puerto rico rural health care pilot program wc docket …puerto rico rural health care pilot program...
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Puerto Rico
Rural Health Care Pilot Program
WC Docket No. 02-60
Puerto Rico Department of Health San Juan, Puerto Rico
Submitted to:
Telecommunications Access Policy Division Wireline Competition Bureau
Federal Communications Commission 445 12th Street, SW, Washington, DC 20554
Erika Olsen [email protected]
Thomas Buckley [email protected] Jeremy Marcus [email protected]
Submitted by: Olga Valentin
Informatics Office Puerto Rico Health Department
PO Box 70184 San Juan, PR 00936
(787)765-2929 [email protected]
Organization
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The Puerto Rico Health Department (PRHD) is committed to the development and implementation of health information systems that facilitate health information exchange; it is legally and financially responsible for the implementation of a point-to-point communication network from its remote healthcare facilities to it’s centralize computer center, Informatics Office, Oficina de Informática y Avances Tecnológicos (OIAT), with the objective to provide more efficient and effective health information exchange. PRDH’s Mission
To promote and to conserve health as an indispensable right of every individual to enjoy life and thus, contribute to the productivity and creativity effort of our society.
PRDH’s Vision
The Department of Health embraces the commitment and privilege as the public organization responsible for the implementation of mechanisms and healthcare services centered around the individual’s daily routine, exempt of political bias, with emphasis on prevention. It is committed to transforming the quality of the services to ones of excellence through physical and human resources; founded on the commitment, respect and responsibility with sensitivity to life and human integrity.
Only the highest principles of scientific and human ethics will serve to guide and inspire new and innovate ways that guarantee the citizen’s right to services of health of unquestionable excellence.
By fortifying and stimulating the emotional and physical well-being of our citizens we will contribute directly to our society’s fulfillment with humility and thus work to respond to ours institutional duty and public obligation.
Objectives The PRDH’s goal is to continue to create a solid foundation for a communication network throughout all the service provider locations, thus increase the feasibility of health information exchange, including a telemedicine project. By creating an effective communication network the following objectives will be achieved: • Provide access to central data sources, such the Hospital Information System and
Electronic Medical Record, (HIS/EMR), implemented at 22 publicly operated facilities • Facilitate healthcare provider access to telecommunication necessary to provide
remote access to Electronic Medical Records across providers • Provide a dedicated and secure communication line to send protected health
information • Provide the network with communication redundancy for continuous access to the
healthcare information
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• Provide access to central data source, such the Data Warehouse, which consolidates data from several local Department of Health Registries
• Facilitate communication between programs via E-mail • Provide internet access to healthcare providers to facilitate access to medical
resources and eligibility verification services. • Facilitate the necessary infrastructure for a Telemedicine Project, including secure
communication and access to the patient’s electronic medical record Scope In 2003, the PRDH was fortunate to receive funding from the local government to design, develop and implement Integrated Health Information System, consisting of seven health information initiatives. The Integrated Health Information System aims to provide integrated solutions to automate various health information exchanges. It includes Hospital Information System/Electronic Medical Record (HIS/EMR), Encounter System for Healthcare Professional providing service for the government funded insurance (Encounter), SmartCard (TI), New Medicare Program Eligibility System (New SAM), Data Warehouse (DW), Telemedicine (Telemed), and Call Center (CC), and Infrastructure for Data Center. As part of the Integrated Health Information System funding, the PRHD received funding for the implementation of the infrastructure necessary to improve the security and capacity of the centralized data center with the aim to support access from remote programs and healthcare provider locales. The improvements to the Data Center included a new electricity generator, and electricity backup systems. New security software was implemented, including Firewall, Anti-Virus, and Monitoring software. Initially, the primary focus of this network was to provide access to two major systems, the public health insurance eligibility system, Eligibility System throughout approximately 90 offices, and the Hospital Information System and Electronic Medical Record, HIS/EMR, throughout thirty-four healthcare facilities. Currently, the HIS/EMR has been successfully implemented at twenty two facilities throughout Puerto Rico. Dedicated communication lines were implemented between remote site and the Data Center. Other programs located in the proximities of these programs were also provided with connectivity to the network, for example Demographic Registry, Women, Children and Infant Program, Immunization Programs. Most participants were given access an electronic mail address and access to internet, as per the definition of their roles and responsibilities. The purpose of this proposal is for the PRDH to continue to maintain and expand the communication network foundation to provide healthcare providers access to the centralized data sources, such as the Eligibility System, HIS/EMR and the Data Warehouse, PRHD internal portal, PRHD WebPage, other Health related Web sources, email, as well as establish a network monitoring system and redundancy in communications. With the additional funding, the PRHD plans to:
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• Extend its communication network to the supra-tertiary Medical Campus of the PRDH, composed of the following three public hospitals: the University District Hospital, the Pediatrics Hospital, and the Puerto Rico Medical Services Administration (ASEM) to facilitate several health information exchange initiatives. These hospitals have their own communication infrastructure and are part of the PRDH organization; however communication among the entity must be optimized to facilitate projects such as Telemedicine, and a shared Continuity of Care Record or Electronic Medical Record.
• Continue to add participants to the HIS/EMR Project. Currently there are 22 facilities implemented and the goal is to implement 34 facilities. The initially funding provides for the maintenance of the communication lines for the first three years. Most of the facilities have been implemented for at least one year. Additional funding to maintain the communication lines must be identified.
• Extend its communication network to other programs, in particular, the Demographic Registry Offices, Mental Retardation Program, the Health Prevention, Promotion and Protection Program, and Primary Healthcare Regional Offices.
• Add communication line redundancy to the HIS/EMR and Eligibility Project participants.
• Extend its communication network to remote executive and administrative users of other centralized data source, such as the new Data Warehouse Project, which provides aggregate information necessary to offer population-based medicine. The PRDH Data Warehouse includes information from the Demographic Registry, the Women Infant Children Program (WIC), Immunization, the public hospital HIS/EMR system, and public insurance claims.
Management Team The project is managed by the Sub secretary of Health, Acting Director of Informatics, Program Staff (e.g., public health advisor, epidemiologist, public health nurse, and health educators), information systems staff, and consultants. The network central data center is located in the PRHD Informatics Office, OIAT. Below you will find a diagram of the current network designed. Target Population The PRHD has the responsibility to generate and enforce public health policies for the entire island, provides health insurance for approximately half the population, provides primary healthcare services, and operates the only supra tertiary healthcare center. As a result, the effects of the proposed initiatives are intended to have a positive impact on the entire island population, although initially the impact is directed at services provided to the medical indigent.
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Current Infrastructure The PRHD network provides connectivity to the following programs and office: • Physician Directory • Healthcare Profession Directory • SARAF (Healthcare Provider Licensing Agency) • Administration • Immunization • Environmental Health • Hospital Information System/Electronic Medical Record • Medicare Program • Women, Infants and Children • Demographic Registry • Mental Retardation Program • Health Promotion, Prevention and Protection Program The PRDH intends to expand the network of the following programs or facilities: Medicare Program, Demographic Registry, Primary Care Facilities, and the supra tertiary Medical Center. To follow a diagram of the current PRDH network infrastructure for the Medicare Program network. It only depicts one remote site of the participating 90 sites. There is a dedicated T1 communication line between the remote sites and the Data Center. There are ten sites with redundant T1 communication lines.
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To follow a diagram of the current PRDH network infrastructure for the HIS/EMR Project. It only depicts three remotes sites of the participating 22 sites. There is a dedicated T1 communication line between the remote sites and the Data Center. There are three sites with redundant T1 communication lines.
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To follow a diagram of the current PRDH network infrastructure for the Demographic Registry Office network. It only depicts one remotes sites of the participating 85 sites. These offices are usual located in the same building as the HIS/EMR and/or the Medicare Program facilities, and thus use the dedicated T1 communication line between the HIS/EMR or Medicare Program sites and the Data Center.
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To follow a diagram of the current PRDH network infrastructure for the Women, Infant and Children Program network. It only depicts the communication network for the regional and local program offices. There is a immanent need to upgrade the telecommunication infrastructure of these facilities because it does not meet code.
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The PRHD has contracted two telecommunication companies for the installation of the communication lines. It aim to supply redundant communication, one from each vendor, but telecommunications services are not available by both vendors throughout Puerto Rico. Telemedicine Experience The PRHD conducted a pilot project between the Vieques’ Center for Disease and Treatment (CDT) Susana Centeno facility and Puerto Rico Medical Services Administration (ASEM) in 2002. This project was limited to Radiology images, where the remote facility, the CDT Susana Centeno, would send Radiology images to be read at the Puerto Rico Medical Services Administration facility. The program equipment was also used to facilitate videoconferencing between the two facilities. There was a significant saving in patient travel expense and an increase in turn around time of results. Most patients, requiring Radiology services, were historical escorted by helicopter to ASEM. The program has been limited due to contractual issues with the billing process of these services by the hospital institution providing the services. There is a TeleMedicine committee reviewing the lesson learned of the pilot project and developing a plan to continue the TeleMedicine initiative. It is an essential component to the healthcare system, because it minimizes patient transportation issues. Patients often are faces with limited access to transportation, especially for specialized service located only the metropolitan centers.
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During this exercise one of the lessons learned was the need to provide the consulting physician access to the patient’s medical. In order to provide this functionality, connectivity amongst facilities and the central data center must be established. The Telemedicine committee, consisting of 11 members of the healthcare community, and directed the Secretary of Health, is addressing necessary legal and policy issues to facilitate Telemedicine. A Telemedicine regulation was written and approved. Other issues deferring the development of a strong Telemedicine initiative are liability issues, insurance coverage and billing procedures. One of the recommendations of the Telemedicine committee to the PRHD and a new PRHD objective is to develop a strong communication infrastructure, as an initially step to several health information exchange projects, recognizing the importance of establishing remote access to an electronic medical record, as a precursor to implementing a Telemedicine Project, to provide the consulting physicians with the patient history, recent diagnosis, and tests results, in order to complement the evaluation. Assumptions:
The following assumptions have been made for this phase of the project: • The PRHD will continue to implement additional participants to the HIS/EMR
project • The PRDH will implement new communication facilities to the remain
Demographic Registry Offices • The PRDH will have the necessary funds to implement redundant communication
lines for the HIS/EMR and the Medicare Program offices. • The PRDH will have the necessary funds to implement redundant communication
lines for the HIS/EMR and the Medicare Program offices. • The PRDH will have the necessary funds to implement communication facilities
at the Primary Healthcare Regional Offices. • The PRDH will implement a Call Center and Enterprise Management technology
concurrently to expanding its network to facilitate providing technological support and preventive maintenance.
Work Breakdown Structure:
The following itinerary is for the implementation of the additional HIS/EMR participants:
WBS Activities Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
1 Agreement Letter for New Participants
1.1 Request signature from Secretary of Health
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1.2 Meet with each facility administration to discuss agreement letter
1.3 Receipt of signed agreement letter 2 Communication lines
2.1 Send T1 line installation request to communication company
2..2 Coordinate installation with communication company, OIAT and facility
Install T1 communication line
2.3 Verify communication has been established between facility and network
3 Computer equipment for facilities 3.1 Order PCs and peripherals 3.2 Deployment of equipment to facilities 3.3 Install equipment in facilities 3.4 Connect equipment to network 4 Access to network
4.1 Request information from providers to create account in HIS
4.2 Collect providers' information 4.3 Create account HIS account
4.4 Provide access to network, Internet and email account
5 Health Information Software 5.1 Install health information software
5.2 Enter data into the health information software
5.3 Coordinate training and Go-live date 5.4 Train healthcare facility staff
5.5 Go-live and provide 24 hours technological support
The following itinerary is for the implementation of the additional Demographic Registry Offices, the Primary Healthcare Regional Office, and the redundancy of the HIS/EMR and Medicare Program participants:
WBS Activities Month 7
Month 8
Month 9
Month 10
Month 11
Month 12
6 Communication lines
6.1 Send T1 line installation request to communication company
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6.2 Coordinate installation with communication company, OIAT and facility
6.3 Install T1 communication line
6.4 Verify communication has been established between facility and network
7 Computer equipment for facilities 7.1 Order PCs and peripherals 7.2 Deployment of equipment to facilities 7.3 Install equipment in facilities 7.4 Connect equipment to network 8 Access to network
8.1 Request information from providers to create account in HIS
8.2 Collect providers' information 8.3 Create account HIS account
8.4 Provide access to network, Internet and email account
Milestones:
The milestones for the network expansion project are: • Letter of agreements are signed • T1 line is installed and connected to the network • Equipment is received at the facilities • The facility provides their information to be entered into the health information
system • Facility personnel is trained in the HIS/EMR
Projected Costs and Resource Requirements: The PRDH estimates for the next fiscal year a cost of $5,107,557 for communications lines installation and equipment, and communication lines services fees. If all new installations are completed, the recurring cost for the communications lines will be $3,567,783 (see Appendix F for details). Current Costs Additional Costs Recurring Costs Communication Lines $1,056,226 $2,511,557 $3,567,783New Installations $0 $488,200 $0Equipment $0 $2,107,776 $0
Subtotal $1,056,226 $5,107,533 $3,567,783 Currently, all project’s participants are non-profit providers; the participant providers are associated to the PRDH. The future participants will also be non-profit providers. The PRDH absorbs all the telecommunication costs for providers who participate in the
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project. Financial support for the project comes from assigned state and federal funds of participating programs (see Appendix B): State Fund 111, State Collection Fund 297 & 410, State Fund 571, and, Federal Fund 272. The PRDH provides the telecommunication service as part of their program thus no revenues are collected from this public service. Currently, access to neither the network nor the data in the centralized database is sold. List of current participants
Data was unavailable on the Rural Urban Commuting Area (RUCA) code for Puerto Rico; according to the Rural Health Research Center the data for Puerto Rico is under analysis and construction, to review the information log on to http://depts.washington.edu/uwruca/index.html. Medicare Program Offices There are currently 90 Medicare Program Offices on the network (see Appendix C for listing). Demographic Registry There are currently 85 Demographic Registry Program Offices on the network (see Appendix D for listing). These office use the communication line installed by the Medicare Program offices or the HIS/EMR facilities ASEM Administración de Servicios Médicos de Puerto Rico Centro Médico de Puerto Rico Bo. Bonacillos Ave. Américo Miranda, Rept. Metropolitano Río Piedras, PR 00935 787-754-0101 Centro Pediátrico Dr. Antonio Ortiz Hospital Universitario Centro Médico de Puerto Rico Ave. Américo Miranda, Rept. Metropolitano Río Piedras, PR 00919 787-777-3535 Hospital San Juan Centro Médico de Puerto Rico Bo. Monacillos San Juan, PR 00936 787-766-2222 University District Hospital Centro Médico de Puerto Rico
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Carr 22 Bo. Monacillos Río Piedras, PR 00935 787-777-3535 Centro Cardiováscular de Puerto Rico Centro Médico de Puerto Esquina Ave. Américo Miranda Río Piedras,PR 00924 787-754-8500 Center for Diagnosis and Treatment The following list of 22 healthcare facilities of non-profit providers associated to the PRDH currently participate in the network; we have included the address, zip code, and phone number for each healthcare facility participating in the network: Rincón Medical Center Car. Estatal 115 Km. 31.1 Bo. Pueblo Rincón, PR 00677 (787) 823-0909 Servicios Médicos de Añasco Car. 402 Km. 1.8 Bo. Las Marías Añasco, PR 00610 (787) 826-2888 Centro Isabelino de Medicina Avanzada Ave. Agustín Ramos Calero Interior Car. 112, Km. 1.4 Isabela, PR 00662 (787) 830-2705 Hospital Universitario Dr. Ramón Ruiz Arnau Ave. Laurel #100, Bo. Santa Juanita Bayamón, PR 00956 (787) 787-5151 Centro de Salud Familiar Susana Centeno Car. 997 Km. 0 Hm. 1 Bo. Destino Vieques, PR 00765 (787) 741-0392 Centro de Salud Comunal de Culebra Calle William Font Final Culebra, PR 00775 (787) 742-0001
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Policlínica Familiar Bernice Guerra 301 Ave. 5 de Diciembre Car. 102 Km. 39.1 Sabana Grande, PR 00637 (787) 873-1755 Centro de Diagnóstico y Tratamiento de Guayanilla Calle José de Diego #13 Guayanilla, PR 00656 (787) 835-4254 Centro Servicios de Salud Juan M. Santiago Car. Ramal 116 Km. 2.2 Guánica, PR 00653 (787) 821-0402 Centro de Tratamiento y Diagnóstico de Adjuntas Calle Dr. Defendini #4 Adjuntas, PR 00601 (787) 829-2860 Hospital Mario Canales Torresola Calle Cementero # 2 Car. Estatal #144 al lado casa Alcaldía Jayuya, PR 00664 (787) 828-9164 Centro de Salud Familiar Santa Isabel Car. 153 Calle Hostos Final #89 Santa Isabel, PR 00757 (787) 845-5050 Centro de Salud Familiar Yabucoa Car. 901 Calle Santurino Rodríguez #100 Yabucoa, PR 00767 (787) 893-0480 Centro de Salud Maunabo Ave. Kennedy Apartado 8 Maunabo, PR 00707 (787) 861-1407 Centro de Servicios Primarios de Salud de Patillas Inc. Calle Guillermo Riefkhol #99 Patillas, PR 00723
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(787) 839-4446 Centro de Salud Hernán Chico Car. 31 Km. 4.0 Naguabo, PR 00718 (787) 874-2837 Centro de Diagnóstico y Tratamiento Las Piedras Ave. José Celso Barbosa #63 Las Piedras, PR 00771 (787) 733-5063 Vega Alta Community Health Car. #2 Km. 31.9 Bo. Bajura Vega Alta, PR 00692 (787) 883-6728 Dorado Community Health Car. # 698 Bo. Mameyal Dorado, PR 0646 (787) 796-3330 Vega Baja Community Health Car. #2 Km. 37.1 Ave. Villa Pinares #81 Vega Alta, PR 00963 Comerío Medical Hospital Car. 778 Km. 0.9 Comerio, PR 00782 (787) 875-3136 Centro de Diagnóstico y Tratamiento Dr. Jorge Franceschi Calle Sergio Peña Almodóvar Esq. Flor Gerena Humacao, PR 00791 (787) 852-8730 List of future participants
Data was unavailable on the Rural Urban Commuting Area (RUCA) code for Puerto Rico; according to the Rural Health Research Center the data for Puerto Rico is under analysis and construction, to review the information log on to http://depts.washington.edu/uwruca/index.html.
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The following 11 healthcare facilities of non-profit providers associated to the PRDH are the future participants in the network; we have included the address, zip code, and phone number for each health care facility which will participate in the network;
Medicare Program Offices There are currently 6 Medicare Program Offices pending installations, including the facilities of Río Grande, Arroyo, Ponce I, Ponce II, Ponce III and the Ponce Regional Office. Demographic Registry There are currently 3 Demographic Registry offices pending installations, including the facilities of Junco, Comerío and Toa Alta. Centers for Diagnosis and Treatment Centro de Diagnóstico y Tratamiento de Río Grande Calle Manuel Pimentel y Castro#200 Río Grande, PR 00745 787-809-1010 Centro de Diagnóstico y Tratamiento de Morovis Morovis, PR 00745 Primary Health Service Regional Offices Antiguo Hospital Distrito Carretera 129 Salida 77 de Arecibo a Lares Arecibo, PR (787) 439-4121 San Juan Bautista Medical Center Car. 172, Urb. Turabo Garden Caguas, PR 00726 (787) 744-3141 Centro Médico de Mayagüez Edif. Antigua Casa de Salud Carretera #2, Tercer Piso Mayagüez, PR Antiguo Hospital de Distrito Hospital San Lucas II, Segundo Piso Ponce, PR 787) 843-9263 Other Program Offices Mental Retardation Program
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CEM Building # 1409, Mezan Avenida Ponce de León, Parada 20 Santurce, PR Health Promotion and Protection CEM Building # 1409, Mezan Avenida Ponce de León, Parada 20 Santurce, PR Centers for Prevention and Treatment of STDs Centro Inmunológico de Arecibo Car. 129 Antiguo Hosp. de Distrito Arecibo, PR 00612-3666 (787) 817-1245 Centro Inmunológico de Bayamón Hospital Universitario Dr. Ramón Ruiz Arnau Casa de Salud Ave. Laurel #100, Bo. Santa Juanita Bayamón, PR 00956 (787) 778-4747 Centro Inmunológico de Caguas San Juan Bautista Medical Center Car. 172, Urb. Turabo Garden Caguas, PR 00726 (787) 744-3141 Centro Inmunológico de Carolina Hospital de la Universidad de Puerto Rico Dr. Federico Trilla Car. # 3 Km. 8.3 Ave. 65th Infantería Carolina, PR 00984 (787) 757-1800 Centro Inmunológico de Fajardo Calle Rafael #55 Edif. 1 Fajardo, PR 00738 (787) 274-5502 Centro Inmunológico de Mayagüez Centro Médico Hosp. Ramón Emeterio Betances Suite 6, Ave. Hostos #40 Mayagüez, PR 00680 (787) 834-2110
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Centro Inmunológico de Ponce Hospital San Lucas II Ave. Tito Castro Car. 14 Bo. Machuelo Ponce, PR 00933 (787) 259-4046 Centro Latinoamericano de Enfermedades de Transmisión Sexual Paseo Celso Barbosa, Edif. de Trauma, Piso I San Juan, PR 00936 (787) 754-8128 Pediatric Centers Centro Pediátrico de Arecibo Car. 129 Antiguo Hospital de Distrito Arecibo, PR 00612-3666 (787) 817-1245 Centro Pediátrico de Bayamón Hospital Universitario Dr. Ramón Ruiz Arnau Casa de Salud Ave. Laurel #100, Bo. Santa Juanita Bayamón, PR 00956 (787) 778-4747 Centro de Pediatría de Caguas San Juan Bautista Medical Center Car. 172, Urb. Turabo Garden Caguas, PR 00726 (787) 744-3141 Centro de Pediatría de Fajardo Calle E Suite 77 Urb. Monte Brisas Fajardo, PR 00738 (787) 801-1114 Centro Pediátrico Mayagüez 410 Avenida Hostos Suite 1, Bo. Sábalos Mayagüez, PR 00682 (787) 834-5830 Centro Pediátrico de Ponce Ave. Tito Castro 931
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Car. 14, Bo. Machuelo Ponce, PR 00933 (787) 840-7202 Women, Infant and Children Program Offices There are plans to upgrade the 101 Medicare Program Offices to meet the current infrastructure standard. (see Appendix E for listing).
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Appendix A: Abbreviation OIAT Oficina de Informática y Avances Tecnológicos, Office of Informatics and
Technological Advances ASEM Asociación de Servicios Médicos de Puerto Rico, Association of Medical
Service of Puerto Rico CDT Centro de Diagnóstico y Tratamiento, Center for Diagnosis and Treatment PRDH Puerto Rico Department of Health RUCA Rural Urban Commuting Area
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Appendix B: Programs in Contribution State Funds I. State Fund (111) Administration General Hospital Institutions State Laboratory Women and Children Program OCASET Informatics Office Regional Offices Environmental Health SAPS SARAFS(Licensing Agency) II. State Fund (272) Medicare Biosecurity BRFS (Risk Factor Surveillance) HOPWA OCASET HIV/AIDS Prevention Cancer Registry SAPS SARAFS Immunization AIDS Surveillance WIC III. State Income Fund (297 y 410) State Laboratory Demographic Registry Regulation and Certification of Healthcare Professionals Environmental Health SARAFS (licensing agency) Physician Certification IV. Fund 571 Hospital Pediátrico Universitario Hospital Universitario de Adultos
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Inte
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arr.
Milit
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o.
31
874-
6540
Yab
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S
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edic
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grad
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arr.
Mili
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89
3-47
78 /
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7100
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Srta
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San
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C
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# 5
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2493
Pat
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Cal
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lber
to R
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#21
Fre
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Ferre
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271-
1762
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Cal
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820-
3883
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5170
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872-
2801
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Mén
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Bar
bosa
218
87
7-26
44
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#36
89
6-45
05
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119
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827-
2544
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Flor
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Ave
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#9
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838-
2266
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402
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Mar
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826-
5650
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alud
Pub
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Cal
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112
832-
8605
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co. P
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2 C
alle
Igna
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Mor
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#43
86
9-30
05
Com
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ra. N
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Lóp
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Gub
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men
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2 #
35 c
arr.
778
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875-
3470
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Dor
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9 C
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857-
4428
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o. P
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9-67
03 /
859-
0308
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Ber
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Edi
f. O
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#
59
867-
3606
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7-66
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828-
1541
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Mar
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5-63
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Aib
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S
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Rita
Gon
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San
Jos
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217
735-
6720
4
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M. O
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A
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86
6-06
73 /
866-
0398
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# 2
824-
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5-87
17 /
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5050
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Cen
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3
829-
1063
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836-
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Car
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189
256-
5040
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39 C
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4-26
05 /
504-
2642
C
anov
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S
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Piz
arro
C
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Cor
chad
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25
6-80
94
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M. M
oral
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Ave
. Gen
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#394
80
1-20
55
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Sol
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28
Cal
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889-
3407
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Pro
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Car
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Cal
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106
757-
9535
/ 75
2-12
80
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75
5-41
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U
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Dáv
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3 A
79
8-33
20 /
269-
5588
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Seg
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269-
6030
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78
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# 29
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26
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720-
0449
A
mel
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Sra
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6
App
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899-
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alud
Fam
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116
82
1-26
50
Gua
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Mor
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C
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Jos
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13
835-
2150
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vist
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arr.
128
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856-
1680
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celo
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871-
2560
Fl
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alud
cal
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822-
2506
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85
4-24
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B. C
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alud
Pub
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862-
3000
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2223
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A
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Urb
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3 73
7-42
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7610
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Bar
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# 5
73
8-23
52
Dem
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Cal
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Riv
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#65
esq.
Cel
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743-
2616
Ju
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M
aria
E. L
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Tu
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Med
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Gro
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Muñ
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734-
3370
7
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S
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M. T
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elga
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Cal
le C
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Bar
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73
3-44
33
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1-80
25
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C
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# 31
87
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M. V
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89
3-71
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106
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R
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715-
2190
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Rod
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nal V
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cón
Ave
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852-
1704
A
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Cal
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Val
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9-21
04
Pat
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H. T
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Cen
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# 3
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2049
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9-43
20
839-
4360
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Cen
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Des
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74
1-18
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Agu
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Cal
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6 86
8-36
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1-66
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89
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#23
7
877-
5675
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5-25
96
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823-
4645
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896-
1652
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829
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Lare
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8-25
72 /
878-
7665
D
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tor
Addr
ess
Tele
phon
e H
atillo
B
lanc
a I.
Gar
cía
Felic
iano
C
entro
de
Sal
ud c
alle
Fer
nand
o V
elás
quez
89
8-35
70
Lare
s E
vely
n P
érez
Col
on
CD
T In
corp
orad
o R
afae
l A. G
onzá
lez
Car
r. 11
K
m. 1
.9
897-
2195
Utu
ado
Man
uel R
odríg
uez
Rod
rígue
z C
entro
de
Sal
ud Is
aac
Gon
zále
z 89
4-24
45
Las
Mar
ias
Car
men
I. C
oria
no R
odríg
uez
Bo.
Mar
avilla
Est
e 82
7-22
20
Mar
icao
V
irgen
E. P
ache
co S
anta
na
#9 A
ve. L
uche
tti
838-
2590
8
Aña
sco
Car
men
I. M
énde
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orre
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entro
de
Sal
ud F
amilia
r Zon
a In
dust
rial B
o.
Mar
ia
826-
0777
May
agüe
z A
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L. C
olon
Orti
z U
nida
d S
alud
Pub
lica
calle
Pila
r Def
illo
832-
1184
/ 83
2-16
00
9
D
emog
raph
ic R
egis
try
City
Ad
min
istra
tor
Addr
ess
Tele
phon
e N
aran
jito
Min
erva
Riv
era
San
tos
Bo.
Ach
iote
Car
r.164
86
9-78
10
Com
erío
Lu
z E
. Rey
es R
íos
Cen
tro d
e S
alud
cal
le G
eorg
etti
# 85
87
5-30
10
Bar
ranq
uita
s A
ida
Fuen
tes
Alv
arad
o C
EM
PR
I cal
le B
arce
ló #
53
857-
3855
C
oroz
al
Car
men
M. C
olon
Pér
ez
Cal
le S
an R
amón
fina
l 85
9-21
83
Oro
covi
s M
arga
rita
Rod
rígue
z P
agan
A
ve. L
uis
Muñ
oz M
arín
86
7-52
88
Villa
lba
Eld
ra E
. Col
on C
ruz
Urb
. La
Veg
a
847-
9210
Ju
ana
Día
z Iri
s R
. Gut
iérre
z M
aria
no
Cal
le L
a C
ruz
# 6
837-
3580
Ja
yuya
E
dith
M. M
edin
a To
rres
Cal
le C
emen
terio
#2
828-
3650
C
oam
o M
aritz
a B
urgo
s C
ruz
Cen
tro C
oam
eño
de M
edic
ina
Ava
nzad
a A
ve.
Muñ
oz R
iver
a 82
5-37
90
Aib
onito
R
amon
ita M
atos
Orti
z C
alle
San
Jos
é de
trás
del c
uarte
l de
la P
olic
ía
735-
1910
G
uaya
ma
Mar
ia E
lena
Col
on R
odríg
uez
Ant
iguo
CD
T B
aldo
rioty
Fin
al O
este
86
4-02
02
Sal
inas
W
anda
I. L
ópez
Rod
rígue
z S
urm
ed M
edic
al C
ente
r 82
4-25
00
San
ta Is
abel
E
nid
Col
on C
ruz
Cen
tro d
e S
alud
Fam
iliar H
osto
s Fi
nal
845-
5050
x.23
7 P
once
B
eatri
z P
érez
Cas
tella
r C
alle
May
or C
ante
ra #
4
842-
3127
P
eñue
las
Iraid
a M
. Rod
rígue
z C
entro
de
Dia
gnos
tico
y Tr
atam
ient
o B
o.
Cue
vas
Car
r. 13
2 K
m. 5
83
6-20
50
Adj
unta
s E
lba
Mal
dona
do M
iro
Cen
tro d
e S
alud
Fam
iliar D
r. D
efen
dini
# 4
82
9-04
05
Loiz
a W
anda
Can
ales
Dáv
ila
Con
cilio
Inte
gral
de
Sal
ud
876-
8165
R
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rand
e Id
alia
Tor
res
Are
na
Rio
Gra
nde
Com
mun
ity H
ealth
Car
e 88
7-34
29
Can
óvan
as
Luz
S. F
erna
ndez
Mon
tañe
z C
entro
de
Sal
ud c
alle
Cor
chad
o fre
nte
cuar
tel
Vale
ncia
87
6-28
98
Faja
rdo
Rod
olfo
Rob
les
Rod
rígue
z A
ve. B
Esq
. E, U
rb. M
onte
bris
as
863-
7360
Lu
quillo
C
arm
en F
igue
roa
Nor
man
dia
Luqu
illo H
ealth
Com
mun
ity C
ente
r ca
lle 4
de
julio
fina
l 88
9-33
77
Dem
ogra
phic
Reg
istry
C
ity
Adm
inis
trato
r Ad
dres
s Te
leph
one
Cei
ba
Viv
ian
San
tiago
Gar
cía
Cal
le J
osé
Rom
ero
#7
885-
7265
10
Cei
ba S
ub
Nim
ia S
. Tor
ruel
las
Bas
e N
aval
Roo
seve
lt R
oad
865-
5968
/ 86
5-59
22
Car
olin
a C
arm
en L
. San
tana
C
alle
Ber
nard
o G
arcí
a #
8 su
r 76
8-61
73
Truj
illo A
lto
Osv
aldo
Qui
les
Fran
co
Cen
tro d
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alud
Exp
. K
m.4
.7 U
rb. L
ago
Esq
. C
arite
28
3-22
45
Bay
amón
M
yrna
Góm
ez O
tero
C
antó
n M
all O
fic. 1
Seg
undo
Pis
o 78
5-04
39 /
288-
5111
64
8-18
83
Bay
amón
Sub
A
lba
Edd
a M
aldo
nado
Mar
rero
A
ve. L
aure
l Lom
as V
erde
s 78
7-51
51
x.18
3 2
69-
0883
G
uayn
abo
Zena
ida
Riv
era
Llop
iz
Gua
ynab
o M
edic
al M
all A
ve. L
a C
umbr
es #
140
28
7-35
00
x.23
17
San
Jua
n E
mne
dies
Dáv
ila
Cal
le Q
uisq
ueya
# 1
71
767-
9120
X
.210
5 ó
2108
/ 76
3-92
34
SJ
Mun
icip
al
Jose
fa C
ente
no V
illega
s H
ospi
tal M
unic
ipal
Cen
tro M
edic
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766-
2222
x.
4026
754
-06
77
SJ
Uni
vers
itario
E
ulal
ia R
iver
a O
rtega
H
ospi
tal U
nive
rsita
rio C
entro
Med
ico
Río
P
iedr
as
754-
0101
x.
2114
ó
3658
To
a B
aja
Iris
N. P
arril
la S
oto
Ave
. Sab
ana
Sec
a fin
al S
ecto
r el 2
6 B
o. In
geni
o 87
0-62
96
Cat
año
Car
men
S. M
arqu
e G
onzá
lez
Cal
le B
erna
rdo
Gar
cía
# 8
Sur
78
8-49
50
11
App
endi
x E
: W
omen
, Inf
ant a
nd C
hild
ren
W
IC
City
Ad
min
istra
tor
Addr
ess
Tele
phon
e C
abo
Roj
o Lc
da. N
ancy
San
tana
C
alle
Muñ
oz R
iver
a #5
7 85
1-80
50
Hor
mig
uero
s S
ra. V
ilma
Bon
illa /
Inte
rina
Pla
za M
onse
rrate
III L
ocal
I C
arr.
#2 K
m. 1
64
Inte
rior
849-
4488
Laja
s Lc
da. M
aria
Can
cel
CFS
Laj
as-C
línic
a W
IC A
ve. F
lam
boyá
n #3
7 /
Ant
iguo
Cen
tro d
e S
alud
89
9-10
44
Sab
ana
Gra
nde
Sr.
Ottm
ar S
antia
go /
Inte
rino
Car
r. 10
2 K
m. 3
9-2
/ Ant
iguo
Cen
tro d
e S
alud
87
3-73
35
San
Ger
man
Lc
da. S
ofia
Sep
ulve
da
Cal
le L
una
Esq
uina
Cas
tro P
érez
Cen
tro
Com
erci
al d
e S
an G
erm
an
892-
3415
Yau
co
Lcda
. Nyd
ia T
orre
s S
ierra
E
dific
io A
-R C
arr.
127
Ext
. 25
de J
ulio
Km
. 0.4
/ A
l lad
o de
la P
anad
ería
Yam
ar y
cer
ca d
e la
Tu
mba
El s
olda
do D
esco
noci
do
856-
6611
Gua
nica
Lc
da. M
aria
de
los
A. O
lan
Bat
all
Cal
le B
uena
Ven
tura
Qui
ñone
s #2
8 / F
rent
e tie
nda
Pre
cios
Loc
os
821-
2997
Gua
yani
lla
Lcda
. San
dra
Felic
iano
Rod
rígue
z C
alle
Ruf
ina
#18
/ Cer
ca F
loris
tería
Bon
nys
835-
1884
B
arce
lone
ta
Lcda
. Olg
a C
olon
Mar
ín
Urb
. Cat
alon
a #
79-A
84
6-02
15
Cia
les
Lcda
. Mar
ibel
Ros
ario
Pér
ez
Cal
le P
alm
er #
4
871-
5713
Fl
orid
a Lc
da. M
aric
elis
Arle
t Pad
illa
Cen
tro d
e S
alud
San
Jud
as d
e Fl
orid
a C
alle
A
nton
io A
lcaz
ar #
27
Sui
te #
1
822-
0316
Man
atí
Lcda
. Ros
a A
lgar
ada
Cal
le R
amos
Vél
ez F
inal
# 2
88
4-70
66
Mor
ovis
Lc
da. J
uana
Mira
nda
Mor
ovis
Com
mun
ity H
ealth
Cen
ter A
ve. C
oroz
al
Esq
uina
Pat
ron
862-
6134
Veg
a B
aja
Lcda
. Iris
D. V
ázqu
ez O
rtiz
Cen
tro d
e S
alud
Fam
iliar U
rb. V
illa P
inar
es,
Cal
le V
illa d
e P
aseo
# 8
1 85
8-24
13
Veg
a A
lta
Lcda
. Nan
cy R
amíre
z C
arr.
#2 /
Fren
te P
lant
a E
léct
rica
Det
rás
Cen
tro
de S
alud
Veg
a A
lta
270-
3183
/ 27
0-23
00
City
Ad
min
istra
tor
Addr
ess
Tele
phon
e To
a A
lta
Lcda
. Nay
da C
héve
re Ir
izar
ry
Cal
le M
uñoz
Riv
era
20 /
Fren
te P
laza
de
Rec
reo
870-
2370
12
WIC
D
orad
o Lc
da. M
adel
ine
San
tiago
C
SF
Dor
ado
Car
r. 69
8 E
ntra
ndo
haci
a B
o.
Mam
eyal
Sui
te 4
27
8-27
98
Gur
abo
Lcda
. Nat
ivid
ad R
iver
a G
urab
o C
omm
unity
Hea
lth C
ente
r San
Ant
onio
Fi
nal S
alid
a B
o. J
agua
s / T
raile
r Fre
nte
al
Par
que
de P
elot
a
737-
1240
/ 73
7-12
55
Agu
as B
uena
s Lc
da. E
lda
Orti
z P
uerto
Ric
o M
edic
al C
are
98 M
uñoz
Riv
era
/ Fr
ente
a C
af. R
ev. Q
uick
, el e
stac
iona
mie
nto
de
la c
linic
a se
enc
uent
ra d
etrá
s de
l edi
ficio
732-
0769
Cid
ra
Lcda
. Hel
da C
olon
C
alle
Jos
é D
e D
iego
Fin
al #
1 / S
alid
a R
ío A
bajo
al
lado
del
Gar
age
Res
aco.
2do
niv
el d
el
Dep
arta
men
to d
e la
Fam
ilia y
A.M
. E
ntra
ndo
por e
l Est
acio
nam
ient
o.
739-
5445
/ 73
9-09
28
Cay
ey
Lcda
. Car
men
La
San
ta
Cay
ey P
R M
edic
al (t
raile
r) L
uis
M. B
arre
ros
#5 /
Trai
ler f
rent
e al
Col
egio
La
Mer
ced
738-
0845
/ 73
8-08
85
Cag
uas
Sra
. Atil
da R
odríg
uez
Edi
f. S
hopi
ng P
laza
Gau
tier C
alle
Gau
tier
Ben
ítez,
Esq
. Geo
rget
ti Lo
cal 3
/ O
ficin
a R
egio
nal
746-
2726
/6
565/
2215
74
3-23
77
Cag
uas
Lcda
. Am
arily
s Á
lvar
ez
San
Jua
n B
autis
ta M
edic
al C
ente
r (Tr
aile
r)
Car
r. 17
2 S
alid
a ha
cia
Cid
ra /
Fren
te a
KF
Chi
cken
743-
4565
/ 25
8-57
57
Cag
uas
I Lc
da. C
arm
en T
. Guz
mán
E
dif.
Pla
za G
autie
r Cal
le G
autie
r Ben
ítez,
Esq
. G
eorg
etti
Loca
l #6
/ 1er
Pis
o Fr
ent O
ficin
a R
egio
nal
743-
2334
Cag
uas
II Lc
da. N
ydia
Leó
n P
laza
del
Car
men
Mal
l Car
r. 17
2 Lo
cal B
-6 2
do
Niv
el
744-
3460
City
Ad
min
istra
tor
Addr
ess
Tele
phon
e Ju
ncos
Lc
da. M
aria
I. R
omán
P
laza
del
Val
enci
ano
C-1
5 A
ve. L
as F
lore
s /
Cer
ca d
el T
ribun
al S
uper
ior d
e Ju
stic
ia
734-
5010
/ 73
4-50
25
734-
5088
/ 73
4-50
55
13
WIC
La
s P
iedr
as
Lcda
. Jua
na C
orte
s C
entro
de
Med
icin
a In
tegr
al J
osé
C. B
arbo
sa
#74
/ Al l
ado
Esc
. Int
erm
edia
Fer
nand
o R
oig.
73
3-08
44
Mau
nabo
Lc
da. G
ladi
s C
olon
C
EM
PR
I Hos
pita
l Ryd
er M
auna
bo A
ve.
Ken
nedy
/ D
etrá
s C
uarte
l Pol
icía
86
1-10
07
Nag
uabo
Lc
da. O
lga
Agu
iar
Cen
tro d
e S
alud
Fam
iliar N
agua
bo C
arr.
Milit
ar
#31
/ Fre
nte
a la
fabr
ica
Dua
l Life
87
4-33
22
Yab
ucoa
Lc
da. I
ris D
. Lab
oy
Cen
tro d
e S
alud
Fam
iliar C
arr.
901
/ C
erca
C
entro
Com
erci
al J
ardi
nes
de Y
abuc
oa
893-
7639
San
Lor
enzo
Lc
da. M
aria
E. C
laud
io
Muñ
oz R
iver
a fin
al /
Fren
te a
l Cen
tro
Gub
erna
men
tal
736-
2400
Hum
acao
Lc
da. Á
urea
Pér
ez
Hos
pita
l Reg
iona
l Ave
. Tej
as, S
egun
do N
ivel
/ C
erca
del
Sup
erm
erca
do d
el E
ste
y K
F C
hick
en
852-
4460
/ 85
2-83
92
Arr
oyo
Eva
De
Jesú
s A
rroy
o / I
nter
ina
Cal
le M
orse
Esq
. Val
entin
a / F
rent
e a
la P
laza
de
l Mer
cado
83
9-62
25
Pat
illas
Aid
a R
iver
a Ti
rado
/ In
terin
a C
alle
Lui
s M
uñoz
Riv
era
(Nor
te) #
24 /
Fren
te
Mau
na C
oop.
83
9-80
20
Cul
ebra
S
r. W
ilfre
do P
ache
co /
Inte
rino
CD
T C
uleb
ra C
alle
Willi
am F
ont (
final
) / C
erca
de
l Edi
ficio
Env
ejec
ient
e 74
2-05
22
Vie
ques
S
ra. N
ora
Cam
acho
/ In
terin
a B
o. D
estin
o, C
arr.
997
Km
. 1.0
74
1-19
64
Agu
ada
Lcda
. Mar
garit
a S
antia
go
Est
ació
n #5
6 E
dif.
Labo
rato
rio A
guad
ero
1er
piso
86
8-81
63
W
IC
City
Ad
min
istra
tor
Addr
ess
Tele
phon
e A
guad
illa
Lcda
. Zul
ma
Lore
nzo
Edi
f. V
icto
ria II
Cal
le M
erce
des
Mor
eno
#6
882-
3189
0 C
amuy
Lc
da. M
yrna
San
to G
uillm
a C
alle
San
Jos
é #3
Cam
uy
898-
1414
Is
abel
a Lc
da. M
iriam
Mat
ías
Cen
tro C
omer
cial
Coo
pera
tivo
Ave
. Jua
n H
ndz.
Orti
z N
um. 1
Alto
s 87
2-52
00
Moc
a Lc
da. L
iana
bel V
illan
ueva
50
7 C
alle
Con
cepc
ión
Ver
a S
. 87
7-00
90 /
877-
7760
Q
uebr
adilla
s Lc
da. A
ixa
Cot
to M
oran
C
alle
Enr
ique
Lin
ares
#20
7 E
dific
io A
mad
or
895-
1678
14
WIC
R
incó
n Lc
da. B
elqu
is M
atía
s C
arr.
115
Km
. 12.
0 82
3-20
40
San
Seb
astiá
n Lc
da. S
ylvi
a Lu
go
Pepi
no H
ealth
Gro
up 1
20 C
alle
Pav
ía
Fern
ánde
z 82
0-12
55
Are
cibo
Cal
le J
esús
Cor
tes
#101
y #
105
Ofic
ina
Reg
iona
l y C
línic
a 88
0-57
58
Hat
illo
Lcda
. Aid
a L.
Rom
án M
oral
es
Cen
tro M
edic
o de
Hat
illo C
alle
Fer
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262-
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Inte
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3768
M
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Rob
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Inte
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Cal
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84
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Cru
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Cal
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#2
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Alc
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Coa
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Lcda
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Prim
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138
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Inte
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735-
0190
Gua
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Bal
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5961
84
0-59
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3605
84
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Cal
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84
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arr.
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3871
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863-
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0-11
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Cal
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Cal
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167
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Ave
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250-
8419
City
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Addr
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phon
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aja
Lcda
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Gar
cía
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Ave
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261-
3999
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18
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Man
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C
DT
Dr.
Que
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359
Cal
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723-
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220
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turc
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3535
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San
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3992
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233
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2940
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chev
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7089
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356
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Ant
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763-
4242
x
220,
242
19
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endi
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ts T
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