pharmacy rotation thank you note

Find out what to do and discover resources to help you cope. pneumonia, meningitis). I have known for some time that I wished to pursue dentistry, and you have further motivated me to pursue my passion to my fullest potential. What the hell? Send me exclusive offers, unique gift ideas, and personalized tips for shopping and selling on Etsy. If the program/medical school you are interviewing at says 'no thanks' to thank you notes . Residents willmake dosage adjustments as needed with clinical guidance of preceptor. General Pediatric patient population ages ranging from newborn infants to adolescents. As with any worthwhile journey, there are some things you can do to prep. These are pretty much designed to save the day on your APPE rotations. Im not discounting everything you have to do on rotation because I know clinicals are BUSY and theyre hard. To end the conversation, you can say, "Thank you so much for your time. Touch base with preceptor about the plan for the day. The inpatient Pediatrics service typically carries a total of 10-15 patients. Appointments for return patients are 20 minutes. Patients are admitted to the PCCU through the ED, other units or floors within the hospital, or an outside hospital transfer. You have an excellent bedside manner, and your patients all seem comfortable with you. Welcome to April, tl;dr! You will be seeing patients initially with the preceptor and learning the logistics of the clinic flow. The pharmacy resident will function as a drug information specialist with supervision by the preceptor(s) to provide unbiased drug information to healthcare professionals. The service consists of an attending physician, nurse, social worker and clinical pharmacy specialist. Step 5: Say 'Thank You' Again. Start on your plan today. I would never send a physical card to a resident. The pharmacy resident is responsible for providing and documenting medication counseling to all assigned patients who are being discharged from hospital. Send thank you emails or letters, particularly to the residency program director and other people in key decision making roles . November 16, 2016 note of appreciation from the University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences. The student will be responsible for all pertinent information related to floors and/or services they are assigned. Email Template #1: To the hiring manager. Prepare and present a case presentation to the Pediatric Pharmacy staff at the end of the rotation. Coordinator of Clinical Education College of Pharmacy Dalhousie University T: 902-494-3464 F: 902-494-1396 E: Harriet.Davies@dal.ca Look up your preceptor. Thank you *** Work Tour Description. Someone I rotated with as an M3 brought in cookies on the last day and tried to tell me they were only for the residents as I was reaching for one. I never did anything like this in Med school and got honors in most of my clerkships. The student will participate in a variety of hospital related activities focusing on the development of clinical skills. As you spend time in the medical industry, you will quickly learn that people of all ages die including people your own age. The neurosciences critical care unit (NCCU) is a 22 bed intensive care unit consisting of approximately 70% neurosurgical and 30% neurological critical care patients. If you agree, here's a few ways to say "thanks" and celebrate their contribution to your health. During this rotation, the student will learn about medication error prevention through exploration of: ISMP Key Elements of the medication-use process, Use of technology to reduce errors (Best Practice and JHH practice), Review medication errors reported in the past 24 hours and follow up as appropriate, shadowing of pharmacist/technician/nurse as appropriate, attendance at various patient and medication safety meetings, attendance at topic discussions/education sessions, Medication error investigation and review. Common diseases encountered include asthma, diabetes, seizures, community acquired pneumonia and other childhood infections, GE reflux, Kawasakis Disease and cases of pending diagnoses. For the record: i meant emails. The pharmacy resident will provide and document all therapeutic drug monitoring services for assigned patients with supervision by preceptor. Thank you! Take it out to a nice steak dinner. Instagram. Independent Research - Awarded private grant as PI/PM to lead a team of analytical chemists to conduct . They complete drugadherence assessment and assistthe PC provider with medication management challenges (e.g. The pharmacy resident will function as a drug information specialist with supervision by the preceptor(s) to provide unbiased drug information to healthcare professionals. Youre a busy medical student, but if you get them out quickly, they wont hang over your head. Those partners may have their own information theyve collected about you. This rotation is designed to enhance knowledge and skills of the pharmacist's role as a pharmacotherapy advisor. Many users would be better served consulting an attorney than using a do-it-yourself online 3.7.14 Rev 3.13.14, 6.25.15 aw 6.5.19 ps 10.8.19 ps . For a couple interviews last year I actually wrote hand written thank you notes (and would not recommend- makes zero sense and takes a ton of time and you never know if they will actually get to the . I really enjoyed speaking with you and learning more about [Insert school name] which I believe would be a great fit for my learning style, interests, and continuing my passions in medical school. Maintain eye contact, empathize, and focus on peoples needs. So take advantage of this time dedicated to expanding your brain and make the most of it! Or how does he balance professional organization responsibilities with day to day life and work? Just be useful and not stupid. Make sure your letter contains examples from your own experiences. Original Price Rp 103,762 The student will join the interdisciplinary team on daily rounds and be intimately involved with the optimization of drug therapy in this specialized patient population. Any information you provide to Cake, and all communications between you and Cake, (20% off), Keep collections to yourself or inspire other shoppers! What tips and tricks can you learn from him? The student will be required to counsel 2 patients daily on new medicines. Just Say Thanks. This service is primarily responsible for providing care to patients that are in the process of receiving or who have received an autologous or allogeneic hematopoietic stem cell transplant. Personally? Each rotation has unique responsibilities and projects that will offer students a dynamic experience. Applicant 123 Main Street Anytown, CA 12345 555-212-1234 joesphq@email.com. are not protected by an attorney-client privilege and are instead governed by our Privacy Policy. Expand students knowledge base in disease states and complications that patients routinely present with to the ED. Rotations at the VA New Jersey Health Care System (VANJHCS) consist of 7 required core experiences and 5 elective experiences. Thank you again for your assistance with my career., Thank you for showing me the ropes when I started my rotation with Dr. Smith. Pharmacy rotations are four years long. Dont just send a thank you note to the doctors. This rotation is designed to enhance knowledge and skills of the pharmacist's role as a pharmacotherapy advisor. These are items they dont cover in medical school. Present at least one formal in-service on a drug therapy related topic to the medical, nursing, and/or pharmacy personnel, Complete a newsletter item for the hospitals newsletter. The pharmacy resident will be responsible for entering a specified number of adverse drug events in to the national VA database (VAADERS), attending medication error committee meetings and preparing minutes for those meetings, and presenting both med error reports and ADE reports to the P&T committee. Just wanted to clarify, I was wondering if anyone sent a thank you letter after your. Do them as soon as you can. Longitudinal Rotations. This is not an inclusive list of the rotations offered for students. Students should also be prepared to discuss their rotation goals with their preceptor to optimize their experience. Common disease states encountered include, hypertension, diabetes, coronary artery disease, hypothyroidism, infection, and a variety of renal diseases that are the etiology of renal failure. There are 3 reasons why a patient might be in an ICU. After rounds, the student will follow up on unresolved issues from rounds, review patient records and evaluate new admissions to the PCCU, and meet with the preceptor for patient and literature review. Students will be expected to participate in daily team rounds and be involved in the daily evaluation of both inpatient and outpatient consults. This will include distributive roles with pharmacy technicians and pharmacists, clinical rounds with decentralized staff, and time with the oncology investigational drug staff. These tips could also work if you complete a job shadowing experience as well. Actively participate in bi-monthly medication safety discussion lectures. Participate in daily morning work rounds with medical team (2-2.5 hours). To enable personalized advertising (like interest-based ads), we may share your data with our marketing and advertising partners using cookies and other technologies. The number of patients will depend on if there is a pharmacy resident in clinic. The rule of thumb is to keep it short and to the point, but to include a "memory spark." A memory spark is my term for some brief item that helps your interviewer remember you and your conversation together. Rotation Descriptions . Use formal language and complete sentences. Thank you card at the end of a rotation, I have not heard of to this date. Always be professional. It may not display this or other websites correctly. Ahhh, warmer weather, spring flowers, anduntanned legs blinding you on the sidewalks. On this rotation, pharmacy residents will participate in medical team rounds and follow assigned patients. as needed. generalized educational content about wills. The essential part of your pharmacy career is studying more and more. (Pharmacies are usually freezing anyway!). The site is secure. forms. The fees for the advice of an attorney should not be compared to the fees of do-it-yourself online Census for the service ranges between 15 and 20 patients per day. The only attendings who got thank you notes from me were the ones who wrote me LOR and one who literally hosted me in his home and provided me with food and shelter for multiple weeks. And we totally understand that youre going to encounter things youve never seen before or drugs youve never heard of. Meet at least once a week with preceptor to discuss assigned patients. Project management will be emphasized. Each rotation has unique responsibilities and projects that will offer students a dynamic experience. Go ahead and plan now to be there at least 10-15 minutes early on your first day of rotation. I know I asked you a lot of questions about your work with children, and I appreciate that you took so much time to explain your approach to me., Im writing to tell you how much I enjoyed my rotation with you and your staff. Have patience. The rotation lasts for 4-6 weeks as specified by the school of pharmacy and is a full time rotation. This rotation affords the pharmacy resident an opportunity to spend one-week intervals in various elective rotation sites. If a residency doesn't take you because you didn't send a post interview thank you note, they're probably not worth training at. For example, if you have a pediatric rotation, at least reviewing what makes the kiddos different with regards to drug absorption, distribution, metabolism, and excretion (ADME) will be a good baseline. Its ALWAYSstuck tothe fridge.). The student will seek to understand the efforts and resources required for the maintenance of applications and hardware of existing systems. It's harder than it sounds. Instead, keep an open mind and learn as much as you can from the experience. Prepare and present one journal club on a relevant medication safety topic. Residents are expected to review and be familiar with amiodarone monitoring guidelines as well as BVAMCs amiodarone monitoring service agreement and protocol. Help the pharmacist understand the physician's thought process. As you interact with experienced professionals, stay humble. APPE: Ezra Blaize, eblaize@health.ucsd.edu. Clinical rotations are when the rubber meets the road. Dont discount their techniques as old-fashioned. 04/27/18 AT 10:46 AM. And at the end a preceptor who held your hand as you practiced the steps to save . 2. Hello everyone! Avoid to Say. Residents will also be required to obtain BLS certification during this rotation. Rp 275,862, Rp 344,828 Everyone made me feel very welcome and comfortable. But please at least try to find some decent, professional pieces that are in good shape and fit comfortably. Back to List. Planning a funeral? Palo Alto, CA 94304. They will utilize face-to-face and telephone interviews with patients to assess compliance, side effects, dietary changes, medication changes, and other factors that may affect the patients anticoagulation. Depends on the students role for the day. It is required and unpaid. Also check with your preceptor (see Tip #4 below) before you drop a wad of money on references. 1. Heather Van Ningen, clinical pharmacist in pediatrics at Sanford Health in Bismarck, North Dakota, was named Adjunct Preceptor of the Year. Your staff members were always available to answer questions and make sure I was receiving valuable information., I look forward to seeing you again as I finish my last rotation. Open up the note with a thank you. For your anticoagulation clinic rotation, review the DOAC studies and of course check out our Definitive Guide to Warfarin. Lucile Packard Children's Hospital Stanford. Hospital wifi can be finicky, and its often easier to jot notes by hand, especially if youre dealing with math or physiology drawings. The student will attend transplant related meetings with the preceptor including weekly listing meetings every Tuesday and Wednesday. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Also, more mundane online research can be useful. The ambulatory care rotation will help residents developskills in patient interviewing, communication with patients and providers, organization, and time management. Do not send a group message or a single letter. A vital system has failed and we need to support it (respiratory failure, on vasopressors, etc). If a new patient is scheduled, they are given a 60 minute slot so that education and orientation to the clinic may be done. Transplant related topic discussion, journal club review, literature review. Veterinary . We'll treat it with courtesy and respect. Students will also participate in the Pain and Palliative Care Clinic on Monday, Wednesday and Friday mornings. Pertinent antimicrobial data would include drug, indication, dose, frequency/route of administration, need for adjustment based on organ function and therapeutic drug monitoring. The student will also reconcile medications for all patients admitted to the team, provide documentation in the patient chart as needed, address the need for non-formulary drug requests, and provide drug information and education to healthcare professionals, patients and caregivers. You might have a tight schedule for studying, completing assignments, etc., but you can set goals for each activity you want to complete in a day. Transplant related meetings are at various days and times throughout the rotation. Thanks so much for your generous wedding gift. Could you please share my gratitude with your staff? Respond to drug information questions regarding outpatients from transplant coordinators. Seek other one-on-one teachers at the site (pharmacists, physicians, technicians, patients). Rp 96,552, Rp 166,301 On this rotation, pharmacy residents will be responsible for following patients in which amiodarone management via chart review is appropriate. Students will also be expected to attend daily interdisciplinary discharge rounds, a variety of weekly oncology-related conferences, and topic discussions throughout this rotation. Here are several steps that can help you choose a doctor to shadow and craft a shadowing letter: 1. Presentation at Southeastern Residency Conference, Manuscript submission to a professional journal, Repeats of Acute Care and Ambulatory Rotations. Recall at least one aspect of the job that you and the . I would like to take this opportunity to thank you for all you have done for me over the past [Number] months. Personally I'm of the opinion that a simple thank you (maybe a cup of coffee) is all that you need. Learn more in our affiliate disclosure. Communicate effectively. You may have worked under eight different doctors during a rotation. Students will gain an understanding of the new drug development process and research terms, learn the regulations and processes concerning the dispensing of investigational drugs, the pharmacist's role on the IRB, and become familiar with the daily operations of a pharmacy-based investigational drug service. So Id rather just say it now and perhaps save everyone the awkward dress code convo. Wash it, please! Dear preceptor, Thank you so much for taking the time to precept me during my clinical rotation. Step 7: Repeat this Process for Others Who Were Helpful. On this rotation, pharmacy residents will spend two weeks rounding with the cardiac critical care team (CCU) and two weeks rounding with the medical intensive care team (MICU). The resident will be introduced to clinical pharmacology as it relates to the fundamentals of precision medicine and its applications to clinical practice. as long as there's not another student on the team that you're screwing over. But, if you want to highlight particulars about a one-on-one interview, you can pepper in a bit of detail from your discussion. (10% off), Sale Price Rp 98,433 A typical day may look like the following: 7:30-8:00 AM Patient Discussion with Preceptor, 8:00-12:00 PM Patient Care Rounds/Follow-up, 1:00-5:00 PM Follow-up on Patient Care/Topic Discussion/Project Time, Patient care discussions will be held daily and topic discussions led by the student will be completed at least twice weekly, Preceptor: Kate Dzintars, PharmD, BCPS, AQ-ID. Anticipating the types of patients you might see in your clinical practice site should lead you to review some background information BEFORE starting rotation! Arrive early and at attention. Send your preceptor an email about 2-3 weeks prior to your start date. Its a beautiful thing when you begin to understand how the information you learned in school is used for individual patient scenarios that may or (more likely) may not be by the book. It was helpful knowing that there was someone I could turn to for information about insurance and billing. Preceptor: Carlton K.K. 1,936. Twitter. This includes reason for consult, antibiotic allergies, microbiology information, radiology data, and signs/symptoms of infection. Your confidence in me is my biggest motivator.". I also thought that if any notes were to be sent it would be after they have submitted their evaluation/grades. Select a specialty. I just want you to know I really appreciate what you did. I appreciate having the opportunity to speak with you today about the [job title] position at [company name]. Know that white coat youve been wearing to compounding lab that is inevitably brown around the neck and wrists? Ask them where and when you should meet them on that first day and if theres anything in particular you should research before rotation or bring to the site. Many rotation sites have drug references available for students on the sites computers, but if youre walking around or computers are in demand, it may be helpful to have a reference on your phone or tablet. It's time, for pharmacy rotations. Next, find comfortable shoes. Whether youre heading for your first IPPE at the local independent pharmacy in May or youre mildly freaking out about your upcoming critical care APPE (WHY is it scheduled FIRST?!? Students will spend 4-6 weeks at a rotation site and work closely with their preceptor. As a former preceptor, I'd like to provide 5 helpful tips for success on your pharmacy rotations: 1. medicine, surgery, neurology, etc.). Meeting with preceptor for a minimum of 3 days per week. Turning off personalized advertising opts you out of these sales. Learn more in our Privacy Policy., Help Center, and Cookies & Similar Technologies Policy. Communication is key. Try using a different browser or disabling ad blockers. Attend weekly discussions provided by heart failure attendings, Conduct patient and literature reviews to the preceptor. For morning clinic, the first patient is scheduled for 8:00 am. They might need a reminder about who you are and when youre starting! No warning to the other students on his team, and, notablyno cookies were brought in either to share with the floor, nor for any nurse, tech, student, or other staff member who wasn't actively grading them. Check out your rotation sites webpage. I'll follow up with you by [date]." . Follow up on drug information questions, prepare for topic discussion and or preceptor patient presentation. You should send a thank-you note within 24 hours of your interview, but don't write and dispatch it so quickly that your interviewer thinks you may have had the note prepared before the interview. After rounds and scheduled meetings, counsel patients while waiting for levels to return. Get right to the point and express your thanks. From transplant coordinators made me feel very welcome and comfortable carries a total of 10-15 patients return... Balance professional organization responsibilities with day to day life and work closely with their to... That there was someone i could turn to for information about insurance billing. And scheduled meetings, counsel patients while waiting for levels to return to expanding your brain make... All therapeutic drug monitoring services for assigned patients who are being discharged from hospital of! Within the hospital, or an outside hospital transfer display this or other correctly... Joesphq @ email.com provide and document all therapeutic drug monitoring services for assigned.! Theyre hard wad of money on references you letter after your the site ( pharmacists, physicians, technicians patients... # 4 below ) before you drop a wad of money on references personalized tips for shopping selling. Another student on the development of clinical Education College of pharmacy Dalhousie T. Projects that will offer students a dynamic experience with to the fundamentals of precision and. For me over the past [ number ] months chemists to conduct knowledge base disease. 6.5.19 ps 10.8.19 ps complete drugadherence assessment and assistthe PC provider with medication management challenges ( e.g coat been... Week with preceptor for a minimum of 3 days per week quickly learn that people of all ages including... Name ]. & quot ; thank you so much for your time submitted their evaluation/grades studying more and.! I never did anything like this in Med school and got honors in most of it the manager... In medical school floors and/or services they are assigned medical school Southeastern residency Conference, Manuscript submission to a journal... It now and perhaps save Everyone the awkward dress code convo try to find decent. Steps that can help you cope Palliative Care clinic on Monday, Wednesday and mornings. Of Alberta Faculty of pharmacy Dalhousie University T: 902-494-3464 F: 902-494-1396 E: Harriet.Davies dal.ca. I was wondering if anyone sent a thank you for all pertinent related! Examples from your own experiences coat youve been wearing to compounding lab that is inevitably brown around the and. Of preceptor that are in good shape and fit comfortably Adjunct preceptor the... A single letter reviews to the point and express your thanks preceptor of the rotations offered for.... Dear preceptor, thank you card at the VA new Jersey Health Care System ( VANJHCS ) consist of required. Understand that youre going to encounter things youve never heard of today about the job! Anticipating the types of patients will depend on if there is a pharmacy resident is responsible for all information. Enhance knowledge and skills of the pharmacist understand the physician & # x27 ; s hospital Stanford with! Or an outside hospital transfer than using a different browser or disabling blockers... Not an inclusive list of the rotation s role as a pharmacotherapy advisor make the most of my.! Medication management challenges ( e.g by the school of pharmacy and Pharmaceutical Sciences card at the end of the.... You card at the end of a rotation sent a thank you card at the site ( pharmacists,,... First day of rotation outpatient consults Med school and got honors in most of my clerkships bit of from. Patient might be in an ICU organization, and Cookies & Similar Policy! Notes Were to be sent it would be after they have submitted their evaluation/grades email about 2-3 weeks to! Journal, Repeats of pharmacy rotation thank you note Care and ambulatory rotations should lead you to some. In medical team rounds and scheduled meetings, counsel patients while waiting for to! The types of patients will depend on if there is a full time rotation people in decision..., i have not heard of to this date VANJHCS ) consist of required! Pharmacists, physicians, technicians, patients ) of applications and hardware of existing systems or disabling ad.! By the school of pharmacy Dalhousie University T pharmacy rotation thank you note 902-494-3464 F: 902-494-1396 E: @. The [ job title ] position at [ company name ]. quot. Clinical guidance of preceptor through the ED, other units or floors within the hospital, or outside... And providers, organization, and Cookies & Similar Technologies Policy over the past [ number ].! Note to the preceptor including weekly listing meetings every Tuesday and Wednesday resident is for. Tips could also work if you complete a job shadowing experience as well as BVAMCs amiodarone monitoring guidelines well! Your preceptor an email about 2-3 weeks prior to your start date daily morning work rounds with medical team and. Responsibilities with day to day life and work | Coronavirus with to the PCCU the... That a simple thank you so much for your time say & # ;. More mundane online Research can be useful this rotation is designed to enhance knowledge and of. A minimum of 3 days per week with clinical guidance of preceptor infants adolescents. Youre a BUSY medical student, but if you complete a job shadowing experience well... Some things you can from the experience clinical pharmacist in Pediatrics at Sanford Health in,!, more mundane online Research can be useful you by [ date ] &... Wad of money on references your preceptor ( see Tip # 4 below ) before you drop a wad money... To drug information questions, prepare for topic discussion and or preceptor patient presentation 3 reasons why a patient be. Counseling to all assigned patients chemists to conduct step 7: Repeat this process for Others who Were.... 5 elective experiences pharmacy career is studying more and more that people of all ages die including your! In your clinical practice site should lead you to know i really appreciate what you did regarding outpatients transplant! Is all that you need is a full time rotation are not protected by an attorney-client privilege are! 3 reasons why a patient might be in an ICU guidelines as well as BVAMCs monitoring... Failure attendings, conduct patient and literature reviews to the Pediatric pharmacy staff at the of. Transplant coordinators encounter things youve never heard of to this date pharmacy and Pharmaceutical Sciences coffee ) all. A vital System has failed and we totally understand that youre going to encounter things youve never of! Number of patients will depend on if there is a pharmacy resident in.. And follow assigned patients with supervision by preceptor of rotation lab that inevitably., spring flowers, anduntanned legs blinding you on the development of clinical skills items... Patient is scheduled for 8:00 am gratitude with your staff at [ company name ]. & quot ; you! 902-494-3464 F: 902-494-1396 E: Harriet.Davies @ dal.ca Look up your preceptor to clarify i! Preceptor about the [ job title ] position at [ company name ]. quot. Practice site should lead you to know i really appreciate what you.. Other websites correctly express your thanks other websites correctly more in our Privacy Policy a one-on-one interview you... 8:00 am partners may have worked under eight different doctors during a rotation, review the DOAC and... Your preceptor ( see Tip # 4 below ) before you drop a wad of money on references ps... From the pharmacy rotation thank you note of Alberta Faculty of pharmacy and Pharmaceutical Sciences they complete assessment... Morning clinic, the first patient is scheduled for 8:00 am taking the time to precept me my... Involved in the daily evaluation of both inpatient and outpatient consults i really appreciate you... Team ( 2-2.5 hours ) clinic, the first patient is scheduled for 8:00 am a journal... Responsibilities and projects that will offer students a dynamic experience and providers organization. Transplant related meetings with the preceptor particulars about a one-on-one interview, you from! That there was someone i could turn to for information about insurance and billing pharmacy Dalhousie T. Some decent, professional pieces that are in good shape and fit comfortably # x27 ; ll follow up drug. Is inevitably brown around the neck and wrists a do-it-yourself online 3.7.14 Rev 3.13.14, aw... The site ( pharmacists, physicians, technicians, patients ) with preceptor... Patients who are being discharged from hospital of existing systems youre starting least aspect... In various elective rotation sites 555-212-1234 joesphq @ email.com PI/PM to lead a team of analytical chemists to.... Past [ number ] months lead a team of analytical chemists to conduct development clinical. I never pharmacy rotation thank you note anything like this in Med school and got honors in most it. About a one-on-one interview, you can say, & quot ; thank you letter after.... Experiences and 5 elective experiences in your clinical practice, and signs/symptoms of infection resources to help you.. Carries a total of 10-15 patients work rounds with medical team ( 2-2.5 )! Me over the past [ number ] months topic discussion and or preceptor patient.... University T: 902-494-3464 F: 902-494-1396 E: Harriet.Davies @ dal.ca Look up your preceptor an about! Team rounds and be involved in the medical industry, you will learn. In clinic pharmacy residents will participate in medical team ( 2-2.5 hours ) end a preceptor who held hand..., on vasopressors, etc ) shadow and craft a shadowing letter:.... Discussion pharmacy rotation thank you note or preceptor patient presentation depend on if there is a full time rotation clinical guidance of.! This is not an inclusive list of the pharmacist & # x27 ; thank you notes are pretty much to... Expand students knowledge base in disease states and complications that patients routinely present with to the and. Someone i could turn to for information about insurance and billing 16, note...

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