| Name (last, first ): | Martin, Carol L. |
| Degree: | N.P. |
| Title: | Nurse Practitioner |
| Department: | Obstetrics & Gynecology |
| Section: | |
| Status: | Nurse Practitioner |
| Proctor: | Brooks, Brouillette, etc. |
| Sex (M,F): | F |
| Pager Number: | 671-3734 |
| Physician ID number: | 512046 |
| NPI Number: | 1245250257 |
LSU Health Sciences Center
Privilege Listing
Martin, Carol L.
Privilege Code Legend| 001 | A | Assessing Patients/Physical Examination/History Taking (Initial & Follow Up) |
| 002 | A | Analyzing & Synthesizing Data |
| 003 | A | Guidance & Teaching |
| 004 | A | Managing Physical & Psychosocial Health Issues |
| 005 | A | Requesting Referrals/Obtaining Consultations |
| 006 | A | Ordering Diagnostic Studies (Including, but not limited to Radiology & Laborary Tests) |
| 007 | A | Interpreting Diagnostic Studies |
| 008 | N | Hospital/Clinic Rounds |
| 009 | N | On Call Privileges |
| 010 | A | Demonstrates Age Specific Growth & Development Knowledge and Skills Appropriate to the Age of Patient/Family served |
| 011 | A | Develop Patient Care Management Plan |
| 012 | N | Coordinates Transfer/Admission/Discharge Plans, including Referrals as needed |
| 013 | N | Other _________________________ |
| 014 | N | Other _________________________ |
| 015 | N | Other _________________________ |
| 017 | A | Implement Treatment Plans |
| 018 | A | Therapeutic Regimens |
| 019 | A | Completently & Safely Performs Diagnostic & Therapeutic Procedures according to Clinical Guidelines |
| 020 | N | Surgical Emergencies, such as, Gastrostomy Tube Dislodgement |
| 021 | N | Peripheral Inserted Central Catheters (PICC) |
| 022 | N | Penrose and vessel loop drain removal |
| 023 | N | Central line removal |
| 024 | N | Assisting in complex procedures |
| 025 | N | Emergency treatment and stablilization |
| 025.1 | N | Intubation and Ventilator Management |
| 026 | N | Other __________________________ |
| 027 | N | Other _________________________ |
| 028 | N | Other _________________________ |
| 030 | A | ** Prescriptive Authority |
| 031 | N | Medical Devices and Appliances Explain/List _________________________________, _________________________________, _________________________________, _________________________________ |
| 032 | N | Other _________________________ |
| 033 | N | Other _________________________ |
| 034 | N | Other _________________________ |
| 034.1 | N | Other _______________________ |
| 034.2 | N | Other _____________________ |
| 036 | A | Document Subjective & Objective Data, Clinical Assessment, Plans and Recommendations |
| 037 | A | Maintains appropriate, timely entries in the Medical Record |
| 038 | N | Other _________________________ |
| 039 | N | Other _________________________ |
| 040 | N | Other _________________________ |
Formulary
| 02 | A | Prescriptive Authority |
| 03 | N | Medications (see approved individual formulary): Actonel Acyclovir Aldara Cream Adlomet Allegra/Allegra D Amitriptylline Amoxicillin Ampicillin Annusol Anusol HC Aristocort Cream Atenolol Augmentin Bactrim DS Bactroban Benadryl Benefiber Bentyl Biaxin Boniva Boric acid suppositories Buspar Calcium with Vit D Celexa Chromagen Forte Ciprofloxacin Clarinex Claritin Cleocin Cream Clindamycin Clindesse Clobetasol Clonidine Colace Combined hormone replacement therapy Combined oral contraceptives Depro Provera Detrol Detrol LA Diaphragms Diflucan Doptheria/Tetanus Ditropan Ditropan XL Doxycycline Effexor Enablex Engerix B Erythromycin Estratest Estratest HS Estrogen Replacement Therapy Estrogen Vaginal Creams Evista Famcyclovir Ferrous sulfate Fibercon Flagyl Folate Fosamax Gardasil Guaifenesin Gynazole Hurricaine gel Hydrochlorothiazide Ibuprofen Implanon Intrauterine Systems (IUD) Keflex Ketek Labetalol Levaquin Levisin Levothyroxine Lexapro Lidocain (for local anesthetic) Lotrimin Lotrisone Macrobid Macrodantin Magnesium Citrate Medrol dose pack Metronidazole Menactra Metamucil Metro gel Miconazole MMR Monistat Monsels Naproxen Naproxen Sodium Nuva Ring Nystatin Cream/Powder Ortho Evra Patch Paxil Penicillin Periactin Permethrin Pepcid Phenergan Plan B Ponstel PPD Prenatal Vitamins Prevacid Prilosec Procardia Procto Foam Progestin (only pills) Propanolol Protonix Prozac Pyridium Reclast Reglan Rhogam Rocephin Selsun Spectazole cream Spironolactone Sulfonamide Vaginal Cream Suprax Surfak Tamiflu Teraconazole Tetracycline Tindamax Trazadone Tylenol Ultram Vaccines - Tetanus Influenza Vag Fem Tablets Valtrex Vaniqa Cream Vesicare Vistaril Vitamin B6 Wellbutrin Zantac Zithromax Zoloft Zofran |
| 05 | N | Medical Devices and Appliances Explain/List _____________________________ ________________________________________ ________________________________________ ________________________________________ |
| 06 | N | Other: _____________________ Other: _____________________ Other: _____________________ |
| 07 | A | PI monitoring to include quarterly chart review audit reports to the committee addressing appropriateness of therapy, e.g., indication, dosage, quantity, route, frequency, and related criteria. |