Wintergreen Medical Center
324-A Beacon Drive
Winterville, NC  28590
Office 252-551-5595
Fax     252-321-7762
M. Craig Simpson, MD
Calvin Ellis, PA-C

Note: to email this entire page, simply copy and paste the entire copy, excluding title, onto your email, and answer the
appropriate questions, and initial the appropriate areas.  Our emails are available on the page Contact Us.

We do not ordinarily prescribe antibiotics or other prescription drugs without seeing the patient face to face.  This is
because other factors may be discovered on detailed verbal history and physical exam in a face to face encounter
than is possible over the phone or internet.  Because of this, we face increased liability risk when we treat patients via
telephone or internet consultations.

Please be aware that telephone/internet care is associated with increased risk of misdiagnosis, and of unnecessary or
inappropriate treatment.  To indicate your understanding of the increased risks associated with non face to face
encounters, please initial here:

In addition, there will be a charge of $35 to your account, and this charge will NOT be submitted to your insurance
company, since they do not reimburse for telephone or internet care.  You may or may not receive antibiotics,
depending on your responses to the questions, but will be charged for this consultation nevertheless.  To indicate your
understanding of this, please initial here:

For sinus, throat, ear, and chest symptoms:
Do you have fever?   (If so, what is your max. temp?)    Chills?    Earache?    Sorethroat?    Ear pressure/popping?    
Postnasal drainage?   If so, is it yellow/green?    Tender or enlarged lymph nodes?    Cough?    If so, is cough
productive of yellow/green sputum?    Any wheezing?    Ever used an inhaler before for wheezing?    Ever had asthma?
  Any shortness of breath?    Chest tightness?   Any other details we should be aware of?

For bladder/urinary tract symptoms:
Do you have burning on urination?    Frequent urination (more than usual)?    Nighttime urination (more than usual)?    
Urge to urinate when there is little urine to expel?    Blood in your urine?   Fever?   Chills?  Back pain/pressure?  
History of prior urinary infections (bladder infections) like this one?   Any other details we should be aware of?

Just copy/paste this entire form to your reply email, put your cursor after each question and answer it, then send back
to us,and we will enter into your chart for documentation purposes.

What antibiotics are your allergic to?
What pharmacy would you like any prescription sent to?    
(we have most phone numbers/fax numbers available, but be specific, for example, CVS Firetower near PCC  vs. CVS
Firetower and Arilington).

We will respond to your answers to let you know once any prescription has been called in, or if we feel it is better to be
seen by a provider at an urgent care facility.  

There are two urgent care facilities open until around 11pm 7days/week:  Physicians East Urgent Care on Arlington
Drive, and MedDirect, at the corner near the hospital Emergency Room.After 11pm, only the PCMH Emergency Room
is open, and only one pharmacy in town is open 24hours:  Walgreen's on Memorial Drive near the hospital.

We appreciate your understanding and your trust in us.
Telephone/Internet Consultations
(after hours and on weekends)