Portal Messaging Policies

Dear Patients,

We have enabled portal messaging to facilitate communication between you and your provider. However, there are limitations to portal messaging that are necessary for your safety, to get enough information to safely provide high quality care for you, to create documentation required by insurance companies/specialist/other third parties, and for your provider to be able to provide care for other patients who are being seen in the clinic during business hours while responding to portal messages.

It may take providers 72 hours to respond to a portal message. Providers only respond to messages during business hours. If you are having symptoms that require a response more quickly (see list below), please do not wait for a response and go to urgent care or the emergency department immediately.  

For a list of emergency resources, go here.

We have divided this page into urgent/ emergent symptoms, non-urgent messages, and pharmacy concerns. Please find the section that corresponds to your concerns.

Urgent/ Emergent Symptoms

Brain/ Mental Symptoms

• Mental health symptoms such as thoughts of hurting yourself or someone else, hallucinations (seeing or hearing things other people don’t see or hear), confusion such as not knowing where you are or what is going on around you, decreased need for sleep, reckless or impulsive behavior that puts you or others at risk of immediate harm, drug use that poses an immediate risk to the safety of yourself or others, being unable to care for your physical needs due to mental health symptoms

• Drug overdose with any of the following: difficulty staying awake, breathing problems, confusion, can't stop vomiting, blue lips/tongue/mouth

• Symptoms of a stroke including one-sided weakness on your body, facial drooping, slurred speech, confusion

• Migraine lasting longer than 5 days

• New or worsening seizures

• Severe headache interfering with your ability to function, especially if accompanied by any of the following: neck stiffness, vomiting, light/ sound sensitivity

Heart/lung symptoms

• New or worsening chest pain or palpitations (heart beating funny, skipping beats, racing >120 beats per minute) especially when accompanied by trouble breathing, weakness, dizziness, confusion, sweating, jaw pain, or vomiting

• New or worsening shortness of breath or breathing difficulty, especially when affecting to do things you normally do

• Cold/flu symptoms in an adult when accompanied by any of the following: fever greater than 103 that doesn’t respond to fever reducing medication, shortness of breath not due to nasal congestion, chest pain not due to muscle soreness from coughing, decreased urine production, blue lips/tongue/mouth, difficulty staying awake, can't keep down liquids

• Blood pressure greater than 180/120 when accompanied by any of the following: chest pain/tightness, shortness of breath/ getting winded, fatigue, palpitations (heart beating funny or skipping beats), decreased urine output, confusion, weakness, or stroke symptoms 

Stomach/pelvic/ genital symptoms

• Vomiting or diarrhea more than 5 episodes in 24 hours with any of the following: inability to keep fluids down, heart rate >100 beats per minute, feeling faint or like you are going to pass out, confusion, sunken eyes, decreased production of tears or dry mouth

• Stomach or pelvic pain that is moderate to severe, interfering with your ability to do things, especially if accompanied by a fever, vomiting, weakness, confusion or other severe symptoms

• Severe menstrual bleeding that soaks through a tampon or pad every hour for several hours, dizziness, fainting, shortness of breath, chest pain, passing large blood clots, or significant weakness

• Vomiting blood or blood in stool more than 1-2 tbsp of bright red blood on the outside of stool, particularly when accompanied by abdominal or pelvic pain or when it is dark, coffee/ground, or tarry

• Urinary tract infection with any of the following: fever, new or worsening low back pain, significant blood in urine, flu-like symptoms, weakness, vomiting, moderate to severe abdominal pain

• Sexual assault or concerns for being drugged

Skin symptoms:

• Animal bite

• Skin infection that is spreading rapidly such as an abscess (cyst/boil) or cellulitis, especially when located in your genital/pelvic region, especially if accompanied by fever or flu-like symptoms 

• Rash when accompanied by flu-like symptoms

General/ Misc

• Feeling so sick for any reason that you can’t safely take care of yourself

• Cold/flu symptoms in an adult when accompanied by any of the following: fever greater than 103 that doesn’t respond to fever reducing medication, shortness of breath not due to nasal congestion, chest pain not due to muscle soreness from coughing, decreased urine production, blue lips/tongue/mouth, difficulty staying awake, can't keep down liquids

• Nosebleeds that don’t stop if two attempts to apply pressure for 15 min uninterrupted don’t stop it

• Blood sugar greater than 250 mg/dL when accompanied by any of the following: stomach pain, fatigue, weakness, vomiting, flu-like symptoms, confusion, decreased urine output

• Needle-stick injury with exposure to bodily fluids especially blood of another person

• Other symptoms that are severe or life-threatening

• Car accident

• On-the-job injury

Bone/muscle symptoms:

• Concern for broken bone

• Concern for dislocation of a joint (knees, shoulders, hips, elbow, wrist, ribs, etc)

• Inability to bear weight on weight bearing joints (knees, ankles, legs, feet, hips)

• Muscle sprain accompanied by severe pain with or without inability to bear weight on a joint

• Severe pain

Non-Urgent Messages

If you request any of the following, you will be asked to schedule an appointment so we can get the information needed to evaluate your request safely, and create the documentation required to accommodate your request required by insurance companies and specialists:

• New referral

• Paperwork for disability, FMLA, other medical leave/paid leave, letter of support for surgery or electrolysis, paperwork for health or life insurance, emotional support animal, or any other form or paperwork

• New orders for blood tests that haven’t been ordered previously or would otherwise require an appointment to discuss

• New prescription for a medication that hasn’t been prescribed by your provider previously 

• New symptoms of a problem that hasn’t been discussed previously or are changing 

• New test such as imaging (xrays, CT, ultrasound etc) or other diagnostic testing

• New orders for durable medical equipment or supplies 

• Any question which your provider deems warrants a conversation due to the complexity or detail required to answer it safely

• Abnormal lab results or lab results that require further discussion or testing

Pharmacy Concerns

We do our best to help you access your medications in a timely way. If we have sent a prescription to your pharmacy and we are showing it has been electronically verified as received by your pharmacy, please follow up with your pharmacy or consider switching pharmacies. Please provide us with 5 days notice prior to running out of medication to refill your medication. If not, you may experience an interruption in your prescription.  The fastest way to request medication refills is on the patient portal.

All prescriptions require follow-up appointments in a time frame required by your provider. For stable conditions, this is generally 3 months for controlled substances such as stimulants. For stable conditions that are not treated with controlled substances, these generally require visits every  6 months for conditions such as diabetes, hypertension, depression, anxiety, etc.

For unstable conditions, meaning symptoms or labs not adequately controlled, you may be required to have appointments monthly or more frequently as determined by your provider. 

Our providers are licensed in OR and WA and can only prescribe medications to pharmacies in those states.