First, consider the prevalence of COVID-19 in your community. The date that your practice can reopen will depend on the incidence of COVID-19 in your practice area/patient population, and whether that rate is increasing or decreasing.

Please consider the following steps when reopening your practice¹

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You may be able to help reduce the spread of the virus by making some changes to your physical space.¹

• Clean and disinfect your entire practice every day before opening and regularly throughout the day
• Re-organize your practice space to minimize patient contact and proximity
• Place a sign on the front door to notify patients: “If you have had any respiratory symptoms in the past 14 days, please do not enter. Call and reschedule once the symptoms have passed.”
• Provide multiple hand sanitizing stations in the waiting area along with receptacles
• Remove magazines, TV remotes, bottled water, coffee machines, and any other items patients may touch from the reception area
• Make sure bathrooms are stocked with soap and paper towels to support hand hygiene. Increase frequency of cleanings throughout the day
• Place a sign in the reception area to educate patients on coughing/sneezing etiquette and other topics related to personal hygiene/safety
• Consider having all team members complete OSHA Infection Control Training
• Position air purifiers throughout the office to provide active sanitation against aerosols

To prepare your team, develop guidelines to identify if a patient is at high or low risk for serious COVID-19 infection. High-risk patients are those who tested positive for COVID-19 or who have one of the following²:

• A cardiovascular condition
• A respiratory condition
• Diabetes
• A weakened immune system
• Neurologic conditions
• Liver disease
• Pregnancy

Ensure that your staff is provided with the appropriate personal protective equipment (PPE) to help reduce the risk of spreading COVID-19.³

The AAD has gathered evidence from dermatologists regarding skin manifestations of COVID-19. A summary of this evidence is available at AAD.org⁴

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Before your patients return to the office, let them know about the precautions you are taking. They may feel more at ease about coming in if they know what to expect when they arrive.

• Consider sending a letter/email notifying patients of changes they may see, and anything they should be aware of before making an appointment
• If possible, schedule appointments with enough time in between for minimal overlap of patients in the office

When confirming appointments with patients over the phone, mention your updated health screening practices. Also:

• Inform patients that people accompanying adults should not wait in the reception area and that no food is allowed inside
• Ask patients to wear a mask and to bring their own pen so they do not have to share

• They have had a fever of ≥100° in the past 14 days. (If the answer is “yes,” reschedule the appointment and refer the patient to their primary care provider for assessment)⁵
• They have tested positive or been in close contact with someone who has tested positive for COVID-19 (If the answer is “yes,” reschedule unless the patient has an emergency need)
• They will have traveled within 14 days of their appointment (If the answer is “yes,” reschedule unless the patient has an emergency need)⁶
• Their health history has changed
• There are any changes in their medication
• They use tobacco or have diabetes
• Their stress level is higher than normal

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Once patients enter the office, consider screening at the first point of contact for:

• Fever ≥100°
• Cough
• Difficulty breathing
• Flu-like symptoms

Also consider incorporating these precautionary steps in your routine:

• When treating patients, your team should use PPE including N95 masks and eye protection¹
• Provide face masks for patients as well. Patients should be asked to arrive at your practice wearing a cloth mask or face covering, but consider providing single-use masks for those who forget.⁵
• Do not perform any procedure without the appropriate PPE. If these are unavailable, refer the patient to a clinician who has the appropriate PPE.⁵
• Isolate high-risk patients while they wait for their appointment in an empty operatory or room⁵
• Limit access within 6 feet of the evaluation/treatment area to the attending HCP and/or assistant⁵
• Clean, disinfect, or discard surfaces, supplies, or equipment more frequently⁵

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Establishing new protocols in everyday interactions¹

• Consider having virtual meetings when possible
• Childcare and schooling options may be complicated or limited. When possible, be accommodating with staff who may be dealing with family challenges outside of work.
• Impress upon staff the importance of staying home if they are experiencing any flu-like symptoms or loss of taste or smell. They should follow the CDC’s Return to Work Guidelines.
• Ask staff each day before they see patients if they are experiencing any symptoms
• Consider implementing noncontact temperature screening for staff. If needed, refer them to urgent care or a primary care physician.
• Familiarize yourself with HIPAA protocols if someone on your staff tests positive for COVID-19. The AMA has developed helpful privacy FAQs.

• Offer telemedicine to help minimize in-office visits
• Consider making your cancellation policy more flexible; patients may be nervous about coming in to your practice during this time
• Make your system paperless wherever possible. For example, consider asking patients to complete previsit paperwork online through a patient portal.
• Minimize the need for follow-up visits by using absorbable or buried sutures for surgical procedures. When possible, conduct follow-up visits via telemedicine.

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