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					                                Medical Staff Services

 Assist the organized Medical Staff in fulfilling their purpose for existence as defined in
   bylaws.
 Support the hospital and Medical Staff in identifying competent physicians and Allied
   Health staff through the initial credentialing and recredentialing and quality profiling
   process.
 Provide support for medical staff leadership and most medical staff department and
   committee meetings and disseminate service call schedules.

Offices are located on A-Level in Administration. Hours of operation are Monday through
Friday 7:00AM- 5:00PM.
Main Office line – 585-2221         Fax Number – 585-3293

Contacts:

Medical Staff Services:
 Lisa Hunt, CPMSM, CPCS, Manager Medical Staff Services – 513-585-0406;
  lisa.hunt@thehristhospital.com
 Sally Cohen, Medical Staff/Policy Coordinator – 513-585-1159 ;
  sally.cohen@thechristhospital.com
 Angel Heard – Credentialing Specialist – 513-585-4093;
  angel.heard@thechristhospital.com
 Barbara Skinner, CPMSM, CPCS, Credentialing Specialist – 513-585-2527;
  barb.skinner@thechristhospital.com
 Hyla Goddard, Office Coordinator – 513-585-2717; hyla.goddard@thechristhospital.com

CPOE:
   Donna Dykes, R.N., M.S.N., CPOE Clinical Coordinator TCH - 513-585-2250/
    donna.dykes@thechristhospital.com

Institutional Review Board:
 Robert Strub, M.D., Chair, TCH Institutional Review Board
 Becky Riddle, IRB Regulatory Specialist, TCH Institutional Review Board
 Erica Jones, Administrative Coordinator, TCH Institutional Review Board

Graduate Medical Education:
    Glenda Overton, Administrative Coordinator, Graduate Medical Education




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                                    TABLE OF CONTENTS


1. Medical Staff Services…………………………………………… ...1
2. Medical Staff……………………………………………………… ..3
3. Administration………………………………………………………4
4. Anesthesiology/ PACU…………………………………………. .....4
5. Breast Center………………………………………………………. .4
6. Cancer Center…………………………………………………….....5
7. Cath Lab………………………………………………………… .....5
8. Central Service…………………………………………………….. .5
9. Clinical Engineering……………………………………………….. 6
10. Committees………………………………………………………… 6
11. Dictation Booths………………………………….…………………7
12. Disaster Program……………………………………..………..…… 7
13. Educational Services…………………………………..…………… 7
14. EEG………………………………….……………………………... 8
15. Emergency Services……………………………………………… ...8
16. Endoscopy………………………………………………………… ..8
17. Environmental Services…………………………………………… .9
18. Food and Nutrition…………………………………………………. 9
19. Heart Station………………………………………………………. .9
20. Intravenous Therapy………………………………………………. .9
21. Laboratory Services………………………………………………. ..10
22. Lockers…………………………………………………………… ...10
23. Medical Library……………………………………………………. 10
24. Medical Records…………………………………………………… 10
25. Pastoral Services…………………………………………………… 11
26. Patient Relations………………………………………………… ....11
27. Physician Dining Room…………………………… .........................11
28. Physician Parking and Access………………………………………11
29. Public Relations and Marketing……………………………………. 12
30. Quality and Utilization Review……………………………………. 12
31. Scheduling Medical Admissions……………………………………13
32. Scheduling Surgical Cases…………………………………………. 13
33. Scheduleease……………………………………………………… ..13
34. Social Functions……………………………………………………. 13
35. Social Work…………………………………………………………14

       MEDICAL STAFF

     The Medical Staff of The Christ Hospital is authorized by the Board of Trustees
     to be self-governed and to organize themselves in conformity with the Bylaws,



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Rules & Regulations approved by the Board of Trustees. The Medical Staff is
responsible for the quality of medical care in the hospital and accepts and
assumes this responsibility subject to the ultimate authority of the Board of
Trustees.

All members of the Staff are responsible to their respective departments on all
matters of professional practice and patient care, as well as on administrative
matters of general concern to their specialties or to the Staff as a whole.

The Staff elects officers of the Staff biennially. The President of Medical Staff
serves as chief executive officer of the Staff. The president-elect assumes the
powers of the President in his absence and automatically succeeds to the
presidency during the next term of office. The Secretary-Treasurer is
responsible for making and preserving the records of the Staff.

The Medical Executive Committee of the Medical Staff serves as the principal
medical policy development and control body of the hospital and is chaired by
the President of the Medical Staff. The work of the medical staff is
accomplished primarily through medical staff committees, all of which report to
the Medical Executive Committee.




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ADMINISTRATION

The Christ Hospital’s Administrative staff is led by Susan Croushore, President and CEO.

Other key Administrative officers include:
Heather Adkins, Vice President, Marking and Community Relations
Victor DiPilla, Vice President, Operations
Berc Gawne, Vice President, Medical Affairs/Chief Medical Officer
Debbie Hayes, R.N., M.S., Vice President and Chief Nursing Officer
John Renner, Vice President of Finance
Rick Tolson, Vice President, Human Resource

Administration staff offices are located near the physician’s entrance on A-Level. Each
department director in the hospital reports to an administrative representative.

ANESTHESIOLOGY/ PACU

The Department of Anesthesiology is a team comprised of board-certified
Anesthesiologists, Certified Registered Nurse Anesthetists, Anesthesiologist’s Assistants,
and support staff responsible for providing all anesthesia services in The Christ Hospital.
In addition to general anesthesia, regional anesthesia and intravenous sedation, the
department also provides acute and chronic pain management services. In house
anesthesia coverage by a physician and an anesthetist care team is available 24 hours a
day. Anesthesia consultations can be obtained or Anesthesiologists can be reached to
answer questions by calling 585-2482.

The main PACU (Post Anesthesia Care Unit), located on B-Level, is a 30-bed unit with
one isolation room. Regular hours of operation are Monday through Friday 7a.m. to 12
midnights: Saturday 8 a.m. to 4 p.m. All down time is covered by staff on-call, making
post anesthesia care available 24 hours per day, seven days per week. The PACU phone
number is 585-2341.

BREAST CENTER

The Christ Hospital Breast Center is located in the Medical Office Building, Suite 324.
The center offers complete breast screening, as well as diagnostic services which include
ultrasound, cyst aspiration, needle localization, stereotactic core biopsy and follow-up
exams. All screening mammograms must have a physician to whom a report is sent. All
Diagnostic exams must have a physician’s prescription.

Comprehensive care is provided by a group of board-certified radiologists and certified
mammographers. The most up-to-date diagnostic equipment is used to detect breast
disease. The Breast Center is accredited through the American College of Radiology and
certified through the FDA, ensuring high-quality mammography.




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CANCER CENTER

The Cancer Center is located on D-Level of the hospital, and is operational Monday
through Friday, 8 a.m. to 6 p.m. The Cancer Center is made up of the departments of
Radiation Oncology, Medical Oncology, Cancer Research and the Oncology Registry. It
provides medical consultation services and medical nursing interventions for radiation
and medical oncology patients. The Center participates in the total oncology program of
the hospital and community, which includes programs for cancer detection, diagnosis,
research, treatment, rehabilitation and follow-up. Staffing is provided by certified
oncology registered nurses, certified radiation therapists, medical physicists, dosimetrists,
research data managers, orderlies, trancriptionists and secretaries. All scheduling is
coordinated by the Cancer Center at 585-2323.

CATH LAB

The Cardiac Cath Lab consists of five bi-plane labs. Approximately 30 cardiologists
perform approximately 5, 000 invasive procedures per year. Approximately one-third of
these are angioplasties. Routine cardiac angiograms, angioplasties, atherectomy, laser
and stents are performed in the labs, as well as peripheral interventional procedures, and
many investigational studies.

The Cath Lab operates Monday through Friday from 7 a.m. to 7:30 p.m. After 7:30 p.m.
weekdays and all day on weekends and holidays, cath lab personnel are on call to respond
to the hospital for emergency procedures within 30 minutes after receiving the page.

The Cardiology Department also has two Electrophysiology Labs that operate from
7a.m.to 5:30 p.m., Monday through Friday. Three cardiologists perform approximately
700 procedures per year. Electrophysiology studies, follow-up electrophysiology studies,
ablations, tilts, cardioversion and permanent pacemaker insertions are performed.

The majority of the staff is critical care cardiovascular nurses. The Patient Care Manager
can be reached at 585-0475. ScheduleEase, 585-2668, schedules cases Monday through
Saturday, 8:30a.m. To 6:00p.m.

CENTRAL SERVICES

Most patient care supplies; treatment trays and special patient care equipment are
supplied to nursing units and specialty areas by the Central Services Department.
Sterilization by steam or ETO for all areas is done in Central Services.

Supplies and equipment from this department are for inpatients or registered outpatients,
if approved. Items or supplies from this department are not available to employees,
house staff or medical staff.




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Central Services operates two case cart systems, one for 8-North Gynecology Surgery
and the other for B-Level O.R. All instruments and sterile disposable supplies are
inventoried and supplied by Central Services.

CLINICAL ENGINEERING DEPARTMENT

The Clinical Engineering Department is located on 4-North (West section) and can be
reached by phone at Ext. 52319. The director’s office is on 4-North (East section). The
X-ray service is based out of C-Level in the X-ray Department, and Hemodialysis service
is located within the Hemodialysis Department on 1-West. The department’s regular
hours are 8:00a.m. To 4:30 p.m., Monday through Friday. After 4:30p.m. and on
weekends, the Clinical Engineering person on call can be reached for service by calling
the operator.
The Christ Hospital recognizes the importance of providing both properly functioning
medical devices and the technical support to assist in the proper purchase, application and
implementation of these devices. The Clinical engineering Department has overall
responsibility for coordination and/or providing services for the hospital. However, all
employees in the hospital are responsible for using equipment properly and safely, and
for reporting problems to the appropriate person.

To report improperly functioning devices in a nursing area, contact the head nurse or
charge nurse. In other departments, contact the department head, supervisor or person in
charge. A written Service Request Form is required. Verbal requests for services
requiring immediate attention can be made by calling the Clinical Engineering
Department person in charge directly (Ext. 52319).

Questions concerning the proper operation, technical aspects or limitations of devices can
be directed to the technician responsible for your area, assistant director or director of
Clinical Engineering. In-services for specific devices and equipment safety topics (e.g.,
electrical safety) can be arranged upon request.

STANDING COMMITTEES

The staff has the following standing committees

         Behavioral Collaborative Clinical Committee
         Blood Transfusion Committee
         Cancer Collaborative Clinical Committee
         Continuing Medical Education Subcommittee
         Credentials Committee
         Department Directors
         Endoscopy Committee
         Graduate Medical Education Committee
         Heart Collaborative Clinical Committee
         Infection Control Committee
         Institutional Review Board



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         Internal Medicine Collaborative Clinical Committee
         Medical Ethics Committee
         Medical Records Committee
         Pharmacy & Therapeutics Committee
         Renal Collaborative Clinical Committee
         Surgical Collaborative Clinical Committee
         Women & Newborn Collaborative Clinical Committee

DICTATION BOOTHS

Dictation booths are located in the surgeon’s lounge off the locker room, directly above
the OR via a dedicated hallway, in Medical Records located adjacent to the Physicians
lounge and on all Nursing units. Please refer to the separate section on Alliance
Transcription for details.

DISASTER PROGRAM

As a part of the Hamilton County Disaster Network, The Christ Hospital has a two-way
radio in the emergency department. The radio is tied into a disaster network, which
includes all hospitals. Hamilton County Civil Defense, Red Cross, Academy of Medicine,
Cincinnati Police Department and Hamilton County Sheriff’s Department. Medical
control center, located at University Hospital, is the coordinator in a disaster. As a
member of the staff, you will be assigned specific months for coverage on the disaster
call schedule.

EDUCATIONAL SERVICES DEPARTMENT

The Educational Services Department provides a variety of educational support services.
The department located on A-West, is open Monday through Friday, 7am to 4pm.

Audiovisual Equipment

Classrooms 1-9 are equipped with 35 mm slide projectors and overheads. Classrooms
4,5,6 and 8 are equipped with ½” VCR’s. Obtain keys form the Educational Services
Office. Equipment not ordinarily located in the classroom must be reserved ahead of
time. Equipment must be picked up (signed out) and returned (signed in) in Video
Production. If unfamiliar with the equipment, request a time for instruction prior to the
meeting or program date.

Classrooms

To schedule a classroom, use the Classroom and AV Scheduling Form, stating the time,
date, group size and title of program or meeting. This form should be sent to Educational
Services. Special room set-ups are identified on the scheduling form. Equipment
requests should be made at the time of scheduling a classroom. If there is a change in a
room already scheduled, please call 585-2366. In order to assure room availability,



                                             7
immediate notification (at least two weeks prior to the event) is required. If there are any
questions, call 585-2366 to schedule an appointment to discuss program needs.

CME

Educational Services participates in the planning and coordinating of physician CME
conferences, in the support of CME Category I programming and in maintaining records
of physician Category I attendance. It is important that each physician signs his/her name
clearly and identifies his/her hospital number in order to receive credit for the program
attended.

Photography

Educational Services staff in Video Production may prepare slides for Hospital
Educational Programs. A minimum of three workdays is necessary to commercially
process film. Material should be camera ready. Please complete the Slide Request Form.
A minimum of three workdays is required to process Polaroid computer-generated slides
form the floppy disk brought to Educational Services. Complete the Slide Processing
Form for either type of slides. Please note that Educational Services does not type slide
information onto disks.

EEG (Electroencephalography)

The EEG department is located on 5-North. It is a two-bed multi-purpose Electro
diagnostic Laboratory, which provides testing to inpatients and outpatients in a timely
and cost efficient manner. The Lab is staffed Monday through Friday, form 7:00a.m. To
3:00p.m. Inpatient tests are scheduled by a written order and patient care secretaries will
input to the computer system. Tests are read by a neurology staff physician and results
mailed within a few days. An oral report can be obtained at least 48 hours after the test
by calling 585-2378. To schedule a patient for a test, call ScheduleEase at 585-2668.

EMERGENCY SERVICES

The Emergency Services Department is located on C-Level. It is open and staffed 24
hours a day, 365 days a year.

ENDOSCOPY

The Endoscopy Department is located in the Courtyard Atrium area on Lobby-level, next
to the Ambulatory Services Department. The unit includes a prep area, six procedure
rooms and recovery area, designed to provide an optimal environment for patients
receiving intravenous sedation. The department is equipped with multiple endoscopic
video systems, including portable fiberoptic video equipment used when performing
endoscopy procedures outside of the department. The Endoscopy Department operates
Monday through Saturday, 7a.m. to 4:00 p.m., with on-call coverage for emergencies;
ScheduleEase does Scheduling of endoscopy procedures at 585-2668.



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    ENVIRONMENTAL SERVICES

    Environmental Services is responsible for the cleanliness and sanitation of the hospital.
    This is accomplished by operating on a 24-hour basis, and includes patient room
    cleaning, offices and auxiliary areas. Environmental Services is also responsible for the
    upkeep of the grounds and garages and the areas surrounding the hospital. Housekeeping
    emergencies can be reported by contacting 585-3031

    FOOD AND NUTRITION SERVICES DEPARTMENT

    The primary objective of Food & nutrition is to provide the best nutrition care possible to
    all patients within the framework of available resources and budget constraints. Three
    well-balanced meals are offered daily. Patients choose from a selective menu. The
    dietitian may give supplemental feedings to the patient upon a physician’s order or
    recommendation.

    Diet Orders: The Cincinnati Diet Manual is the reference source used by The Christ
    Hospital as well as most other Cincinnati health care facilities. The manual is available
    in all nursing units for use by the staff. All patients MUST have a diet order written with
    the admission orders. Should you have any problems ordering a specific diet, please page
    the Registered Dietitian (R.D.) on staff.

    Nutrition Consult Services: An R.D. is available for consultation Monday through Friday,
    from 7:30 a.m. to 5:30 p.m., for any nutrition-related problem. On weekends, one R.D. is
    available for consults throughout the hospital.

    HEART STATION

    The Heart Station is located in the Courtyard Atrium on C-Level and provides a variety
    of non-invasive cardiac procedures.

    The Heart Station is staffed by board certified cardiologists and registered cardiac
    sonographers. Cardiologists on staff are invited to administer GXT’s and interpret
    Echo’s for their own patients. Dictated interpretations for ECG’s, SA ECG and Echo’s
    are available for review in the Lanier system. The work type for ECG’s in Lanier is “12”
    and for SA ECG’s and Echo’s is “13”. Questions and concerns may be directed to the
    Heart Station Manager at 585-1455.

    INTRAVENOUS THERAPY DEPARTMENT

    The intravenous Therapy Department is located on 4-North and provides 24-hour
    coverage. The IV Therapy provides the following services.
       -     Hangs all blood and blood components on all floors except ICU, ER, PACU,
             Endoscopy, Cancer Center and O.R.
-   Hangs all TPN’s throughout the hospital. Changes tubing on TPN every 24 hours.



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-   Changes all central line dressings except on ICU’s (unless on TPN) and 4-West.
-   Places all PICC’s and Midlines.
-   Responds to all codes.
-   Accesses portacath, passports and cathlinks.
-   Urokinase lines except in ICU.
-   Regitine Dopamine infiltrates.
-   Removes and cultures central lines per Epidemiology standards, except in ICU’s
-   Serves as back up for the floor nurses.
-   Accesses dialysis lines when dialysis unable.
-   Performs therapeutic blood draws (phlebotomies) on in-house patients.

    LABORATORY SERVICES

    The Health Alliance Laboratory Services blends the laboratory services of Christ,
    University, and St. Luke and Jewish Hospitals to form a full-service clinical reference
    laboratory. Each Alliance hospital has an Immediate Response Lab (IRL) for tests
    requiring a turn-around of less than three hours, in addition to tests best conducted in
    close proximity to patients.

    The Christ Hospital IRL is located on C-South. Anatomic Pathology can be reached at
    585-1111 and Cytology at 585-1114. Both are located on B-South.

    LOCKERS

    Lockers can be obtained by calling the OR control desk at 585-2345.

    MEDICAL LIBRARY

    The Christ Hospital has a library for the use of its Medical Staff. The library is located
    on 1 North of the Hospital. Its hours of operation are 8:30am to 7:00pm Monday –
    Thursday, 8:30am to 5:00pm Friday and Saturday 12pm to 4:00p.m. The library has no
    weekend hours. Medline, Cancerline and AIDS line services are available in the library.
    Call 585-2737 for assistance.

    MEDICAL RECORDS

    Medical Records located on A South. The department is staffed 24 hours a day seven
    days a week for medical record retrieval. The office is open 7am to 7pm., Monday
    through Friday and 7am to 3:30pm.on Saturday. You can reach Medical Records by
    calling 585-2354.


    PASTORAL SERVICES

    A chaplain is available 24 hours a day, seven days a week, A chaplain may be reached
    through the Department of Pastoral Services at 585-2265, Monday through Friday, from



                                                10
8:30am until 5:00pm. The chaplain on call may be reached on Saturdays, Sundays and
during the evening and night hours by contacting the operator.

Staff chaplains at TCH have received clinical training and are available to minister to
patients and families in a variety of ways; i.e., traditional sacramental role (baptisms,
communions, anointing, worship), crisis intervention and general counseling.

PATIENT RELATIONS

The role of the department is to oversee the patient satisfaction and associate recognition
processes for the hospital.

The department serves as the patient advocates for the hospital. Part of that process is
overseeing the client advocate process for behavioral medicine patients. The department
collects, tracks and forwards appropriately patient feedback that is received by calls to the
patient satisfaction line (585-2100), letters to the senior vice president or during requests
to meet with patients and or visitors to discuss concerns. Patient satisfaction data is
reported to department managers on a quarterly basis and in hospital collaborative
clinical committees on a semi annual basis. The department initiates the hospital process
for physician practice complaints when such a request is made from a patient.

ASSOCIATE RECOGNITION

The Patient Relations department is responsible for the Associate of the Month program
as well as recognizing departments for their patient satisfaction scores.

PHYSICIAN DINING ROOM

The physicians’ dining room, adjacent to the cafeteria, is open 11:00am to 1:30pm
weekdays for lunch. If you prefer, you may sign the charge ticket, and the hospital will
bill your office monthly.

PHYSICIANS PARKING AND ACCESS

Parking decals are required and are available form the Medical Staff Services Office,
585-2221. Enter the garage and park on Level P, which is reserved for physician parking.

Use physician’s entrance to access the medical office buildings and the hospital.

When the hospital or medical office building is locked, your identification card, assigned
by the Safety and Security Department located on 7 North, will permit you to use the
physicians’ entrance from Level A of the garage. You can enter the doctors’ surgical
dressing room on Level A by using your access card.

The physician’s lounge, medical staff office, surgeon’s lounge, locker room,
administrative offices, physicians’ dining room and Nippert Educational Center are all



                                             11
located on Level A.

PUBLIC RELATIONS AND MARKETING

The Christ Hospital public relations and marketing departments serve as the keeper of the
hospital’s image as Cincinnati’s leading hospital. As part of this purpose, the department
serves as communicator to and advocate of the hospital’s internal and external
publication.

Publications include The Examiner, a periodic newsletter for medical staff, as well as
other publications for employees, patients and visitors.

The Examiner is a periodic newsletter with information about the hospital’s policy and
procedures, managed care, physician activities and regulations that affect our physicians.
All members of the medical staff receive this publication.

Media relations for the entire hospital are coordinated by Public Relations. If you are
planning a project, procedure or event at The Christ Hospital that may interest the news
media (or the hospital staff), please call Public Relations at when you begin planning so
we can coordinate the release of information.

If you are working with the media on a story for your private practice and filming or
photography is to be done at the hospital, please contact Public Relations to make
arrangements.

If you have any questions, please call 585-8082. Heather DeWeese is the Director of
Public Relations and Marketing for The Christ Hospital. She can be reached at 585-8086.

QUALITY AND UTILIZATION REVIEW

The QUR Department is located on 6 West of the hospital. It’s primary function is to
provide staff support for the medical staff component of the hospital’s Performance
Improvement Program. The responsibilities include concurrent and retrospective review
of patient medical records for quality and appropriateness issues; coordination of medical
staff peer review; data collection and analysis for quality-related studies; communication
and documentation of peer review findings and quality studies; and consultation to
medical staff on JCAHO, Peer Review Organization and insurance requirements.
Additionally, the department provides consultation to hospital departments on the
aforementioned issues. Hours of operation are Monday through Friday, 7:30am to
4:00pm. The phone number is 585-2447.



SCHEDULING MEDICAL ADMISSION




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The Admitting Department is located on C Level in the Courtyard Atrium. To schedule a
medical admission, call Bed Booking at 585-2291. Booking coordinates admissions of
all types and bed placement with nursing units. Booking is available 24 hours per day,
seven days per week.

SCHEDULING SURGICAL CASES

Cases are scheduled up to 90 days in advance through the Surgical Booking Office at
585-2727. Their hours are weekdays, 8:30a.m. To 5:00p.m. We have open OR times as
well as a block-scheduling system based on utilization.

Emergency Cases

Emergency and add on cases that need to be done that day are scheduled through the
operating room control desk at 585-2345. Emergency GU cases are scheduled by calling
the GU department at 585-2308, Monday through Friday 8:00a.m to 3:30p.m.

SCHEDULEEASE

ScheduleEase is located in the Admitting Department on C-Level, and operates Monday
through Friday, 8:30am to 6pm, and Saturday from 9am to 1pm. This area allows a
physician office to schedule all procedures for its patient with one phone call. The
purpose of ScheduleEase is to coordinate exams on patients in the most service oriented
way possible. ScheduleEase personnel will call all professional services departments that
perform the testing needed for a patient and will plan the patient’s schedule as
conveniently as possible for the patient. Prior to services being rendered, outpatients will
be registered by admitting to reduce the registration time when the patient arrives the day
of the scheduled exam(s). ScheduleEase schedules outpatients for procedures in the
following departments: Breast Center, Diagnostic Radiology, Dietary Counseling, EEG,
Endoscopy, Heart Station, Nuclear medicine, Pulmonary Function, Ultrasound, Vascular
Lab, EMG, Perinatal Center and Cath Lab, Angio. Orders can be faxed 24 hours per day
to 585-4452, and ScheduleEase will call the patient to set up testing.

STAFF SOCIAL FUNCTIONS

The medical staff hosts an annual dinner dance each fall for members of the staff and
their spouses.




SOCIAL WORK DEPARTMENT

The Social Work Department office is located in 7 North. Hours of operation are 8:30am
to 5:00pm Monday-Friday, 8am to 12 noon Saturday. A Social Worker is on call on
Saturday afternoon, Sundays and evening hours through the hospital operator.



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All modalities of psychosocial services are available including assessment, crisis
intervention, specialized discharge planning, abuse/neglect assessment/interventions;
domestic violence assessment/interventions, hospice evaluation/referral, address financial
issues, referrals to community resources, patient/family conflict resolution, psychosocial
counseling and bereavement counseling, etc.




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