This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Some weight loss clinics also insist that patients take additional supplements, such as vitamin B12 shots and 5-HTP, to boost phentermine despite the supplements unproven effectiveness. As a reminder, Ohio law requires physicians who prescribe any controlled substances, not just opioids, to submit an ICD-10 code with that prescription. If the doctor finds that the patient is a good candidate for Phentermine, they may prescribe a certain dose and provide specific details on dosage and lifestyle choices that should accompany the use of this medicine. Phentermine is intended to help overweight and obese patients who have already tried losing weight with diet and exercise. However, the medication does have a considerable street value. Many physicians who currently receive the reports have found that the reports help them better understand, and possibly alter, their prescribing practices. History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension), During or within 14 days following the administration of monoamine oxidase inhibitors, Known hypersensitivity, or idiosyncrasy to the sympathomimetic amines, Effect on the ability to engage in potentially hazardous tasks [see, Withdrawal effects following prolonged high dosage administration [see, Development of primary pulmonary hypertension [see, Development of serious valvular heart disease [see, Effects on the ability to engage in potentially hazardous tasks [see, The risk of an increase in blood pressure [see, the potential for developing tolerance and actions if they suspect development of tolerance [see, the risk of dependence and the potential consequences of abuse [see. Any knowledge would be most appreciated. W0Qxe {>x??}# cGCSGGC[G(P A@3'i~ (2[n! 121 0 obj <>/Filter/FlateDecode/ID[<5D80FCFEE48BF540827EEA7155FB4128>]/Index[104 35]/Info 103 0 R/Length 85/Prev 180155/Root 105 0 R/Size 139/Type/XRef/W[1 2 1]>>stream However, if it is almost time for your next dose, skip the missed dose and go back to your . One of the most important things to consider is the fact that the drug should never be accompanied by an MAO inhibitor. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use . In some cases, the side effects were life-threatening and led to the death of a patient. information and will only use or disclose that information as set forth in our notice of It also isn't for people who are pregnant, may become pregnant or are breastfeeding. To avoid trouble with sleeping, take the last dose of the day about 4 to 6 hours before bedtime, unless your doctor tells you otherwise. U.S. Food and Drug Administration. Highlighted below are the topics discussed at the meeting that OSMA is closely following. Therefore, coadministration of Phentermine and these drug products is not recommended. Rule 4731-11-02 | General provisions. Store at 20 to 25C (68 to 77F) [See USP Controlled Room Temperature]. Overdosage of pharmacologically similar compounds has resulted in fatal poisoning usually terminates in convulsions and coma. It is illegal & unsafe to buy phentermine online consider Phen Caps instead! In a single-dose study comparing the exposures after oral administration of a combination capsule of 15 mg Phentermine and 92 mg topiramate to the exposures after oral administration of a 15 mg Phentermine capsule or a 92 mg topiramate capsule, there is no significant topiramate exposure change in the presence of Phentermine. Between the consultation, labs, prescription, and supplements (if applicable), weight loss clinics are also an expensive option. Patients with a larger body weight may need to take a larger dose, depending on whether they have any health concerns that may be worsened by the usage of a larger dose. In order to use Phentermine, the doctor needs to prescribe the drug for a specific patient. In patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73m2), limit the dosage of Phentermine to 15 mg daily [see Dosage and Administration (2.2)]. The risks include, but are not limited to: See also, for example, Adverse Reactions (6) and Use in SpecificPopulations (8). stream If a patient would like to take other supplements, they should consult their doctor first. I hold a DEA cert. There are reports of patients who have increased the dosage of these drugs to many times than recommended. Existing health conditions that may act as a problem include diabetes, thyroid disorders, hypertension and kidney disease. Phentermine: 18.75 to 37.5 milligrams (mg) once a day, taken before breakfast or 1 to 2 hours after breakfast. The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. - 7 privacy practices. Amphetamines and other stimulant drugs have been extensively abused and the possibility of abuse of Phentermine should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. The limited usefulness of agents of this class, including Phentermine, [see Clinical Pharmacology (12.1, 12.2)] should be measured against possible risk factors inherent in their use such as those described below. Comprehensive review of current and upcoming anti-obesity drugs. %PDF-1.6 % Patients should be advised to report immediately any deterioration in exercise tolerance. Safety and effectiveness in pediatric patients have not been established. A physician is the only person who can prescribe phentermine. ADIPEX-P (phentermine hydrochloride) tablets, for oral use CIV ADIPEX-P (phentermine hydrochloride) capsules, for oral use CIV Initial U.S. Approval: 1959 %%EOF ). She is passionate about promoting health at any size. Late evening medication should be avoided because of the possibility of resulting insomnia. 0 Contraindications History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension) During or within 14 days following the administration of monoamine oxidase inhibitors Hyperthyroidism The drug is classified under a certain chemical class known as amphetamine as it has a similar pharmacology value to other drugs classified in the class. Avoid use of Phentermine in patients with eGFR less than 15 mL/min/1.73m2 or end-stage renal disease requiring dialysis [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)]. Review/update the It is not uncommon for patients to experience a change in their sexual interest. In some cases, the use of Phentermine has also led to the development of symptoms that are related to erectile dysfunction. The patient could have had the prescription for the month of October filled at another pharmacy. This search engine indexes the Drug Enforcement Administration Diversion Control Program Web Site (www.deadiversion.usdoj.gov) only. Children 16 years of age and youngerUse is not recommended. It is illegal and unsafe to buy phentermine without a prescription. hWmo8+jE'"m{F Another important fact to consider before taking Phentermine is that it should never be used by women who are pregnant or who are currently breastfeeding. Taking more than the prescribed amount of Phentermine can lead to an overdose, which means if a patient misses a dose, they should never try to make up for it by taking more than the prescribed amount at the next dose. Specializes in NICU, PICU, Transport, L&D, Hospice. privacy practices. Some of the most common withdrawal symptoms include weight gain, fatigue, insomnia and a bad mood. Take the disintegrating tablet with or without food. Review/update the 1-612-816-8773. The possibility of abuse of Phentermine should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. Some patients experience an increase in sexual interest, while others notice that they have a lower libido. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. hb``````>X,K10wdjdZ(`l Ro4' b2h>$:-9.AKL1}c$vEP;-@c=en`Y %YQh` &^ In order to help patients reduce their risk of developing these diseases when they are obese, doctors usually prescribe Phentermine. ). Accessed Oct. 11, 2022. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Place the tablet on the top of your tongue right after removing it from the bottle. Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. The medical boards ICD-10 Committee is tasked with reviewing ICD-10 data that physicians submit to the OARRS system when prescribing controlled substances. The MAO inhibitors (Monoamine Oxidase Inhibitors) are used to treat depression, especially a specific type called atypical depression. It is a class IV controlled substance because of its serious side effects and addiction potential. The most common brand of Phentermine is a product known as Adipex, but officially called Adipex-P. Phentermine Hydrochloride Tablets are indicated as a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index 30 kg/m2, or 27 kg/m2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia). A doctor is the only person who can determine if phentermine is right for you. If not, additional education or an additional certification may be needed. The use of Topamax and Phentermine is actually an FDA-approved combination. This was often referred to as Rainbow Pills as all four drugs were often provided to a patient at the same time. 2 A physician will usually start with a physical examination to determine if the patients health is in a state that will not be negatively affected when taking this drug. Below we explain how to get phentermine, including why you need a prescription, who can take this medication, and how to get your doctor to prescribe phentermine. other information we have about you. ). Systemic exposure of Phentermine may increase up to 91%, 45%, and 22% in patients with severe, moderate, and mild renal impairment, respectively [see Dosage and Administration (2.2) and Use in Specific Populations (8.6)]. Should the collaborating physician have restrictions on his/her ability to prescribe controlled substances including controlled substance weight loss medications, the CTP holder would be limited by the same restrictions.The administrative rules, Advanced Practice Registered Nurse Certification and Practice, contained in Chapter 4723-8, of Ohio Administrative Code (OAC), require all APRNs to utilize and incorporate into the nurses practice knowledge of Chapter 4731.,ORC, and rules adopted under that chapter by the State Medical Board that govern the practice of the nurses collaborating physician. Not only can losing weight harm an unborn baby during pregnancy, but the drug may also cause adverse effects. But it isn't a good choice for people with heart disease, high blood pressure, an overactive thyroid gland or glaucoma. Available for Android and iOS devices. Columbus, Ohio 43215 Phone: (614) 466-3934 Web: www.med.ohio.gov State Medical Board of Ohio 30 E . 104 0 obj <> endobj The Formulary can be accessed on the Board of Nursing website: www.nursing. The Topamax is added to Phentermine in order to intensify its effects and to help patients lose weight faster. The medical board would like to work with the pharmacy board to make OARRS reports more available and helpful to physicians. In 1968, three years after its release, Aminorex was withdrawn. This content does not have an English version. Phentermine Hydrochloride Tablets, USP 37.5 mg are white oval shaped bisected tablet with blue specs, debossed with 810 on bisected side. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema, and patients should be evaluated for the possible presence of pulmonary hypertension. Rx only. Obesity has been linked to many different diseases, including type 2 diabetes and cardiovascular disease. While suffering from any of these health concerns may be a cause for concern, it does not mean a patient will not be able to use Phentermine at all. The first use of Phentermine as a drug to help treat obesity dates back to 1938. Concomitant use of alcohol with phentermine may result in an adverse drug reaction. Bariatric doctors are doctors that specialize in weight management. Below is a chart of body mass index (BMI) based on various heights and weights. The doctor also looks at the patients medical history for any pre-existing medical conditions that the medication should not be taken with. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendations in this regard. L^%0:T'xHGi,KGyVfZ5WI6&ZU1/VqM4.ct\i2gTAtQV%[$*/tbn"xS8JU$bljsI2)bs_/FouVGwCqX';z{0REZbSX,bXWPS#Bf|il#o'y`?jv{;!bS F#vPGzD"1~5~F%mW9YlGIQVYOS~kojbdQS!>|@Ph If you miss a dose of this medicine, take it as soon as possible. The health information contained here is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. Alternatively, 18.75 mg twice daily. The FDA has categorized this drug as X for pregnancy, which means it should not be used during pregnancy under any circumstances. Do You Need a Prescription for Phentermine? JC. The weight loss experts who OSMA has consulted with have indicated that misuse of phentermine is unlikely. Rule 4731-11-04.1 Controlled substances: utilization for chronic weight management. This study guide will help you focus your time on what's most important. N;d0)zQ|,]8EtXy(En"GX omjU3Y3>kfkYHYi]-zhm{= o`i$G1BK%?9Z+(dm`mKt,?;6K@Q 7}}*Tw>7BkKsJ;E|Viexb T-3j%5QB%wI5'$5oB :h*C"Q7yjTzLO%6QS/u>HX 4DGz*A!1*p"7$-joX2YF8ht@\l[&LS$FU=udM&y.l_ It is both dangerous and potentially illegal to use an online phentermine doctor. Phentermine is approved for use for up to 12 weeks. Create well-written care plans that meets your patient's health goals. They are usually real doctors who prescribe real phentermine without the now-mandatory face-to-face consultation. There is a problem with % Drugs of this class used in obesity are commonly known as anorectics or anorexigenics. It has not been established that the primary action of such drugs in treating obesity is one of appetite suppression since other central nervous system actions, or metabolic effects, may also be involved. This does not only include prescription drugs but also: Common drugs that are known to interact with Phentermine include Dopamine, Venlafaxine, Linezolid, Ephedrine, Isoproterenol, Epinephrine, Norepinephrine and a Phenylephrine injection. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Later on, between 1940 and 1960, Phentermine was combined with other medications to improve its effectiveness. To provide you with the most relevant and helpful information, and understand which Since 1997, allnurses is trusted by nurses around the globe. Manifestations of acute overdosage include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, and panic states. A weight loss doctor will be more familiar with the research on phentermine for weight loss and, in many cases, more likely to prescribe it. If you miss a dose of this medicine, take it as soon as possible. Each brand has its own way of manufacturing the drug and, in some cases, combines it with other chemicals to make it more effective or to add additional features to its use. Start with your primary care doctor and schedule an appointment to discuss weight. Won Son J, et al. However, phentermine is not appropriate or safe for everyone. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. National Association of Boards of Pharmacy. Clinics specializing in weight loss often employ bariatric specialists who have additional training in obesity management. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Each tablet contains the following inactive ingredients: starch, lactose anhydrous, microcrystalline cellulose, colloidal silicon dioxide, stearic acid, magnesium stearate and blue sugar spheres. To provide you with the most relevant and helpful information, and understand which This content does not have an English version. The amount of weight loss associated with the use of an anorectic drug varies from trial to trial, and the increased weight loss appears to be related in part to variables other than the drugs prescribed, such as the physician-investigator, the population treated and the diet prescribed. Unpublished raw data. Other brands of this drug include Suprenza, Phentercot, Acxion, Elvenir, Terflamex, Panbesy, Duromine, Fentermina, Phentermin, PHentermine and Lomaira. For oral dosage form (extended-release capsules): Adults and children 16 years of age and olderOne capsule once a day, taken before breakfast or 10 to 14 hours before sleeping. 4 0 obj According to the medical board, at this time, only physicians who prescribe opioids are receiving benchmark style reports and the board thinks that all prescribers who report into OARRS should receive the same information. Find out everything you need to know about weight loss drugs in our prescription weight loss pill guide. Succeed on your weight loss journey with our curated resources! Phentermine also is offered combined with topiramate for weight loss (Qsymia). Drug information provided by: IBM Micromedex. It depends on supplements a patient would like to take. The structural formula is as follows: Phentermine hydrochloride is a white, odorless, hygroscopic, crystalline powder which is soluble in water and lower alcohols, slightly soluble in chloroform and insoluble in ether. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Phentermine also has many potential drug interactions (e.g., with MAOIs), so the prescribing doctor and pharmacist know about ALL other medications and supplements taken within the last two weeks. More, these sites also operate pharmacies that are not VIPPS-accredited, so you may also be putting your personal information and or money at-risk ( You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. For oral dosage form (disintegrating tablets): Adults and children 17 years of age and olderOne tablet once a day, taken in the morning. Generic name: Phentermine hydrochloride The Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances Prescribing Guidelines offer clinical guidance for the acute care environment where there is no established patient-doctor relationship. Please consult with your physician before you make any decisions regarding your health. 5 If you are allergic to other stimulants, amphetamines, cold medications or diet pills, you have a higher risk of being allergic to these pills too. Cumulative urinary excretion of Phentermine under uncontrolled urinary pH conditions was 62% to 85%. LiverTox National Institutes of Health. Phen Caps is recommended by over 30,000 people like you who want to lose weight fast and effectively without the drawbacks of prescription medications. Due to its status as a controlled substance, the sale, distribution, and possession of this drug is tightly regulated by the DEA and international regulatory authorities ( 2021; doi:10.1007/s13679-020-00422-w. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. More specifically, this medication is an option for people with a body mass index (BMI): Greater than 30 kg/m2 Greater than 27 kg/m2 + one or more weight-related condition Rule 4731-11-01 | Definitions. Phentermine is not a miracle drug taken daily and the body simply starts losing weight all by itself. The drug is also available in regular capsules that are taken orally with a glass of water. Phentermine is a schedule IV drug that requires a consultation with the doctor and a prescription. Your doctor may prescribe both of these drugs separately, or choose to prescribe Qsymia, which is another medication that combines Phentermine and Topamax. It is not known if Phentermine is excreted in human milk; however, other amphetamines are present in human milk. The drug has two primary functions in the human body, which is the reason why it is always accompanied by these lifestyle changes. potentially hazardous activities such as operating machinery or driving FULL PRESCRIBING INFORMATION in the presence of other risk factors (e.g., controlled hypertension, 333-33-100411 Tasks 35 health information, we will treat all of that information as protected health State Medical Board of Ohio 30 E. Broad Street, 3rd Floor, Columbus, OH 43215-6127 (614) 466-3934 med.ohio.gov While discussing the use of Phentermine with the doctor, a patient is provided a list of lifestyle changes to implement while using this product. Dosage should be individualized to obtain an adequate response with the lowest effective dose. But regarding phentermine monotherapy, phentermine hydrochloride (HCl) is a sympathomimetic Drug Enforcement Agency (DEA) scheduled IV drug approved as an anti-obesity medication and marketed in the US since 1959 (See Table 1).The reported weight reduction efficacy of phentermine [10] derived from . So some health care providers might order it for longer use. See full prescribing information for ADIPEX-P. One should bear in mind that Phentermine is not only a drug to help reduce the baseline body weight of patients, but it also reduces a patients risk of developing certain health diseases. Studies have not been performed with Phentermine to determine the potential for carcinogenesis, mutagenesis or impairment of fertility. Gastrointestinal symptoms include nausea, vomiting, diarrhea and abdominal cramps. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Accessed Oct. 11, 2022. The goal of the drug is to help patients lose weight and increase energy since the withdrawal symptoms of include fatigue and weight gain through an increase in appetite, the product is rendered a waste of the patients time and money. ]c,'303:20/) @d` )2 Cardiovascular effects include arrhythmia, hypertension or hypotension, and circulatory collapse. Phentermine should never be taken after 6 pm in the afternoon as it causes insomnia. See DrugAbuse and Dependence (9.3). Yes, phentermine is a federally controlled substance because it may be abused or lead to It is impossible for them to complete the necessary physical evaluation (and follow-up) that is required to ensure that phentermine will not cause you undue harm. The CPG determination is specific to Qsymin, Belviq and Contrave only. Mayo Clinic Proceedings. Implementation of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. Dispense in a tight container as defined in the USP, with a child-resistant closure (as required). Different brands manufacture, distribute and sell Phentermine drugs. The promotion of this brand as a diet pill started in 1990. IBM Micromedex. As phentermine is similar to amphetamine, it is a controlled drug (class C5) and has the potential for abuse. Perreault L. Obesity in adults: Drug therapy. I am looking for information/advice/links to prescribing Phentermine (adipex ) in conjunction with diet and exercise in My private PCP business in the state of Ohio. Advise pregnant women and nursing mothers not to use Phentermine [see Use in Specific Populations (8.1, 8.3)]. Ask your healthcare professional how you should dispose of any medicine you do not use. = Plus, the doctors are not familiar with your overall health status, instead relying entirely on self-reported information, which is often incomplete or inaccurate. Rule 4731-11-03 | Utilization of anabolic steroids, schedule II controlled substance cocaine hydrochloride, and schedule II controlled substance stimulants. However in the presence of topiramate, Phentermine Cmax and AUC increase 13% and 42%, respectively. These are two schedule- IV medications, phentermine/topiramate (Qsymia), and locaserin (Belviq), as well as non-controlled naltrexone hydrochloride/ buproprion hydrochloride (Contrave). Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This brand is manufacturedby Teva Pharmaceuticals (formerly GATE Pharmaceuticals). They help the body produce a larger amount of energy from fat cells, which further reduces body fat percentage. When tolerance to the anorectant effect develops, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. If we combine this information with your protected Phentermine is a popular prescription drug that is often used to treat obesity. When mental impairment is present while taking Phentermine, a patient is also advised not to drive to avoid the risk of being involved in an accident. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Taking too much Phentermine can be harmful to the patients body. This site complies with the HONcode standard for trustworthy health information: verify here. The CPG determination is specific to Qsymin, Belviq and Contrave only. Based on Ohio's opioid prescribing guidelines, we developed an opioid prescribing rule that applies to all BWC-certified prescribers. The board expressed concerns that removing the prescribing restrictions could lead to misuse of weight loss drugs such as phentermine. These include, but are not limited to:Whether the care and treatment of obese patients and weight management is new to the APRNs existing practice, and whether this aspect of practice is within the APRNs national certification and patient population specialty, meeting the scope of practice requirements in Section 4723.43, ORC. In some cases, the use of this drug in combination with other pills may cause the effects of other drugs to increase. Current Obesity Reports. Phentermine, an amphetamine congener, is the most widely used anti-obesity drug in the U.S. It can help weight loss by making you less hungry. There is a problem with information and will only use or disclose that information as set forth in our notice of the unsubscribe link in the e-mail. Phentermine has been linked to many complications; knowing these details will help patients minimize their risk of experiencing such unwanted scenarios. Phentermine is for people with obesity or overweight who haven't been able to lose enough weight with diet and exercise alone to improve their health. Missed Dose . The dosage may be adjusted to the patients need. Symptoms of extremely high blood pressure, such as uneven heartbeats, chest pain, blurred vision, anxiety and a severe headache. information submitted for this request. Facts & Comparisons eAnswers. The drug is classified under a certain chemical class known as amphetamine as it has a similar pharmacology value to other drugs classified in the class. If your dose is different, do not change it unless your doctor tells you to do so. In addition, Section 4723.431(A), ORC, requires the APRNs collaborating physician to be practicing in Ohio in a specialty that is the same or similar to the nurses nursing specialty.Section 4723.481(B), ORC, prohibits the prescriptive authority of the CTP holder from exceeding the prescriptive authority of the collaborating physician. For more information, the rule package submitted to the Common Sense Initiative (CSI) office for review can be found here:https://med.ohio.gov/LinkClick.aspx?fileticket=Q2JmI7o-3HI%3d&portalid=0, 2023 The Ohio State Medical Association. Before starting with consumption of this medication, patients should get informed about potential adverse effects to be able to determine whether a newly-developed symptom is a sign of a health issue or just a side effect associated with Phentermine. He or she may prescribe the medication him/herself if you are an appropriate candidate, or he/she may choose to refer you to a specialist for further evaluation and follow-up. The possible role of Phentermine in the etiology of these valvulopathies has not been established and their course in individuals after the drugs are stopped is not known. Duromine is not funded by Pharmac, so patients pay $160-$200 per month when they present a standard prescription of 30mg daily - in addition to the GP consultation fee. iQJG\If6CuoG^|&qXegM,+vmC [To w{`F@kMxVBrH7.1g B;H _BfHPXK#Q All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.
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