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CONTRACT C2311 II. SCOPE OF SERVICE A. General Service Description Purpose Upon request from each institutional Department's Health Services Administrator, the Contractor shall provide all inmate clinical laboratory services as requested by each correctional institution. The Department reserves the option to request specifically designed sensitivity panels and Department profiles as required and as can be performed within the Contractor's capability. B. Rules and Regulations The Contractor shall ensure that all Contractor's staff providing services pursuant to this Contract hereinafter referred to as "Contractor's staff" ; , and the delivery of services under this Contract comply with prevailing ethical and professional standards, Department rules and procedures, including the Department's Health Services' Bulletins Technical Instructions, and memoranda, and all applicable state and federal laws, rules and regulations. C. Medical Records and Documentation The Contractor shall ensure that Contractor's staff document each healthcare encounter in the inmates' medical record, utilizing the SOAP format and specific Department of Corrections' forms. All documentation shall be as outlined in the applicable sections of the Florida Administrative Code, pertinent Department's Health Services' Bulletins Technical Instructions, and applicable Florida Statutes. D. Contractor's Responsibilities 1. The Contractor shall provide specimen pick-up and delivery service to all institutions, on a daily basis, Monday through Friday of each week. Weekend and holiday pick-ups will be offered where there is sufficient demand or need determined by the Department. The Contractor shall establish, with each institution, a schedule of days each week and specific arrival times for specimen pick-up at the respective facility. Adjustments shall be made to these schedules, based upon increased workloads, as mutually agreed upon by the Contractor and the Department. 2. The Contractor shall provide a list of services to each institution that includes the following: a ; overview of services offered by the Contractor; b ; procedures and equipment for collection of specimen for each test; c ; instructions and any special precautions for handling, preserving and packaging specimens for submission to the Contractor's lab; d ; test methodology; and e ; normal values or expected therapeutic ranges. 3. The Contractor shall provide, at no charge to the Department, all supplies necessary solely for the collection, preservation and preparation of specimens submitted to the Contractor for testing and flonase.

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Are at higher risk of depressed mood and lower self-worth, and are more likely to think about suicide. People with Attention Deficit Disorder ADD ; have a higher incidence of depression, possibly from repeated school failures, self-esteem issues or even due to a chemical imbalance--no one knows for sure. People in northern climates tend to experience more depression, especially in winter. Stress is associated with depression. Under stress, the hypothalamus secretes corticotropin-releasing hormone ACTH ; , which increases the level of cortisol in the blood. This causes the body to produce adrenaline to support a "flight or fight" response, which is the body's natural reaction to danger. The problem is that under chronic stress, our systems become more sensitive to smaller amounts of stress, which affects the balance of chemicals in our bodies, thus increasing the risk of depression. Not surprisingly, depression is more common following a significant loss of some kind. Low self-esteem is associated with depression, which is one reason why people with spina bifida are more likely to be depressed. Other psychological risk factors for depression include decreased social support and isolation. Learned helplessness--where someone feels, rightly or wrongly, that there is nothing they can do to improve their situation--may be a component of depression. For example, imagine an 8th grader who tries hard to make friends, but none of her efforts are successful. After a while, she quits trying and gives up. And even after starting at a new school with all new kids, she doesn't try to make friends, because she has learned to be helpless. Anxiety: Sister to Depression If someone is anxious, they're also much more likely to be depressed, and the reverse is also true. Many of the medications used to treat depression are also used to treat anxiety. Like depression, anxiety tends to run in families. Symptoms of anxiety include feeling tense or fearful, a sense of dread, panic or even terror. People who are anxious may be worried all the time. Anxiety interferes with concentration and tends to result in a preoccupation with self. Symptoms of obsessive-compulsive disorder OCD ; include repetitive, purposeful behaviors that serve to reduce anxiety. Dr. Liptak recommends the book Just Checking, written by a young woman with OCD. When people would talk to her, she would count their words. Like depression, severe OCD behaviors eventually interfere with functioning. How to Treat Depression There are many ways to treat anxiety and depression. Many studies have shown that exercise alone can have a profound effect; so one healthy response to depression is to increase exercise. Wheelchair-based sports programs are great, providing both physical activity and social contact. Hippotherapy--horseback riding--is lots of fun and stretches the muscles and joints as well. Medications and counseling may both be indicated. Counseling can be crucial, especially if the person has low self-esteem or learned helplessness. Sometimes it's very helpful for the entire family to receive counseling. Medications alone won't improve self-esteem or eliminate behaviors based on learned helplessness. The medications of choice today are the SSRIs selective serotonin reuptake inhibitors ; , which include Prozac, Paxil, Zoloft, Effexor, and Serzone. Each has its unique potential side effects, which can sometimes be severe. A word of caution: Don't stop the drugs suddenly; taper off. Abrupt discontinuation can cause dizziness, fatigue, headache, nausea and or insomnia. Dr. Liptak says that and furosemide.
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