FOR PATIENTS
- Complete the forms by clicking the links in the email you received from Front Line Mobile Health. These forms will take approximately 60 minutes to complete, but can be submitted separately.
a. Scope of Service
b. Pre-Arrival Questionnaire
c. Organizational Climate Assessment
d. Human Performance Assessment
2. You will be notified by your leadership when your lab collection date is.
3. Labwork: Each facet of your blood and specimen collection is vital to getting the fullest picture of your health. You will be providing urine, blood, and a stool sample (based on age). The location of your specimen collection varies between departments, so please consult with your leadership for those specific instructions.
a. You must ensure that you have fully fasted for 12 hours prior to the blood draw. This means no food or drinks, except for water and black coffee (cream and sugar will void the test).
b. While inconvenient, please complete the stool sample portion to screen for a GI bleed pathology, which can be an indication of colorectal and/or gastric cancer.
c. The following is a list of tests that will be performed but can vary based on age:
i. Complete Blood Count
ii. Lipid Panel
iii. Comprehensive Metabolic Panel
iv. Hemoglobin A1c
v. Uric Acid
vi. C-Reactive Protein
vii. Urinalysis with microscopic
viii. Fecal Occult Blood
ix. Prostate Specific Antigen (Male Only)
x. CA-125 (Female Only)
xi. Anti-body Titers- Hepatitis, MMR, Varicella, Tetanus, Tuberculosis and Covid-19
4. Following your lab draw, you will have a day where you complete all the diagnostic testing, either on-site at a Front Line facility or a location where Front Line is deployed to your department. Your leadership will designate the location and communicate that with you. At this appointment you will have ultrasounds, x-rays, biometric analysis (height, weight, vision, and body composition analysis), a cardiopulmonary exercise test on a bike, as well as an audiogram. Please allow up to 2 hours for this portion of the physical. In order to be best prepared, it is critical you do the following:
a. Be sure to wear athletic clothing and shoes and arrive well hydrated.
b. Do not have any caffeine or a heavy meal for 3 hours prior to the appointment. This will elevate your blood pressure and heart rate and flag you unnecessarily for associated conditions.
c. Do not work out 24 hours prior to your appointment.
d. Avoid loud noises prior to hearing testing (ie, motorcycles, gun shots, loud music, etc) This falsely indicates hearing loss.
e. Ensure that you have a full bladder prior to your ultrasound.
f. If you wear glasses or contacts, please wear those to your appointment for your vision testing.
5. At the end of the testing portion of your annual physical, you will have a head-to-toe exam with a Front Line provider. This may be on the same day as your diagnostic testing or at a later date. You will receive a full copy of all your results and have an opportunity to discuss these results and ask questions. This portion of the physical can last up to an hour.
CPET (Cardiopulmonary Exercise Test)
Cardiopulmonary Exercise Test is a highly sensitive, non-invasive stress test. A disease or condition that affects the heart, lungs or muscles will limit how much faster and harder these systems can work. A CPET assesses how well the heart, lungs, and muscles are working individually, and how these systems are working in unison. Your heart and lungs work together to deliver oxygen to your muscles, where it is used to make energy, and to remove carbon dioxide from your body.
The full cardiopulmonary system is assessed during a CPET by measuring the amount of oxygen your body is using, the amount of carbon dioxide it is producing, your breathing pattern, and electrocardiogram (EKG) while you are riding a stationary bicycle.
The traditional treadmill stress test only relies on the EKG, which only partially assesses the heart and nothing else
To learn more, please watch this video.
The entire test takes roughly 45 minutes. Lung function tests are first and then time is spent prepping for the exercise test. There is a resting and warm up phase prior to starting the exercise stage. Exercise last 8-12 minutes, of which only 2-3 minutes are at a higher intensity. To get the most accurate results, it is important that you give your best effort for as long as you possibly can. If you do not give a maximum effort, your test may be “indeterminate” and a full cardiovascular assessment may not be captured. The exercise workload will be adjusted on an individual basis to help each person give his or her best effort.
Since you will be exercising, please wear comfortable clothes and proper shoes, no sandals boots or crocs. Make sure your chest is accessible for proper setup of the 12 lead EKG, and if necessary, please shave your chest. Do not eat or drink (except water) for 3 hours before your test. Exercise should be avoided for 24 hours before your test to ensure you are able to perform your best, sore legs will only reduce your ability to achieve your max.
CPET testing provides a higher level of precision over the treadmill, its 4x more precise to be exact. Dysfunction can be detected at earlier stages while in the small vessels, along with many other heart, lung, and muscular conditions. The biggest difference between them is CPET testing on a cycle allows for the assessment of left ventricular dysfunction and the presence of myocardial ischemia.
The test is not a pass/failure. Each person is compared to individuals of their same age, height and weight. Functional capacities (V02) greater than 85% are desired. Included in the results are stroke volume, the presence/absence of inducible dysfunction, and ventilatory efficiency. Other measurements are obtained and will be further explained at the follow up with our provider. Each person is provided a cardiovascular exercise prescription based on oxygen consumption which is considered the gold standard.
Mets and power (watts) are measured but are not “hard breaks” in terms of pass/fail. CPET directly measures peak VO2 with maximal exertion. Expressing peak VO2 as percent (%) predicted based on age, sex, height, weight refines risk stratification based on fitness. For example, a smaller stature individual may achieve 100% of his/her predicted VO2 and have absolute peak VO2 < 42 ml/kg/min or 12 Mets. If there is no underlying cardiac dysfunction, normal % predicted peak VO2 individuals are low risk for CV events regardless of not being able to achieve 12 Mets. Likewise, larger individuals that can exceed 12 Mets on the Gerkin TMST may have reduced % predicted peak VO2 due to unknown congenital causes or acquired heart disease in need of more aggressive risk-factor modification.
Watch this video for more information:
IMAGING
No. Diagnostic Ultrasound is regarded as a safe imaging modality and does not produce ionizing radiation like that produced by x-rays. Ultrasound (sonography) imaging uses high-frequency sound waves to view inside the body. Ultrasound images are created based on the reflection of sound waves off the body structures. The strength of the sound signal and the time it takes for the wave to travel through the body provides the information necessary to produce an image.
Ultrasound is utilized to evaluate the major organs of the body. The thyroid, abdominal organs, and reproductive organs are thoroughly assessed. The abdominal organs consist of the liver, pancreas, gallbladder, kidneys, spleen, bladder, and prostate. In males, the testicles are evaluated, and any signs of a hernia or a hydrocele (fluid collection). The ovaries, uterus, and adnexal regions are evaluated in females.
Chest X-rays are utilized to evaluate the heart, lungs, airways, bones of the chest and spine, and smaller surrounding structures. It is routinely used to help diagnose shortness of breath, persistent cough, fever, chest pain, or injuries. Chest x-rays can also reveal signs of fluid in or around the lungs.
No. Front Line has chosen an x-ray unit that emits the lowest possible radiation to our patients. Chest x-rays are one of the lowest doses of radiation that an individual can receive. Front Line has taken high regard to ensure we utilize the lowest radiation possible while still achieving high quality diagnostic images. It is worth mentioning that our annual natural exposure for living on earth is 3.1mSv, and a chest x-ray is approximately 0.1mSv. The annual safe limit is 5.0mSv per the CFR (10 CFR part 20). In essence, you could have another 20 chest x-rays performed in order to meet the annual safe limit beyond your natural exposure.
No. Ultrasound is utilized to access the structure of an organ, not the function. Ultrasound is used to evaluate for normal and abnormal structures within an organ. Common findings are the ability to assess if an abnormal finding within an organ is benign or cancerous based on the structure’s appearance.
Yes. Our goal at Front Line is to provide each individual with information to help them make an informed decision about their diagnosis. We have local doctors that we can refer each individual to or help direct the individual to the doctor they should seek out for their diagnosis. For example, if an individual has a significant finding of a thyroid nodule, we will refer the patient to seek out an ENT (ear, nose, and throat) doctor for an appointment.
Yes. We have two options for individuals to obtain a copy of their X-ray and Ultrasound images.
Option 1: an individual can bring a USB drive to our main office, and we can transfer imaging directly to the USB drive.
Option 2: we can send a secured link via email to allow an individual to view their images from their home computer. Upon viewing the images, a person can copy the images to their personal computer and then save those images to a USB drive or email them directly to their physician. Option 2 allows individuals to access their images from their homes and not have to drive to the main office.
Front Line does not currently provide this service. What we can do is provide each individual with a copy of their reports via secured email and provide you a copy of the images via a USB drive.
Front Line is capable of sending a copy of your imaging reports via email that is encrypted for patient safety.
Imaging reports are typically ready within 48-72 hours on a routine basis. If we feel that something requires a STAT read – we will send the imaging across immediately and have results back within one hour on most accounts.
Please watch this short video for a detailed explanation of the imaging portion of your annual physical.
We ask that you do not eat before your ultrasound but have a full bladder.
