport the victim to the Emergency Room upon stabilization For Patients and Visitors Outside the Hospital
(Mary Potter Physicians’ Pavilion, Halsted Center, Burbank Facility, Palos Diagnostic Center Call 911 to activate the Emergency Medical System
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Code Purple Code Purple is the Perinatal Hemorrhage Rapid Response Team
This Is a perinatal situation requiring additional staff, lab, blood products, personnel and equipment
To activate dial 70 Announce Code Purple and your location
The Code Purple team consists of Lab Respiratory Nursing Supervisor ICU RN Various physicians
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• Is activated for violent patient situations • Activate by calling 5960
• Announce you need the Crisis Intervention Team and your location
• The Crisis Intervention Team consists of• Security personnel• The Nursing supervisor• Pastoral Care personnel• A Behavioral Health RN
Crisis Intervention Team
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Documentation
• If documenting in the Meditech Computer system
• Document under your instructors Meditech number• Make a note: “Documentation done by and your name”
• Performing a blood glucose with the LifeScan meter• Is done under your instructors INS # number
• Rather than documenting in the computer system • A hand written note may be done on the Progress Notes
• Co-signed by faculty
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Medication Administration
• Medications are obtained from
the automated dispensing machine - Pyxis• Using your your instructors bio-ID.
• Remember the RIGHTS of
medication administration• Right patient• Right time and frequency• Right dose• Right route of administration• Right drug
• You are responsible for all medications you administer!
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Medication Policies
What medications students DO NOT giveBlood or any blood productsThe initial dose of any IV medicationsChemotherapy
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Medication Documentation
Documentation of medications and IV’s is Done on the Medication Administration Record - MAR,
PRN Medication Administration Record - PRN MAR and the IV Administration Record - IVAR
The MAR, PRN MAR and IVAR are kept on the patient’s clipboard
All medications must be Signed by you Co-signed by your faculty
According to LCMH policy
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MARInformation contained on MAR
Patient visit # Patient Name DOB Patient Medical
Record # Age Date Admitted Primary Diagnosis MAR Date Allergies
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PRN MAR
MK Nowicki RN MKN
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IVAR
650
50 50
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High Alert Medications
• Be aware of those medications that when taken as recommended can cause injury to the patient
• Always do a 2 RN check on High Alert Medications • Such as insulin. • This is a 2 RN check• Between instructor and RN• Not just student with faculty
• Your faculty has the LCMH policy regarding what medications are High Alert Medications
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Measuring I&0 at LCMHFluid Equivalents
1 oz.= 30cc
Plastic glass 210cc
1 cup (8oz) 240cc
Plastic Pitcher 900cc
Soup Bowl 180cc
Milk Carton 240cc
Jello/Ice Cream/ Fruit Ice ½ cup 120cc
Juice (foil cover) 120cc
Juice (plastic cover) 80cc
Pop 1 can (12oz) 360cc
Coffee/Tea (8oz) 240cc
Ensure 1 can 240cc
Small Milkshake (8oz) 240cc
Large Milkshake(16oz) 480cc
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Always ask for assistance with lifting or moving patients
Bend your knees and lift with
your legsTighten your stomach muscles
and pull the object close to your body
Be sure the weight of the object isn’t more than you can lift
Ergonomics
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Safety and Emergency preparedness are necessary To promote and maintain a safe and secure environment for patients, staff
and visitorsLCMH has information on Chemical spills and directions on cleaning the spill
This can be found in the Material Safety Data Sheet (MSDS) Found in the Environment of Care (EOC) manual on each unit
In the event of a power failure All rooms are equipped with red outlets for critical care equipment
LCMH is part of a Hospital and Community Emergency Response System This is a community based response by healthcare organizations to
emergencies
Safety & Emergency Preparedness
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“Pursuit of Pain-Free Health Care”
In our efforts to maintain this platform LCMH Provides Minimally invasive procedures
such as Da Vinci robotic surgery Diagnostic tools
Laparoscopic cameras 40-slice CT scanners
Continues to promote a health care experience that provides
Easy access Personal attention
Our Platform at LCMH
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The Future of LCMH
To be completed in the fall of 2012
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ReferencesReferences provided on request
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