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<p class="Office" style="margin-left:-5.05pt"><br>
<br>
OFFICE OF THE DIRECTOR <o:p></o:p></p>
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<o:p> </o:p></p>
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<img width="195" height="73" id="Picture_x0020_1" src="cid:image006.jpg@01D61A39.DEB3ED40"><o:p></o:p></p>
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<p class="Governorname" style="margin-left:-5.05pt">Kate Brown, Governor<o:p></o:p></p>
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<a name="Text7"></a>500 Summer St NE E20<o:p></o:p></p>
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<a name="Text13"></a>Salem OR 97301<o:p></o:p></p>
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<a name="Text14"></a>Voice: 503-947-2340<o:p></o:p></p>
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<a name="Text15"></a>Fax: 503-947-2341<o:p></o:p></p>
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<span class="Headersandcontents"><o:p> </o:p></span></p>
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<span class="Headersandcontents"><span style="font-size:12.0pt;font-family:"Calibri",sans-serif;mso-fareast-language:EN-US"><br clear="all" style="page-break-before:always">
</span></span>
<div class="WordSection2">
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:14.0pt">Framework for Restarting Non-Emergent and Elective Procedures<o:p></o:p></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:14.0pt">in Medical and Dental Offices<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt">On April 14<sup>th</sup> Governor Brown announced a public health framework for restarting public life and business in Oregon. This plan outlines the necessary tasks, discrete steps and guidelines for step-by-step
reopening. Among those important tasks is a look at how and when to resume non-emergent and elective procedures requiring personal protective equipment (PPE) that were cancelled as a result of Governor Brown’s Executive Order No. 20-10<a style="mso-footnote-id:ftn1" href="#_ftn1" name="_ftnref1" title=""><sup><sup><span style="font-size:14.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[1]</span></sup></sup></a>.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt">The following is a framework for restarting non-emergent and elective procedures in medical and dental offices that require PPE, including priorities, required steps and specific criteria<a style="mso-footnote-id:ftn2" href="#_ftn2" name="_ftnref2" title=""><sup><sup><span style="font-size:14.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[2]</span></sup></sup></a>.<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:14.0pt"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:14.0pt">Priorities<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:14.0pt">The following priorities must inform all actions towards resuming non-emergent and elective office-based procedures requiring PPE:<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:14.0pt"><o:p> </o:p></span></b></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Minimize the risk of SARS-COV-2 transmission to patients, healthcare workers and others;<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Avoid further delays in healthcare for Oregonians;<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Maintain adequate hospital capacity in case of an increase in COVID-19 cases;<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Minimize health emergencies presenting at emergency departments;<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Reduce financial impacts to Oregon’s health system; and<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo1">
<![if !supportLists]><span style="font-size:14.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Support the healthcare workforce in safely resuming activities.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<b><span style="font-size:14.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US"><br clear="all" style="page-break-before:always">
</span></b>
<p class="MsoNormal"><b><span style="font-size:14.0pt">Approach and Criteria for Medical and Dental Offices<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:14.0pt">To address each of these priorities, the following steps and specific criteria must be met in order to resume and maintain non-emergency and elective procedures in office settings (i.e., medical and dental
offices) requiring PPE:<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">1.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Prior to resuming non-emergency and elective procedures in medical or dental offices, the following criteria must be met:<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">a.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">The office must have adequate PPE supplies on hand<a style="mso-footnote-id:ftn3" href="#_ftn3" name="_ftnref3" title=""><sup><sup><span style="font-size:14.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[3]</span></sup></sup></a>.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo3">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>i.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">The medical or dental office can sustain recommended PPE use for its workforce for two weeks without the need for emergency PPE-conserving
measures. <o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo3">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>ii.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">If a facility proposes to extend the use of or reuse PPE, it must follow CDC guidance.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">b.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Medical or dental office is following strict infection control policies as recommended by CDC.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">2.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Once non-emergency and elective procedures resume, start slowly and reassess every two weeks.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">a.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Decrease caseload volume to maximize social distancing.
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>i.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">Medical and dental offices should implement social distancing measures within waiting rooms and other areas of the office.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>ii.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">Medical and dental offices should use physical barriers within patient care areas when possible.
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">b.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">In order to maintain or expand this volume, office must continue to meet all items in 1 (a-b).<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">c.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Medical or dental office must maintain a plan to reduce or stop non-emergency and elective procedures should a surge/resurgence of COVID-19 cases occur in their region.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">d.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Prioritize procedures based on whether their continued delay will have an adverse health outcome.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>i.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">Non-emergent and elective procedures should be prioritized based on indication and urgency<a style="mso-footnote-id:ftn4" href="#_ftn4" name="_ftnref4" title=""><sup><sup><span style="font-size:14.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[4]</span></sup></sup></a>.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">e.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Strongly consider the balance of risks vs. benefits for patients in higher-risk groups such as those over age 60 and those with compromised immune systems or lung and heart function.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.0in;text-indent:-.25in;mso-list:l0 level2 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">f.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Medical and dental offices should utilize enhanced risk screening of patients prior to delivering care.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>i.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">Pre-screen patients via tele-medicine or tele-dentistry when applicable.
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:1.5in;text-indent:-1.5in;mso-text-indent-alt:-9.0pt;mso-list:l0 level3 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>ii.<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-size:14.0pt">Screen all patients for COVID-19 risk factors and symptoms, including temperature checks.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:2.0in;text-indent:-.25in;mso-list:l0 level4 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">1.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">Patients with COVID-19 symptoms should not undergo non-emergent or elective procedures.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:2.0in;text-indent:-.25in;mso-list:l0 level4 lfo2">
<![if !supportLists]><span style="font-size:14.0pt"><span style="mso-list:Ignore">2.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:14.0pt">When adequate testing capability is established, consider screening patients by laboratory testing before proceeding with a non-emergent or elective procedure.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt">The Governor’s Office in consultation with the Oregon Health Authority will determine the necessary tools to monitor that these criteria are being met and when different or additional criteria should be considered.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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<hr align="left" size="1" width="33%">
<div style="mso-element:footnote" id="ftn1">
<p class="MsoFootnoteText"><a style="mso-footnote-id:ftn1" href="#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[1]</span></span></span></a>
In order to <a name="_Hlk38006694">preserve PPE and limit all non-essential visitation to hospitals and other health care facilities</a>, Governor Brown issued
<a href="https://www.oregon.gov/gov/Documents/executive_orders/eo_20-10.pdf">Executive Order No. 20-10</a> on March 19, 2020 to cancel all elective and non-urgent health care procedures that require personal protective equipment (PPE) effective March 23, 2020.<o:p></o:p></p>
</div>
<div style="mso-element:footnote" id="ftn2">
<p class="MsoFootnoteText"><a style="mso-footnote-id:ftn2" href="#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[2]</span></span></span></a>
A separate framework for restarting elective and non-emergent veterinary procedures will be published by the Oregon Health Authority.<o:p></o:p></p>
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<div style="mso-element:footnote" id="ftn3">
<p class="MsoFootnoteText"><a style="mso-footnote-id:ftn3" href="#_ftnref3" name="_ftn3" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[3]</span></span></span></a>
The state will explore options for resupply of PPE to those facilities that were asked to give up their surplus when the Governor’s Executive Order was established.<o:p></o:p></p>
</div>
<div style="mso-element:footnote" id="ftn4">
<p class="MsoFootnoteText"><a style="mso-footnote-id:ftn4" href="#_ftnref4" name="_ftn4" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-size:10.0pt;font-family:"Times New Roman",serif;mso-fareast-language:EN-US">[4]</span></span></span></a>
Urgent and emergent care should continue in accordance with OHA and CMS guidance.<o:p></o:p></p>
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