McLennan County Medical Society

McLennan County Medicine 1866-2016 Celebrating 150 Years

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Table of ContentsOn Our Cover 2 150 Years Of Waco Medicine 3 A Message From TheThe Texas Medical Associationmeeting in Waco in front of the MCMS Immediate Past PresidentMcLennan County Courthouse, 4 How To Make The Most Of Your Doctor’s VisitMay 13-15, 1919. 6 Waco’s Medical Residency McLennan County Medicine A recent graduate physician’s perspective on residency & medical care in Waco 1866-2016 7 Preparing For The Cold & Flu Season Celebrating 150 Years 9 Vaccinations 10 Know Your Medication 11 To Screen Or Not To Screen An update on prevention 13 The Family Health Center What a community can do when it works together 15 Member Directorywww.facebook.com/McLennan-County-Medical-Society P.O. Box 7658www.mclennancountymedicine.org Waco, TX 76714 7543 Bosque Blvd., Suite EE Waco, TX 76712 Phone (254) 776-2882 Fax (254) 776-4667

By Tim Martindale, MD McLennan County Medical Society President150 years ago on April 30, 1866, ten physicians met in a drugstore and formed the Waco MedicalAssociation. It was ten years after the City of Waco incorporated, the year after the Civil War ended, theyear before construction began on the Suspension Bridge.The McLennan County Medical Society is celebrating this Fort House Museum Exhibit: MCMS has partnered with Historicmilestone in five main ways: Waco Foundation to develop an exhibit of artifacts, photos and memories and displayed from April to June. The opening wasProfiles of Waco Medicine: Past and Present is a weekly April 8, then a cocktail reception on April 30, the anniversary ofnewsletter written by board president Dr. Tim Martindale. Each the first meeting, and also a luncheon to be held later during theweek, there is information about county medical society events, exhibit.a unique story taken from somewhere in the past 150 years ofWaco Medicine, and a profile of a current physician talking about Historical Marker:  A permanent McLennan County historicalthe present and the future of Waco. The goal of the newsletter is marker was approved and will be placed at Heritage Square, andto heighten awareness of MCMS among physicians, to celebrate a dedication event will be held.the many heroes and events of medicine in Waco through theseyears, and to remind ourselves of the goals and values that drew 150th Anniversary Endowed Scholarships to MCC and Baylorus to medicine, and reinforce our unity and commitment to University: Most importantly, physician and community leadersmedical excellence, and care of the patient in our community. met as 2016 approached and decided we wanted a lasting legacy of education to commemorate this anniversary. So scholarshipsOral History Projects, in partnership with the Baylor Institute of have been formed and approved, to be awarded annually to pre-Oral History, have been developed by interviewing physicians med students at Baylor University, and to nursing students atresulting in audio and bound transcripts of memories of the past McLennan Community College. We are trying to raise “$150,000number of years and these physicians’ and spouses’ experiences. for the 150th”. This scholarship would not only provide supportFunding was provided by a grant from Cooper Foundation. for future medical professionals for the community, but there is aParticipating physicians/spouses included: Dr. Steven Corwin, commitment to mentor and be alongside these students in theirDr. Charles Gamble, Dr. Don Risinger, Dr. William Turney, Dr. training and their careers, hopefully to return to Waco, and serveRobert Angel and Mrs. Carol Crosthwait, and Mrs. Jane Scruggs alongside current medical providers here. We ask everyone inand Mrs. Kay Turney. There will be receptions revolving around Waco to consider supporting this initiative. If you would like tothese interviewees during the year, and the transcripts will be on donate to the scholarship, contact our executive directorthe websites of the Baylor Institute of Oral History, the McLennan JoAn Felton at (254) 776-2882 orCounty Medical Society, and will be broadcast by KWBU. admin@mclennancountymedicine.org.  2

A Message From TheMCMS Immediate Past-President By Sean DeLue, MD McLennan County Medical Society Immediate Past-PresidentIn 2015 I had the pleasure of presiding as President of the While I am proud of our efforts there are still some areas inMcLennan County Medical Society (MCMS), which is part of need of improvement. Overall, McLennan County ranks 131the Texas Medical Association. MCMS has over 450 physician out of 237 when health behaviors (i.e. smoking, diet andmembers who all serve our great county in the hopes of exercise), social and economic factors (i.e. poverty), and ourfurthering health and wellbeing. Recently the Robert Wood physical environment (i.e. parks and recreational activities) areJohnson Foundation released county health ranking and I considered. Though we have work to do in order to become athought that it would be helpful to inform others more healthy population, I look at our city withof their findings. “Through the days of hope. I know that we have local physicians and civil servants who are willing to put in the We are happy to announce that we ranked blessings and the days effort to raise our standings. The results of this23rd in clinical care out of 237 Texas counties. of pain they serve our study should hopefully give perspective onThat puts McLennan County ahead of the Texas friends and families our overall health, promote conversation andaverage, and well above the national average, eventually result in action.when it comes to parameters such as the number tirelessly.”of physicians and dentists per capita, mental health access, As one of the oldest county chapters of the TMA we will continuepreventable hospital admissions, and diabetic management. to serve our community to the best of our ability. This year weWorking in a multitude of outpatient clinics, two hospitals, and a turned 150 years old and have enjoyed the fun and festivitiesresidency I truly feel that this community of doctors has the heart associated with this occasion. Thank you McLennan County forof the healer. Through the days of blessings and the days of pain entrusting your lives to us.they serve our friends and families tirelessly. The next time yousee your doctor please feel free to express the effect that theyhave had on your life. 3

1. Know Your Information Insurance benefits: Nowadays, insurance companies are always changing benefits and rules. Know what your insurance will pay for, what your copay and deductibles are. Have your insurance information with you. Sometimes also your employer has special benefits such as wellness physicals and forms it helps to know about. It is a hassle to keep up with this, but the front office staff and your doctor can use your information to get you the most service for your dollar, and avoid later uncovered bills, or at least know about them so you have a choice.How To Make The Most “...make the most of your time,Of Your Doctor’s Visit and you, the office staff and the physician will all haveBy Tim Martindale, MD a better experience. “Family Medicine Medicines: Have either a carefulA visit to a physician can be a difficult thing. You must call and accurate list with all details, or the actualgo through the process of making an appointment, collect your bottles with you. This avoids medicineinformation, get time off from your job or arrange babysitting, errors, dangerous interactions, frustratingget there early and fill out paperwork, pay your co-pay, wait until wrong refills, noncompliance with diseaseyou are called, go through a check-in process and then meet with management. Have the info necessary ifthe doctor. The whole experience can be intimidating, daunting, your insurance requires meds to be filledexhausting or exasperating. Or it can be warm and friendly, relaxed through mail order. Know if you can getand productive, and you can leave with your goals accomplished. 90 day supplies. If you can, bring yourThe difference can be preparation. Here is a physician’s perspective insurance’s drug formulary with you inon how you can prepare to have the best doctor’s visit possible. case you need to change medicines due to side effects, interactions, or cost. This 4 can save you many extra calls and delays. Medical history: Keep a card/paper with lists of medical issues (asthma, hypertension, diabetes, cholesterol, serious injuries, etc.), surgeries (tonsils, appendix, gallbladder, hernia, hysterectomy, c-sections and deliveries, etc.), procedures (colonoscopy, bone

density, mammogram, heart studies, provider walks in to an exam room first schedule the visit, when you areetc.), family history (heart conditions, where someone has waited a long time, checked in by the nursing staff, andcancers, strokes, diabetes, etc.). Include they know they feel disrespected and when the doctor comes in the room,dates/years on surgeries and procedures neglected, and they feel bad. They all three times mention what you hopewhen possible. Mention if you smoke know they took time off work, arranged happens in the visit. Is it an acute illness,(government rules require we ask). The babysitting and rides, have other is it a general review of several medicalnursing staff can get this updated in appointments. conditions, do you need to do/reviewyour chart, and the doctor can review it labs and tests, is it an employer-benefitas well. This can save a lot of time and It is rare that waiting times happen wellness check, is it an annual physicalerrors, and get you better care. due to anyone on the medical team paid for by insurance, do you have goofing off. But when the emergency forms that need to be filled out, do you Home monitoring: If you have high room calls about a patient in need, have refills you need done, do you needblood pressure, bring some readings; if when someone says they’re here for approval for medical equipment ordiabetes, logs of sugars; if migraines, a allergies, but couldn’t say their life was services? Many times people get to whatheadache diary. This will help the doctor falling apart, when a mom brings in her seems to be the end of the visit, and theyhelp you greatly. sick child and is sick herself, when a haven’t gotten what they needed most. provider has to tell someone they have Also, sometimes you made the visit for Labs: If possible, have necessary a life-changing medical condition and something simple, then accumulate a listlabwork done before your visit, so that take time to explain thoroughly, when of other things you had wanted to talkthe labs are there for you to review with someone thinks a symptom is a small about sometime, but this might not bethe physician at the visit. This is always a thing and it’s a major problem, when a possible to accomplish in the timelot easier than explaining results over teenager needs time to talk about hard planned, and another appointment mightthe phone, though sometimes you don’t life questions or life goals, it just doesn’t need to be made.know what labs you’ll need till you talk, fit in the schedule and waits happen.or insurance requires labs on day of visit, But be aware that your medical team will 4. Plan To Pay Your Part Of The Billor some labs take longer to come back. work to give you that same compassion At The VisitNow many insurances are charging and kindness and thoroughness, all while This means you need to know yourdeductibles on labs, so it may be working to keep waits to a minimum.important to talk first with your doc what benefits, deductibles and responsibilities,labs are really necessary and how often. If Usually the least waits are the first but it’s always so much easier forthe labs require significant discussion, it of the morning and afternoon, and waits everyone if you pay at the visit. You knowmight be better to come in for a second are worse on Mondays and Fridays. the value you just received, so you feelvisit for a thorough, clear review and good about paying (later it’s just anotherplan. 3. Talk To Your Doctor About bill); you can ask about the bill right then Your Expectations (letters and bills that come later are often2. Be Willing And Relaxed About Doctor-patient relationship: Each either confusing or are neglected); it Forms And Waiting costs medical offices a lot of money to Forms: Ok, every single person in physician has their own style and pay billing services and collection agents characteristics, but so does each to pursue the money, and it’s not nearthe medical office hates these as much as physician-patient relationship. Talk as friendly as paying in person at time ofyou do. But insurance and government about the way you like to work with your service. If you come to your next officeand electronic records are constantly physician. Do you prefer your provider to visit, and there is an outstanding bill,changing them, and grading medical be a partners with you in your health, to it’s frustrating, confusing and annoying,providers on quality based on them educate you and then make the decision when you just need medical help, andbeing up to date and accurate. Even if together, or do you prefer them to “just a previous bill, deductible, or copayyou’re in for a rash, and were at the office tell you what to do”? Do you like them becomes an issue. But if you don’t pay forthree months ago, there may be updated to be thorough and review anything the service theyforms. Changing electronic medical else patients want if time allows, or just provide, medical offices can’t pay theirrecords, and changing government and take care of the main concern quickly staff, rent, utilities, insurances, medicalinsurance requirements complicate the and go on with your day? Do you prefer supply bills, lab and equipment bills, ordelivery of medical care greatly, and are a supportive and gentle style, or a swift lastly the provider’s salary.a constant challenge, slowdown and kick and some stern warnings? If you tellfrustration for all medical offices. Try to and remind your provider of what you So consider taking a little time andbe patient and willing with them. hope for and expect, they will be able to prepare for your next visit. You will be tailor their communication and time to healthier, make the most of your time, Waiting: Here’s the other thing your need. and you, the office staff and the physicianmedical offices dislike as much as you do. will all have a better experience.We know your time is important, your life Today’s visit expectation: This is aand schedule are full, your children are major way you can help avoid waits, andrestless and impatient. When a medical make sure your needs are met. When you 5

Waco’s Medical Residency A Recent Graduate Physician’s Perspective on Residency and Medical Care in Waco. By William McCunniff, MD Family PhysicianEvery summer across the United States, a new cohort of physicians full-scope family medicine training and attracts applicants from acrossgraduates from hundreds of residency programs and enters into the the country. Most of the clinical experience occurs at the Familyworkforce. Some people are surprised to learn that Waco is home to Health Center, while hospital-based care takes place at Hillcrest andone of the premier family medicine residency training programs in the Providence hospitals. At both hospitals, the residents work alongsidecountry. With enthusiasm, excitement, and a sense of relief, twelve some of the finest physicians in Texas for month long rotations in almostfamily medicine residents graduate from Waco’s program each June. all of the medical specialties. The residency program offers a fellowshipHaving completed a long and arduous road, we cherish the opportunity in Sports Medicine and an international medicine track which enablesand privilege to care for our fellowman. residents to serve overseas on a missional basis. Additionally, twenty family medicine, OBGYN and pediatric trained faculty membersThe road to completion includes four years of college, followed in provide valuable instruction and teaching on a daily basis whichsuccession by four more years of medical education. Texas currently provides even more unique exposure to hospice, psychology, nursinghas 9 medical schools with plans for home care, dermatological procedures, andmore in order to help meet the demand “Having completed a long and business management. Over the last two years,for medical care in future years. Medical arduous road, we cherish the ten graduates have decided to remain in Wacoschool graduates then go through an and establish practices in our area. There areadditional selection process in order to opportunity and privilege to countless more graduates already established inbe matched into medical residencies at care for our fellowman.” our community, and there is a good chance youprograms around the country. These may be seeing a Waco trained physician already!programs vary in length between threeand six years with some even pursuing fellowships upon completion Entering the healthcare field at such a tumultuous period inof residency. history provides limitless opportunities for growth among new and experienced physicians in Waco and all across the country. NeverEach training program differs in regards to medical specialty and before has technology played such a pivotal role in patient access,includes pediatrics, internal medicine, family medicine, obstetrics communication between hospitals and specialists, and overall patientand gynecology, surgery and multiple surgical subspecialties, care. The capabilities to heal are at an all time high with new therapeuticpsychiatry, emergency medicine, sports medicine, infectious disease, options being developed by the day. As a new family medicinecardiology, gastroenterology, neurology, dermatology, otolaryngology, physician entering the healthcare landscape in Waco, I do not takepulmonology, neonatology, gerontology, rheumatology and several for granted the chance to work alongside some of the finest patients,more focused fields. nurses, specialists and primary care physicians in Texas and across the country. Waco is teeming with an incredible amount of quality primaryResidency training in Waco is unique in that the only program in the and specialty care, and it is an honor and privilege to assist in providingcity is the Waco Family Medicine Residency Program, which offers exceptional care to our community for years to come. 6

Preparing For Cold THE “COMMON COLD”and Flu Season 1. CAUSE – Various viruses with an incubation period around 1-2 weeks. By Charles H. Stern, MD 2. TRANSMISSION – person to person by Family Physician airborne virus containing droplets from sneezing or coughing.AS WE APPROACH THE FALL AND WINTER months it is notunusual for many of us to experience symptoms such as nasal 3. PREVENTION – Frequent hand washing.congestion, sore throat or cough. These symptoms are common Covering of one’s nose and mouth whento a number of illnesses. Fortunately, many of these ailments can sneezing or coughing. Reducing exposurebe managed by the patient without seeing the doctor or coming to to infected individuals.the office. I have composed the following educational informationto aid you in the knowledge of diseases and promotion of better 4. SYMPTOMS – Fatigue, fever, sneezing,health. congestion, sore throat and cough.THE REALITY – Ninety percent of acute respiratory infectionsare caused by viruses. Viruses DO NOT respond to antibiotics. Respiratory symptoms will typically lastYet 60 to 80% of patients who seek care for an acute respiratory around 7-10 days.illness in the U.S. leave the doctor’s office with a prescription forantibiotics. No one likes to be sick and we all yearn for a quick fix to 5. TREATMENT – All symptomaticfeel better. Doctors and patients need to work together to come up treatment (prescription or over thewith evidenced based treatment plans that reduce the inappropriate counter) relieves congestion and coughoveruse of antibiotics. symptoms 50% of the time according to scientific studies. Avoid the use of cold and cough products in children under age 6. Take all medications as directed and review all warnings prior to taking. Congestion – Decongestants - avoid if you have heart disease, high blood pressure or prostate disease. Expectorants. Saline nasal irrigations 2-4 times a day. Fever – Acetaminophen and/or Ibuprofen. Cough – Benzonatate Perles, Buckwheat Honey. Inhalers if the patient has wheezing. “Ninety percent of acute respiratory infections are caused by viruses. Viruses DO NOT respond to antibiotics.”7

Narcotic containing cough syrups should SINUSITIS – “SINUS INFECTION” When To Call Thebe avoided. 1. CAUSE – Viruses. Allergies (usually Doctor’s Office with itching of the eyes, nose or throat). For Advice Or AnGeneral –Bed rest and push fluids. Appointment Bacteria (usually after 10 days ofTHE “FLU” – INFLUENZA symptoms). Recurring fever - 101 degrees orally1. CAUSE – Influenza viruses (September after a period of feeling better duringto March). Incubation 1-2 weeks. 2. SYMPTOMS – Nasal congestion, sinus a respiratory illness. pain and pressure in the cheeks, upper2. TRANSMISSION – Same as the teeth or forehead. Abrupt onset fever and chills.common cold. Excellent studies have shown that Wheezing or shortness of breath.3. PREVENTION – Influenza vaccines discolored nasal discharge (e.g. green or[injectable or nasal (age restriction)] are yellow) is not an indication of a bacterial Pleurisy – pain in your chest whenthe best. Same hygienic measures as sinus infection unless the patient has had taking in a deep breath.mentioned above. symptoms 10 or more days. Severe sore throat or ear pain.4. SYMPTOMS – Same as with the 3. PREVENTION/TREATMENT –common cold, but patients usually Frequent saline nasal irrigations Cough lasting more than 3 weeksexperience high fever and chills for 3-5 (2-5 times a day). Nasal cortisone and not responding to regulardays and significant body aches. The sprays prior to and through peak symptomatic treatment.“flu” typically lasts 10-14 days. allergy seasons. Decongestants and expectorants. Sinus pain and congestion lasting5. TREATMENT – Symptomatic treatment more than 10 days and notis the same as for the common cold. Antibiotics are a consideration when responding to regular symptomaticAntiviral medications are available but patients have had sinusitis symptoms for treatment.must be started within 48 hours of the 10 days or more.onset of symptoms to have a possible Symptoms acutely worsen after a 2 tobenefit. The CDC provides doctors Even then scientific studies have shown 3 day period of improvement.prescribing guidelines for these products. near equal patient relief from saline nasal irrigations plus decongestants compared Patients with chronic lung disease,BRONCHITIS – “CHEST COLD” to saline nasal irrigations plus a course of asthma, COPD, chronic bronchitis.1. CAUSE – Mostly viruses (90%). Rarely antibiotics.bacterial (e.g. Pertussis – “whooping Patients who arecough”). STREP. THROAT immunocompromised or taking 1. CAUSE – Bacteria – Strep. Pyogenes. immune suppressing medications.2. TRANSMISSION – Same as the Causes 9% of all sore throats. Most sorecommon cold. throats are caused by viruses. Strep. You need clarification or guidance throat tends to be most common around regarding self treatment or you have3. PREVENTION - Tdap vaccine that the beginning and end of the school questions about your illness.immunizes against Pertussis. year.Same hygienic measures as the common 2. SYMPTOMS – The sore throat fromcold. strep is usually severe and comes on abruptly. It is usually accompanied by4. SYMPTOMS – Same as the common fever, chills, headache and nausea. Nasalcold although patients may experience congestion and cough rarely occur.wheezing or productive cough. Acough productive of discolored sputum 3. TREATMENT – Penicillin is the(e.g. green, yellow, brown) in a healthy antibiotic of choice. If a patient isindividual does not indicate a bacterial allergic to penicillin, then your doctorinfection. On average the cough lasts up will prescribe an appropriate substitute.to 3 weeks. While symptoms are usually better within 48 hours, we encourage patients to5. TREATMENT – Symptomatic treatment take a full 10 day course of antibiotics tois the same as for the common cold. If prevent a rare complication known asa patient is experiencing wheezing, the rheumatic fever.doctor may prescribe inhalers for this.Antibiotics do not change the course or Acetaminophen, Ibuprofen andlength of illness except in patients with anesthetic throat sprays can be used forCOPD (e.g. emphysema), chronic lung pain.disease or those with compromisedimmunity. 8

Vaccinations By Karen C. Kemper, MD Pediatrician dangerous to children who are unable to receive the vaccinations and are left at risk when exposed to unvaccinated children. Some states are refusing to allow exemptions for religious reasons or personal conviction, allowing only medical exemptions, in order to further the protection of the public at large. There has also been an interesting backlash. Parents are asking if their physician allows children in their practices whose are not immunized, because they do not want their children exposed unnecessarily to vaccine preventable diseases.IN 1965, MY FAMILY MOVED into an Presently, there are 16 vaccine Vaccines are not only for children.old home built in 1906 that had been preventable diseases for which children Adults also need vaccines againstoccupied by a minister. In the attic, we should be vaccinated before age 16: tetanus, whooping cough, shingles andfound an old trunk filled with books. DTaP: Diphtheria, Tetanus, acellular pneumonia. Special vaccinations suchOne of the books was a Presbyterian Pertussis (Whooping Cough) as Yellow Fever, Japanese Encephalitishymnal copyright 1867. I was intrigued IPV: Polio and Typhoid are recommended for traveland began to flip through the pages Hib: Hemophilous influenza type B in certain parts of the world. Rabiessearching for familiar hymns. Soon to PCV 13: Pneumococcal vaccinations are given after exposure to amy astonishment and dismay, I realized HepB: Hepatitis B rabid animal to prevent a fatal outcome.that more than half of the books songs HepA: Hepatitis Awere hymns for children’s funerals. I RV: Rotavirus More and more vaccines are beingcried tears that day for the many children MMR: Mumps, Measles and Rubella developed and in our children’swho did not survive childhood and that VZV: Varicella (Chicken Pox) lifetimes it is conceivable that there willmoment was a formative one for a 14 year MCV: Meningococcal even be vaccines against cancers andold girl who would one day become a HPV: Human Papilloma virus autoimmune diseases such as juvenilepediatrician. diabetes and celiac disease. Influenza (annually)At the turn of the century, child mortality For more information on diseases andwas approximately 30% before age 2. By Concern about vaccine harm and vaccines visit: http://www.cdc.gov/16 years of age it was 60%. Today with association with autism, promoted by vaccines/default.htma mortality rate of only 0.006 % we can the passionate testimonials of beautiful http://www2.aap.org/immunization/reasonably expect our children to live and famous actors and actresses, have families/families.htmlhttp://www2.aap.a healthy life into adulthood. Besides prompted some parents to refuse org/immunization/families/families.htmlhygiene, good nutrition and improved vaccination for their children. Theresafety standards, vaccinations against have been 13 large scientific studiescommunicable diseases have done disproving a link between vaccinesmore to reduce risk of death than any and autism, but despite this hardother medical advancement. The CDC science their fears persist and we areestimates that vaccinations will prevent seeing the results of not vaccinatingmore than 21 million hospitalizations and with outbreaks of whooping cough,732,000 deaths among children born in influenza and measles. This is particularlythe last 20 years. 9

Know Your MedicationsKeep your Personal Medication List up to date and carry it with you atall times, especially when visiting your doctor, pharmacy or hospital.Your List should include all medicines you take; over-the-counter,supplemental (e.g. vitamins, herbs, etc.), and prescription medicines.“Working TOGETHER, you YOUR LIST SHOULD INCLUDE THESE IMPORTANT FOR YOUR SAFETYcan help your team take INSTRUCTIONS: • Tell the prescribing doctor or • The Name of the medication – better care of you.” pharmacist if you are having significant Brand & Generic names side effects from a medication. • NEVER remove a prescription • The Dose (10 mg, 500 mcg, etc) label from the bottle or mix different medications in one bottle. • How you are supposed to take it (by • Store your medications in a cool, dry mouth, etc) place; out of reach of children and pets. • NEVER share YOUR medications with • How Often you are supposed to take it other people, even family members. (once a day, every 8 hours, etc) • Use a pill organizer if you take several medicines more than once a day. ASK • Why you are taking it (for diabetes, for FOR HELP from a trusted person to fill blood pressure) the pill organizer. •Your Drug Allergies YOU are an important partner with your health care team! DO’S AND DON’TS Do follow your doctor’s directions for Working TOGETHER, you can help your taking your medications. team take better care of you. Don’t skip doses or cut tablets in half to COMMUNICATE any questions you have save money about medications with your Health Care Provider’s office or your Pharmacist. Do talk to your doctor BEFORE stopping any medication Do read the information that comes with your medication Don’t be afraid to ASK QUESTIONS.Pharmacy Name And Phone Number: _____________________________________________________________Health Care Providers Name And Phone Numbers:Primary Care: ________________________________________________________________________________Specialists:__________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________ 10

To Screen or Not to Screen An Update on Prevention By Sean DeLue, MD Family PhysicianWe have all heard the saying: “An ounce of prevention is worth a time to time. Furthermore, just because this agency recommendedpound of cure”, but in todays world of confusing and contradictory the screening it does not mean that your insurance agrees to cover it.medical science it can be difficult to know what should be tested Also understand that if you are reading this then you are an individual,and what should not. Everyone wants to avoid terrible diseases like and as an individual the best course of action is to talk to your doctorcancer and heart attacks but most also want to avoid unnecessary and about what you learn here and determine what is right for you. So,expensive testing. So which preventative actions are worth the price here we go from A to Z…of admission and which are more trouble than they’re worth? Foryears physicians would test out of habit or based on whatever article Abdominal Aortic Aneurysm: It is recommended to have a one-timethey last reviewed in “Doctors Weekly” (not a real magazine by the screening by ultrasound for men ages 65 to 75 who have ever smoked. way). You might say, “There has to be a better way!” and you wouldbe right. Aspirin: Daily aspirin (typically 81 mg) use has been beneficial for men ages 45-79 and women ages 55-79 by decreasing the incidence ofThe U.S. Preventive Services Task Force (USPSTF) was created and heart attack in men and stroke in women. This is only if the risks for afunded through the Department of Health and Human Services gastrointestinal bleed are low. Talk to your doctor if you have ever had(HHS) with support from the Agency for Healthcare Research and any form of abnormal bleeding before starting aspirin therapy.Quality (AHRQ). The USPSTF is an independent group of experts inprimary care who study prevention and evidence-based medicine Blood Pressure: All adults over the age of 18 should have their bloodin order to determine screenings, counseling services, or preventive pressure checked. How often this should be checked is based on yourmedications. They gather together copious amounts of data to particular history and medical issues.provide standards of care based on the scientific data so far. Someof their recommendations have been well accepted and some Breast Cancer: Women ages 50-74 should receive mammographyhave been highly debated. This article is not meant to debate the every 2 years. This may need to be yearly or started earlier based onrecommendations, only to report them. Keep in mind that science is your risk factors, which should be determined by your doctor.ever evolving and refining so these recommendations change from 11

Cervical Cancer: Women ages 21 to 65 should be screened with Pap Osteoporosis (thin bones): Screening should occur in women who aresmear every 3 years. Another option for women ages 30 to 65 who 65 years or older.want to lengthen the screening interval is to screen with a Pap smearand human papillomavirus (HPV) testing every 5 years. If you have Prostate Cancer: The USPSTF recommends against prostate-specificever had an abnormal Pap smear your doctor may want to check you antigen (PSA) screening. You’re probably thinking, “How can this be,more often. doctor? I’ve received my PSA test every year for the past ten years.” This was probably the most controversial decision handed down.Chlamydia and Gonorrhea: Sexually active women ages 24 and They found that there was insufficient evidence to show that PSAyounger and older women who are at increased risk for infection screening in asymptomatic adult males provided any benefit to healthshould receive screening. This is often done at the time of your Pap or lifespan. In fact, it was found that several men were harmed bysmear. complications of procedures for every one helped.Cholesterol: Asymptomatic men ages 35 and older and women ages At this point I’m sure your brain is overloaded with all this preventative45 and older should be screened. Younger individuals are screened medicine goodness and you no doubt have several questions to askbased on risk factors. your doctor. Don’t forget there is no preventative measure as good as healthy living. Here are a few recommendations before I let you go:Diabetes: Screening is recommended in adults with sustained bloodpressure (either treated or untreated) greater than 135/80 mm Hg. WORK TO OBTAIN YOUR IDEAL BODY WEIGHT through diet. Yes,Talk to your doctor about screening if you are overweight or have a this is a difficult request for most but your body will thank you for it.strong family history of diabetes. Be careful when you pursue any fad dietsFall risk: Exercise or physical therapy or medications. These will rarely lead youand vitamin D supplementation are to healthy long-term weight management,recommended to prevent falls in community- which should be your goal. Increase yourdwelling adults aged 65 years or older who fruits and vegetables, stick to lean meats suchare at increased risk for falls. as chicken and fish and avoid sweets. Eat slowly and limit your portion size. Your doctorHepatitis: Hepatitis B screening is can provide further information on the rightrecommended for individuals at high risk diet for you.of blood exposure. Hepatitis C screening isrecommended as a one-time check for all EXERCISE REGULARLY. Moderate exercisethose born between 1945 and 1965. should be performed at least 150 minutes per week. If you have not exercised for a long-HIV: Adults ages 15-65 should be screened. time you should build your regimen slowly toThe frequency of screening is determined by avoid injury. Talk to your doctor to make sureyour risk factors so talk to your doctor. the exercise you have chosen is right for you.Immunizations: REDUCE STRESS. Most people do not respect Chicken pox: All adults should get 2 doses if they have not been the effect of stress on their physical well-being. It will not only make previously vaccinated and have never had the disease. you fatigued and anxious but sick as well. Take time out from the Flu: All adults should get their flu shot yearly. hustle and bustle of the day and find your happy place. You Genital warts: Women ages 18-26 and Men ages 18-22 should deserve it! receive 3 doses of the vaccine. Measles, Mumps, and Rubella: Adults 18-55 should get at least 1 SLEEP AT LEAST 8 HOURS per night. If you snore heavily, talk to your dose of the vaccine. doctor. Pneumonia: After 65 you should receive a single dose of both the 13 and the 23 valent vaccine. These shots are separated by up to a STOP THE USE OF TOBACCO. Go to www.smokefree.gov or talk to year, which will be determined by you doctor. your doctor for further assistance. Shingles: Adults over the age of 60 should get a single vaccine. Tetanus, Diphtheria, and Pertussis: Adults over 18 should get a LIMIT YOUR ALCOHOL USAGE. Men should drink no more than 2 single Tdap followed by a Td every 10 years. and women no more than 1 drink per day. A drink is considered to be 12 oz of beer, 6 oz of wine, or 1 oz of liquor.Lung Cancer: Receive an annual screening with low-dose computedtomography if you are an adults ages 55 to 80 with a 30 pack-year Hopefully now you are armed with the information to stay just asmoking history and currently smoke or have quit within the past 15 little bit healthier. Remember that the recommendations made hereyears. FYI: Multiply the number of packs per day times the number of were in no way a complete list of preventative services. Many testsyears you smoked to get the pack-years value. Screening should be evaluated by the USTSTF simply have inconclusive evidence anddiscontinued once a person has not smoked for 15 years. need further study. Preventative services suggestions are constantly evolving so make sure you stay up to date with your doctor. Stay healthy Waco. 12

The FamilyHealthCenterWhat A Community Can DoWhen It Works Together.By Roland A. Goertz, MD, MBACEO, Family Health CenterThis year marks the forty-fifth year of signed on to the effort, but especially medical community believe the presenceoperation of the Family Health Center the two local hospitals and the local of the training program has helped(FHC) (formerly the Family Practice physician community. Groups met and maintain high quality levels of careCenter). Community leaders who worked an agreement was reached to develop across the board. The Center itself is anwith the McLennan County Medical and work to accredit a Family Practice economic engine for the community withSociety to create the Center would be very (now Family Medicine) program for over 480 staff and a budget of $45 millionpleased with what has developed. When I Waco. Such a program potentially solved a year.came to Waco in 1997 to be the CEO of the several problems. Its direct care givingCenter I individually invited many of the and training would provide basic care All of this happened because leadersremaining leaders who had helped create to the then marginally served uninsured in local business, government andthe organization to lunch to tell me about population based on a discounted cost healthcare cared about their communitytheir roles. Although they all recounted of care model, it would provide more and sought a way to answer somethe story a bit differently there was more assured emergency room and after hours big problems they decided neededthan ample agreement on why they did coverage for both hospitals and over solutions. And fortunately at that samewhat they did. time it would supply increased physician time a new model of physician training workforce for the area. Involved came along that could solve more thanThe 1960s was a turbulent period for the business leaders also saw the project, one of the problems. And also at thatUS. Social issues divided the Country if successful, as an economic incentive same time, leaders of the McLennancreating unrest in many regions. Some for business growth – better health care County Medical Society saw the vision oflocal government and business leaders resources would lead to a more attractive what could be, and decided they wantedwere concerned that similar things could community. their community to be healthier andhappen in Waco. A need that was obvious more prosperous. Those original leadersto many was a lack of basic health care for All of the mentioned desired outcomes would be pleased!the population who struggled to afford have happened. The Family Healthcare. A number of more populous counties Center provides basic care to over 51,000in Texas created hospital districts to patients a year, with 21,000 of themaddress the issues but McLennan County uninsured and over 80 % living at theand Waco took a different approach, federal poverty level or less. The residencymaybe because of its smaller size or program was accredited in 1969 andmaybe because they had another solution entered its first class of trainees in 1970.in mind – The Family Practice Center. Today 12 physicians graduate every year, over 400 total since 1970, and half of allThe physician discipline of General the Family Physicians who practice inPractice was converting to the specialty the area were trained by the Center. Theof Family Practice at the time. Members program in its work of caring and trainingof the McLennan County Medical Society physicians has on site presence at bothtook a leading role when they recognized hospitals around the clock. Many in thethe training rules of this new specialtywould allow a community like Waco to 13create and accredit a program if everyone

Thank you to our Circle of Friends: Thank you to our Circle of Friends: GOLD LEVEL Baylor Scott & White Hillcrest Medical Center First National Bank of Central Texas Texas Medical Liability Trust SILVER LEVEL Providence Healthcare Network BRONZE LEVEL Advanced Pain Care Artistic Images by the Mayfields Baylor Alumni Network McLennan Community College WSI Internet Partners GOLD LEVELirst National Bank of Central Texas Texas Medical Liability Trust SILVER LEVELor Scott & White Hillcrest Medical Center Providence Healthcare Network BRONZE LEVEL 14Artistic Images by the Mayfields Baylor Alumni Network McLennan Community College

MCMS Member DirectoryPlease contact MCMS at (254) 776-2882 or admin@mclennancountymedicine.org if changes to contact information are needed. PhysiciansD. Crawford Allison, MD Sherwin Attai, MDHillcrest Bosque Clinic Waco Cardiology Associates7300 Bosque Blvd 7125 New Sanger Road, Suite AWaco, TX 76710 Waco, TX 76712-4054P (254) 202-2600 P (254) 399-5400F (254) 202-2694 F (254) 772-8669Ashley Honey Amar, MD John Francis Bagnasco, MD333 Londonderry Drive, Suite 300 Waco Center for Women’s HealthWaco, TX 76712 601 W Hwy 6, Suite 101P (254) 751-1144 Waco, TX 76710-5592F (254) 751-1185 P (254) 772-5454 F (254) 772-6464Meera Amar, MDDiabetes & Endocrine Center of Gary K. Barbin, MDCentral Texas, PA Internal Medicine Clinic333 Londonderry Drive, Suite 200 301 Richland West CircleWaco, TX 76712-7930 Woodway, TX 76712-7932P (254) 751-9777 P (254) 537-6200F (254) 751-9788 F (254) 537-6201Neil K. Amar, MD T. Marc Barrett, MDDiabetes & Endocrine Center of Providence Healthcare NetworkCentral Texas, PA 6901 Medical Parkway333 Londonderry Drive, Suite 200 Waco, TX 76712-7998Woodway, TX 76712 P (254) 751-4723P (254) 751-1144 F (254) 751-4769F (254) 751-1185 Lauren Gallemore Barron, MDNiran Jan Amar, MD One Bear PlaceAllergy & Asthma Center, PA PO Box 97202333 Londonderry Drive, Suite 100 Waco, TX 76798Waco, TX 76712-7930 P (254) 710-2065P (254) 751-1144 F (254) 710-2674F (254) 751-1185 Floyd Lee Barry, MDHari B. Ancha, MD Family Health CenterWaco Gastroenterology Associates Martin Luther King Clinic364 Richland West Circle, Suite A 1911 Martin Luther King BoulevardWaco, TX 76712-7919 Waco, TX 76704P (254) 537-0911 P (254) 313-5000F (254) 537-0313 F (254) 313-5999Jeffrey L. Arnold, MD Lynda Barry, MDProvidence Family Health Clinic Hillcrest China Spring Clinic6614 Sanger Avenue 9821 China Spring HighwayWaco. TX 76710 Waco, TX 76708P (254) 537-6100 P (254) 202-7400F (254) 537-6101 F (254) 202-7450 15

Reed Bartz, MD Jerry Alan Benham, MDElite Sports Medical Center Waco Orthopedic &5100 Franklin Avenue, Suite C Sports Medicine ClinicWaco, TX 76710 6600 Fish Pond Road, Suite 201P (254) 754-0375 Waco, TX 76710-2582F (254) 754-2667 P (254) 752-9638 F (254) 752-2201Jacob R. Battle, MDWaco Orthopedic & Edward Garrison Benton, Jr., MDSports Medicine Clinic Southwestern Sports Medicine5500 Fish Pond Road, Suite 201 50 Hillcrest Blvd., Suite 303Waco, TX 76710-2582 Waco, TX 76712P (254) 752-9638 P (254) 741-1400F(254) 752-2201 F (254) 741-1428John Joseph Bawduniak, III, MD Jeana Lynn Benwill, MDWaco Surgical Group, PA Waco Infectious Disease Associates, P.A.6600 Fish Pond Road, Suite101 7030 New Sanger Avenue, Suite 202Waco, TX 76710-2582 Waco, Texas 76712P (254) 776-3188 P (254) 772-4400F (254) 776-3671 F (254) 399-0247Mark Alan Beaird, MD Bill Hall Berryhill, MDFamily Health Center 7003 Woodway Drive, Suite 310Women’s Health Center Waco, TX 76712-6163120 Hillcrest Medical Blvd., Suite 300-2 P (254) 776-0310Woodway, TX 76712 F (254) 776-7815P (254) 313-6500F (254) 313-6599 Rima Bishara, MD VA Health AdministrationNeil M. Bealka, MD 4800 Memorial DriveStephenville Medical & Surgical Clinic Waco, Texas 76711-13292406 S State Highway 36 P (254)297-3000Gatesville, TX 76528-2518P (254) 865-4267 Genevieve J. T. Blackwelder, MDF (254) 865-8293 1121 Lake Air Drive Waco, TX 76710-4417Brian Kelly Becker, MD P (254) 772-8330Waco Center for Women’s Health601 W State Highway 6, Suite 101 Greg D. Blaisdell, MDWaco, TX 76710-5592 Providence Clinic DePaulP (254) 772-5454 301 Londonderry DriveF (254) 772-6464 Waco, TX 76712-7915 P (254) 751-4880Paul Anthony Bednarz, MD F (254) 751-4885Southwest Sports Medicine50 Hillcrest Medical Blvd, Suite 303 Scott E. Blattman, MDWaco, TX 76712 Providence Family Health ClinicP (254) 741-1400 6101 Woodway Drive, Suite 200F (254) 741-1428 Woodway, TX 76712 P (254) 537-6300 16 F (254) 537-6301

Todd Eric Blattman, MD Joseph Bond Browder, MDProvidence Family Health Clinic Browder Clinic6101 Woodway Drive, Suite 200 7005 Woodway Dr Ste 201Woodway, TX 76712 Waco, TX 76712(254) 537-6300 P (254) 732-3633(254) 537-6301 F (254) 732-3661Henry J. Boehm, III, MD Rodney Andrew Brown, MDRadiology of Texas Waco Cardiology Associates100 Hillcrest Medical Blvd 7125 New Sanger Road, Suite AWoodway, TX 76712-8897 Waco, TX 76712-4054P (254) 202-4100 P (254) 399-5400 F (254) 772-8669Keith A. Boles, MDFamily Health - McGregor Jason Kyle Bryant, MDCommunity Clinic Premier ER500 South Johnson Drive 9110 Jordan LaneMcGregor, TX 76657 Waco, TX 76712P (254) 313-5200 P (254) 399-0740F (254) 313-5299 F (254) 399-0736Corbett H. Boone, MD Brian Douglas Bull, MDSouthwest Sports Medicine Hillcrest Bellmead Clinic50 Hillcrest Medical Blvd., Suite 303 851 N Loop 340Woodway, TX 76712 Waco, TX 76705-2592P (254) 741-1400 P (254) 202-7500F (254) 741-1428 F (254) 202-7599Adam M. Borowski, MD Cathryn Darlene Burbidge, DOWaco Radiology, PA Providence Clinic - Londonderry6901 Medical Parkway 7003 Woodway Drive, Suite 312Woodway, TX 76712 Woodway, TX 76712P (254) 751-4299 P (254) 772-7300F (254) 751-4549 F (254) 772-7351James Wesley Boss, MD John M. Burbidge, Jr., DOWaco Gastroenterology Associates Providence Clinic - Londonderry364 Richland West Circle, Suite A 7003 Woodway Drive, Suite 312Waco, TX 76712-7919 Woodway, TX 76712P (254) 537-0911 P (254) 772-7300F (254) 537-0313 F (254) 772-7351Ronald William Bradshaw, MD Steven Richard Burgard, MDBaylor Univ Health Services Mid-Texas Anesthesia Associates, PA1 Bear Pl Unit 97060 405 Londonderry Drive, Suite 105Waco, TX 76798-7060 Waco, TX 76712-7920P (254) 710-1010 P (254) 776-0266F (254) 710-2499 F (254) 776-2511Mace Lain Brindley, MD Karen L. Burnett, MDWaco Ear, Nose & Throat Waco Surgical Group, PA601 W Hwy 6, Suite 106 6600 Fish Pond Road, Suite101Waco, TX 76710-5592 Waco, TX 76710-2582P (254) 776-7744 P (254) 776-3188F (254) 751-9206 F (254) 776-3671 17

Renesha Christine Butler, MD Jeff D. Chancellor, MDProvidence Pediatric Clinic Waco Center for Women’s Health7003 Woodway Drive, Suite 230 601 W Highway 6, Suite 101Woodway, TX 76712 Waco, TX 76710-5592P (254) 537-6400 P (254) 772-5454F (254) 537-6401 F (254) 772-6464Jenny S. Carl, MD Baochong Bolin Chang, MDFamily Health Center Waco Regional Cancer CenterWomen’s Health Center 3420 Pine Avenue120 Hillcrest Medical Blvd., Suite 300-2 Waco, TX 76708-3130Waco, TX 76712 P (254) 752-2900P (254) 313-6500 F (254) 752-2902F (254) 313-6599 Christina A. Chen, MDKaren Carmody, MD 201 Old Hewitt Rd6301 Imperial Drive Woodway, TX 76712Waco, TX 76712 P (254) 772-2006P (254) 751-3302 F (254) 772-2011Edward Dean Carpenter, MD Cary D. Chisholm, MDWaco Gastroenterology Associates Central Texas Pathology Laboratory, PA364 Richland West Circle, Suite A 601 W. Hwy 6, Suite 111Waco, TX 76712-7919 Waco, TX 76710P (254) 537-0911 P (254) 752-9621F (254) 537-0313 F (254) 752-8378Larry Wayne Cartmell, Jr., MD Eric John Chudej, MDCentral Texas Pathology Laboratory, PA Providence Family Health Clinic - West601 W Hwy 6, Suite 111 1401 Jane LaneWaco, TX 76710 West, TX 76691P (254) 752-9621 P (254) 826-3073F (254) 752-8378 F (254) 826-3854Janie Castillo, MD Gordon Michael Clark, Sr., MDFamily Health Center McLennan County Hospital Services, PC110 S 12Th Street 6901 Medical ParkwayWaco, TX 76701 Waco, TX 76712P (254) 313-6350 P (254) 751-4551F (254) 313-6375 F (254) 751-4550Carena L. Chai, DO Stephanie Elise Claus, MDFamily Health Center Family Health Center1600 Providence Drive South 18th Street Community ClinicWaco, TX 76707 1800 Gurley LaneP (254) 313-4257 P (254) 313-6000F (254) 313-6375 F (254) 313-6098Carl G. Chakmakjian, DO Amby Jenea Cline, DOFamily Health Center Hillcrest Bosque Clinic1700 West State Hwy 6 7300 Bosque BoulevardWaco, TX 76712 Waco, TX 76710P (254) 399-0741 P (254) 202-2600F (254) 313-6375 F (254) 202-2694 18

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Chad S. Conner, MD Holly Williams Davis, MDWaco Orthopedic & Sports Mid-Tex Anesthesia Associates, PAMedicine Clinic 405 Londonderry Dr Ste 1056600 Fish Pond Road, Suite 201 Waco, TX 76712-7920Waco, TX 76710-2582 P (254) 776-0266P (254) 752-9638 F (254) 776-2511F (254) 752-2201 Andrew Kilani Day, MDEdward David Contreras, MD Waco Cardiology AssociatesWaco Gastroenterology Associates 7125 New Sanger Road, Suite A364 Richland West Circle, Suite A Waco, TX 76712Waco, TX 76712-7919 P (254) 399-5400P (254) 537-0911 F (254) 772-8669F (254) 537-0313 Sean D. DeLue, MDJessica K. Cook, MD Scott & White Clinic - WacoFamily Health Center 7700 Fish Pond RoadMcGregor Community Clinic Waco, TX 76710-1031500 South Johnson Drive P (254) 761-4444McGregor, TX 76657P (254) 313-5300 Nelson Dale DeStaffany, MDF (254) 313-5299 Mid-Tex Anesthesia Associates, PA 405 Londonderry Drive, Suite 105Jesse S. Cover, MD Waco, TX 76712-7920Family Health Center P (254) 776-0266Madison Copper Community Clinic F (254) 776-25111610 Providence DriveWaco, TX 76707-2261 Jacquelin D. Dewbre, MDP 9254) 313-4800 Hillcrest Pediatric ClinicF (254) 313-4899 120 Hillcrest Medical Blvd., Suite 100 Woodway, TX 76712Roger Wade Cowart, MD P (254) 202-6100Providence Internal Medicine Clinic F (254) 202-6195301 Richland West CircleWaco, TX 76712-7932 John Daly Dietrick, MDP (254) 537-6200 Family Health CenterF (254) 537-6201 1600 Providence Drive Waco, TX 76707Donald Stanley Cross, MD P (254) 313-4200Waco Cardiology Associates F (254) 750-83267125 New Sanger Road, Suite AWaco, TX 76712-4054 Carl Anthony Dunn, MDP (254) 399-5400 Waco OB/GYN at HillcrestF (254) 772-8669 120 Hillcrest Medical Blvd., Suite 201 - 2 Waco, TX 76712Pramila Kirit Daftary, MD P (254) 399-6000Allergy & Asthmma Care of Waco F (254) 399-6019221 Jewell DriveWaco, TX 76712 Thomas F. Eastwood, MDP (254) 753-3646 Waco Gastroenterology AssociatesF(254) 753-1411 364 Richland West Circle, Suite A Waco, TX 76712-7919 19 P (254) 537-0911 F (254) 537-0313

Jon M. Ellis, MD Charles E. Gamble, MDSouthwest Sports Medicine Hillcrest Pediatric Clinic50 Hillcrest Medical Blvd., Suite 303 120 Hillcrest Medical Blvd., Suite 100Waco, TX 76712 Waco, TX 76712P (254) 741-1400 P (254) 202-6100F (254) 741-1428 F (254) 202-6195Carlos Adolfo Encarnacion, MD Randy Carl Gardell, MDTexas Oncology - Waco Central Texas Neurological Association1700 W Highway 6 205 Woodhew Drive, Suite 110Waco, TX 76712 Woodway, TX 76712-6689P (254) 399-0741 P (254) 399-9291F (254) 399-0779 F (254) 399-8414John Joseph Faillace, MD Gary Fred Geldmeier, MDWrist & Hand Center of Waco Central Texas Pathology Laboratory, PA7003 Woodway Drive, Suite 302 601 W Hwy 6, Suite 111Woodway, TX 76712-6163 Waco, TX 76710P (254) 732-0005 P (254) 752-9621F (254) 732-0042 F (254) 752-8378Lisa Lynnette Falls, MD Jeffrey Charles Gerik, MDFamily Health Center Radiology Consultants of Texas1600 Providence Drive 100 Hillcrest Medical BlvdWaco, TX 76707-2261 Waco, TX 76712P (254) 750-8200 P (254) 202-4100F (254) 750-8326 Richard Lee Gibney, MDGary W. Fischer, MD CentraL Texas Nephrology AssociatesMid Tex Anesthesia Associates 5940 Crosslake Parkway405 Londonderry, Suite 105 Woodway, TX 76712Waco, TX 76712 P (254) 666-2999P (254) 776-0266 F (254) 420-2014F (254) 776-2511 John Howard Gill, MDNathan B. Forrest, DO Family Health CenterWaco Radiology, PA 1600 Providence Drive6901 Medical Parkway Waco, TX 76707Waco, TX 76712 P (254) 313-4200P (254) 751-4299 F (254) 313-4549F (254) 751-4549 Aric Christopher Gillen, MDJoel Gary Freitag, MD Family Health Center205 Woodhew Drive, Suite 110 Women’s Health CenterWoodway, TX 76712-6689 120 Hillcrest Medical Blvd., Suite 300-2P (254) 399-9291 Waco, TX 76712-8948F (254) 399-8414 P (254) 313-6500 F (254) 313-6599Eugene H S Fung, MDArthritis & Osteoporosis Clinic Robert Joseph Go, MD2911 Herring Avenue, Suite 306 Central Texas Nephrology AssociatesWaco, TX 76708 5940 Crosslake ParkwayP (254) 755-4582 Waco, TX 76712F (254) 755-4585 P (254) 666-2999 F (254) 420-2014 20

Roland Adolph Goertz, MD, MBA Charles W. Guy, II, DOFamily Health Center Hillcrest ENT & Facial Plastics50 Hillcrest1600 Providence Drive Medical Blvd., Suite 206Waco, TX 76707 Waco, TX 76712P (254) 313-4201 P (254) 202-7950F (254) 313-4326 F (254) 202-7999Josh H. Goldstrich, MD Barbara M. Hair, DOWaco Surgical Group, PA Concentra Medical Center6600 Fish Pond Road, Suite101 4205 Franklin AvenueWaco, TX 76710-2582 Waco, TX 76710-6904P (254) 776-3188 P (254) 772-2777F (254) 776-3671 F (254) 772-2770Jon Marc Goodnight, MD Harold Bruce Hamilton, MDWaco Orthopedic & Sports Medicine 205 Woodhew Drive, Suite 200Clinic Waco, TX 76712-66556600 Fish Pond Road, Suite 201 P (254) 776-9775Waco, TX 76710-2582 F (254) 776-9779P (254) 752-9638F (254) 752-2201 John Bryan Hamilton, MD Premier ERJames Thomas Graham, Jr., MD 9110 Jordan LaneHillcrest Hewitt Clinic Waco, TX 767121001 Hewitt Drive P (254) 399-0740Woodway, TX 76712 F (254) 399-0736P (254) 202-7800F (254) 202-7856 Bryan John Hanysak, MD Waco Gastroenterology AssociatesChristopher D. Greener, MD 364 Richland West Circle, Suite AMid-Tex Anesthesia Associates, PA Waco, TX 76712-7919405 Londonderry Drive, Suite 105 P (254) 537-0911Waco, TX 76712-7920 F (254) 537-0313P (254) 776-0266F (254) 776-2511 Donald Mike Hardin, Jr., MD Family Health CenterJackson O. Griggs, MD 1600 Providence DriveFamily Health Center Waco, TX 76707-22611600 Providence Drive P (254) 750-8200Waco, TX 76707-2261 F (254) 750-8326P (254) 750-8200F (254) 750-8326 James Patrick Harkins, Jr., MD Waco Eye Associates PARebecca D. Guess, MD 321 Richland W. CircleMid-Tex Anesthesia Assoicates Waco, TX 76712405 Londonderry Drive, Suite 105 P (254) 756-4457Woodway, TX 76712-7920 F (254) 756-1718P (254) 776-0266F (254) 776-2511 Thomas J. Harris, MD Texas Oncology - WacoJeffrey Ross Gunter, MD 1700 West Hwy 6Waco Dermatology Waco, TX 767126609 Sanger Avenue P (254) 399-0741Waco, TX 76710 F (254) 399-0779P (254) 399-6941F (254) 399-6567 21

Kristi Lynn Hartman, MD Richard Earle Helmer, MDFamily Health Clinic - Sanger Avenue Central Texas Cardiovascular, PA6614 Sanger Avenue 405 Londonderry, Suite 301Woodway, TX 76712 Waco, TX 76712P (254) 537-6100 P (254) 741-6333F (254) 537-6101 F (254) 741-6364Randy J. Hartman, MD Scotty Roy Hermann, MDHillcrest Emergency Services 405 Londonderry Drive, Suite 106100 Hillcrest Medical Boulevard Waco, TX 76712-7920Waco, TX 76712 P (254) 776-4961P (254) 202-9195 F (254) 776-4964F (254) 202-9149 Burritt William Hess, MDWilliam Richard Haskett, MD Family Health CenterWaco Center for Women’s Health 1600 Providence Drive601 W State Highway 6, Suite 101 Waco, TX 76707-2261Waco, TX 76710-5592 P (254) 750-8200P (254) 772-5454 (254) 750-8326F (254) 772-6464 William Mark Hinds, MDDavid E. Haynes, MD Hillcrest Legends ClinicSouthwest Sports Medicine 50 Hillcrest Medical Blvd., Suite 10450 Hillcrest Medical Blvd., Suite 303 Woodway, TX 76712-8946Woodway, TX 76712 P (254) 202-7300P (254) 741-1400F (254) 741-1428 James R. Hodges, MD 7005 Woodway Drive, Suite 201Katherine Anne Haynes, MD Waco, TX 76712-6160Waco Center for Women’s Health P (254) 772-2222601 W State Highway 6, Suite 101Waco, TX 76710-5592 David Glenn Hoffman, MDP (254) 772-5454 Waco Surgical Group, PAF (254) 772-6464 6600 Fish Pond Road 101 Waco, TX 76710-2582Jennifer Lynn Headrick, MD P (254) 776-3188Hillcrest Internal Medicine & F (254) 774-3671Senior Care Center2201 MacArthur Drive, Suite 2200 Bradford W. Holland, MDWaco, TX 76708 Waco Ear, Nose & ThroatP (254) 202-7130 601 W Hwy 6, Suite 106F (254) 202-7149 Waco, TX 76710-5592 P (254) 776-7744Scott E. Hecox, MD F (254) 751-9206Southwest Sports Medicine50 Hillcrest Medical Blvd., Suite 303 Keith D. Horner, MDWaco, TX 76712 Providence Health Clinic - WoodwayP (254) 741-1400 Medical CenterF (254) 741-1428 6101 Woodway Drive, Suite 20 Woodway, TX 76712Casey D. Hector, MD PA P (254) 537-6300Mid-Tex Anesthesia Associates F (254) 537-6301405 Londonderry Drive, Suite 105Waco, TX 76712-7920P (254) 776-0266F (254) 776-2511 22

Stephen Gabriel Howlett, MD Kelly M. Janish, MDNeurology Services Providence Pediatric Clinic - Woodway405 Londonderry Drive, Suite 301B Medical PlazaWaco, TX 76712-7922 6101 Woodway Drive, Suite 230P (254) 756-6875 Waco, TX 76712F (254) 756-1334 P (254) 537-6400 F (254) 537-6401Allen Lee Hueston, MDMHMR Danny Sean Julian, MD110 S 12th Street Family Health Clinic - Lake ShoreWaco, TX 76701-1810 2100 Lake Shore DriveP (254) 752-3451 Waco, TX 76708-1271F (254) 752-7421 P (254) 537-6160 F (254) 537-6695Kyle L. Hulme, MDHillcrest Bosque Clinic James Kevin Kavanagh, MD7300 Bosque Boulevard Mid Tex Anesthesia AssociatesWaco, TX 76710 405 Londonderry Drive, Suite 105P (254) 202-2600 Waco, TX 76712-7920F (254) 202-2694 P (254) 776-0266 F (254) 776-2511Richard Kenneth Hurley, MDProvidence Pain Management Karen Cervenka Kemper, MDAssociates Hillcrest Pediatric Clinic405 Londonderry Drive, Suite 311 2201 Macarthur Drive, Suite 2205Woodway, TX 76712 Waco, TX 76708P (254) 537-6550 P (254) 202-6190F (254) 537-6551 F (254) 730-2691Amanda Rose Hutchens, MD Lacy Coker Kessler, MDWaco Neonatal Group 2410 Wycon Drive, Suite 204100 Hillcrest Medical Boulevard Woodway, TX 76712Waco, TX 76712 P (254) 420-0002P (254) 202-2911 F (254) 239-2443Melanie Bivona Illich, MD Rizwan H. Khan, DO1316 Washington Avenue Texans Anesthesia Associates PLLCWaco, TX 76701 7005 Woodway Drive, Suite 101P (254) 776-3366 Woodway, TX 76712F (254) 776-8466 P (254) 741-6641 F (254) 537-4691Kerry D. Irons, MD701 W Loop 340, Suite A Dong W. Nathan Kim, MDWoodway, TX 76712-6841 Texas Oncology - WacoP (254) 776-0418 1700 W Highway 6F (254) 741-9638 Woodway, TX 76712-2452 P (214) 399-0741Kyle D. James, MD F (214) 399-0779Hillcrest Hewitt Clinic1001 Hewitt Drive Lisa Johnson Kirk, DOWaco, TX 76712-8486 Brazos Integrative MedicineP (254) 202-7800 318 Richland West Circle, Suite BF (254) 202-7856 Woodway, TX 76712 P (254) 776-8008 23 F (254) 776-6892

Howard Norman Klaskin, MD Brent Lee Kutach, DOWaco Radiology, PA MId-Tex Anesthesia Associates, PA6901 Medical Parkway 405 Londonderry Drive, Suite 105Woodway, TX 76712 Woodway, TX 76712-6166P (254) 751-4299 P (254) 776-0266F (254) 751-4549 F (254) 776-2511Mark S. Klepper, MD Ben Ford LaGrone, MDWaco Lung Associates MId-Tex Anesthesia Associates, PA340 Richland West Circle 405 Londonderry Drive, Suite 105Woodway, TX 76712-6163 Woodway, TX 76712-7920P (254) 537-6600 P (254) 776-0266F (254) 537-6601 F (254) 776-2511Joseph Edward Knipper, MD Jeff J. Leinfelder, MD601 W Hwy 6, Suite 103 Central Texas Eye Clinic, PAWaco, TX 76710-5592 601 W Hwy 6, Suite 108P (254) 751-9040 Waco, TX 76710F (254) 751-9018 P (254) 752-8328 F (254) 752-7724Kenneth Walter Koeritz, Jr., MDOB-GYN Associates of Waco Stacy L. Lessman, MD2501 Ambassador Drive Family Health CenterWoodway, TX 76712-8944 Elm Avenue Medical & Dental ClinicP (254) 752-4395 609 Elm Avenue Waco, TX 76704Donald Ray Koester, MD P (254) 313-6900Family Health Center F (254) 313-69591600 Providence DriveWaco, TX 76707-2261 Isabel A. Lind, MDP (254) 313-4252 Family Health CenterF (254) 750-8582 1600 Providence Drive Waco, TX 76707Frances E. Koller, MD P (254) 750-8200Providence Clinic DePaul F (254) 750-8326301 Londonderry DriveWaco, TX 76712-7915 Isaac J. Lippe, MDP (254) 751-4880 Providence Express Care - NorthF (254) 751-4885 2100 Lakeshore Drive, Suite 200 Waco, TX 76708Jeremy Korteweg, MD P (254) 537-6158Family Health Center F (254) 537-6159Martin Luther King Clinic1911Martin Luther King Boulevard Natalie Crump Lippe, MDWaco, TX 76704 Providence Family Health ClinicP (254) 313-5000 Woodway Medical PlazaF (254) 313-5999 6101 Woodway Drive, Suite 200 Woodway, TX 76712John David Kosarek, MD P (254) 537-6300Hillcrest Midway Clinic F (254) 537-63017702 Central Park DriveWaco, TX 76712-6535P (254) 202-7700F (254) 202-7710 24

John Frederick Liu, MD Mohammad I. Malik, MDWaco Eye Associates PA Hillcrest Physician Services321 Richland West Circle Hospitalis ServiceWaco, TX 76712-7919 100 Hillcrest Medical BoulevardP (254) 756-4457 Waco, TX 76712F (254) 756-1718 P (254) 202-5379 F (254) 202-5349William Scott Livesay, MD405 Londonderry Drive, Suite 203 Nolan Scott Malthesen, MDWaco, TX 76712-7921 Waco Orthopedic & Sports Medicine ClinicP (254) 772-5855 6600 Fishpond Road, Suite 201F (254) 772-3277 Waco, TX 76710 P (254) 752-9638Michael Allen Loden, MD F (254) 752-2201Family Health Clinic - Lakeshore2100 Lake Shore Drive Jeffrey T. Manning, MDWaco, TX 76708-1271 Mid-Tex Anesthesia Associates, PAP (254) 537-6160 405 Londonderry Drive, Suite 105F (254) 537-6695 Waco, TX 76712-7920 P (254) 776-0266Twila Dawn J. Lovett, MD F (254) 776-2511Hillcrest Physician ServicesHospitalist Service Michelle Trice Manning, MD100 Hillcrest Medical Blvd. Waco Center for Women’s HealthWaco, TX 76712-8897 601 W State Highway 6, Suite 101P (254) 202 -5370 Waco, TX 76710-5592F (254) 202 -5349 P (254) 772-5454 F (254) 772-6464Webster S. Lowder, MDSurgical Associates, PA Stephen L. Mark, MD3400 Hillcrest Drive 213 A Old Hewitt RoadWaco, TX 76708-3120 Waco, TX 76712P (254) 752-2587 P (254) 772-6770F (254) 752-2653 F (254) 772-8471Sudhir Madisetty, MD Gerard Anthony Marroquin, MDCentral Texas Pediatrics Family Health Clinic1607 Lake Success Drive Woodway Medical PlazaWaco, TX 76710-2908 6101 Woodway Drive, Suite 200P (254) 772-0783 Woodway, TX 76712F (254) 772-1463 P (254) 537-6300 F (254) 537-6301Joel B. Mahan, MDFamily Health Center Jill Waters Marsh, MDElm Avenue Medical & Dental Clinic Family Health Center609 Elm Avenue McGregor Community ClinicWaco, TX 76704 500 S Johnson DriveP (254) 313-6900 McGregor, TX 76657F (254) 313-6959 P (254) 313-5200 F (254) 313-5299Rebecca Diane Mahan, MDFamily Health Center Timothy Dean Martindale, MDSouth 18th Street Community Clinic Providence Family Medicine Clinic1800 Gurley Lane 7104 New Sanger RoadWaco, TX 76706 Waco, TX 76712-3928P (254) 313-6000 P (254) 537-6270F (254) 313-6098 F (254) 537-6271 25

Matthew C. Maruska, DO Sophia C. McFadden, MDCross Timbers Orthopedics Coryell Medical Clinic561 North Graham 1507 W Main Street, Bldg. 2Stephenville, TX 76401 Gatesville, TX 76528P (254) 965-2663 P (254) 865-8261F (254) 968-5912 F (254) 248-0626James Wilcox Mason, MD Clint W. McHenry, DOEpiphany Dermatology Providence Family Health Clinic Lakeshore7106 Sanger Avenue 2100 Lakeshore DriveWaco, TX 76712 Waco, TX 76708P (254) 537-1265 P (254) 537-6160F (254) 537-1310 Micah Stephen Meyer, MDRobert C. Matlock, MD Central Texas Nephrology Associates, PAProvidence Sleep Clinic 5940 Crosslake Parkway305 Londonderry Drive, Bldg. 3 Waco, TX 76712Waco, TX 76712 P (254) 666-2298P (254) 537-6191 F (254) 420-2014F (254) 537-6468 Chris Miars, DOSean D. McCarthy, MD Southwest Sports Medicine1316 Washington Avenue 50 Hillcrest Medical Blvd., Suite 303Waco, TX 76701-1129 Woodway, TX 76712P (254) 776-3366 P (254) 741-1400F (254) 776-8466 F (254) 741-1428Joan M. McClary, MD Douglas Brian Michaels, MD1612 Austin Avenue, Suite C Central Texas Pathology Laboratory, PAWaco, TX 76701 601 W Hwy 6, Suite 111P (254) 757-3774 Waco, TX 76710 P (254) 752-9621Amy Rachelle McCourt, MD F (254) 752-8378Waco Radiology, PA6901 Medical Parkway Kimberly Louise Micus, MDWoodway, TX 76712 Baylor Scott & White HealthP (254) 751-4299 120 Hillcrest Medical Blvd., Ste. 201-2F (254) 751-4549 Waco, TX 76712 P (254) 420-0002William T. McCunniff, MD F (254) 235-2443Hillcrest Midway Clinic7702 Central Park Drive Aurora M. Mignosa, MDWoodway, TX 76712 Providence Clinic DePaulP (254) 202-7700 301 Londonderry DriveF (254) 202-7710 Woodway, TX 76712-7915 P (254) 751-4880Brett Aaron McFadden, MD F (254) 751-4885Providence Physician Services10000 Stonington Circle George Robert Mills, MDWoodway, TX 76712-7610 Mid-Tex Anesthesia Associates, PAP (940) 372-7232 405 Londonderry Drive, Suite 105 Waco, TX 76712-7920 26 P (254) 776-0266 F (254) 776-2511

Todd Allen Moffatt, MD Gregory A. Newman, DO1000 W. Hwy 6, Suite 410 Providence Express Care - LondonderryWoodway, TX 76712 7003 Woodway Drive, Suite 311P (254) 230-1234 Waco, TX 76712F (254) 718-3732 P (254) 537-6000 F (253) 537-6001Mark Kevin Moore, MDWaco Enter for Womens Health Karen Y. Ni-Jones, MD601 W State Highway 6, Suite 101 Hillcrest General SurgeryWaco, TX 76710-5592 50 Hillcrest Medical BoulevardP (254) 772-5454 Waco, TX 76710F (254) 772-6464 P (254) 202-7204 F (254) 202-7298James Edward Morrison, MDBaylor Scott & White Anastacia J. Nix, MDHillcrest Medical Center Hillcrest Bellmead Clinic100 Hillcrest Medical Boulevard 851 N Loop 340Waco, TX 76712 Waco, TX 76705P (254) 202-9416 P (254) 202-7500Boris Alberto Murillo, MD Alan Douglas Northcutt, MDWaco Lung Associates Central Texas Pathology Laboratory, PA340 Richland West Circle 601 W Hwy 6, Suite 111Waco, TX 76712 Waco, TX 76710P (254) 537-6601 P (254) 752-9621F (253) 537-6601 F (254) 752-8378James P. Myatt, MD Eric Franklin O’Neill, MDWaco Heart & Vascular 1000 W Highway 6, Suite 500300 Richland West Circle, Suite 1 Waco, TX 76712-3790Waco, TX 76712 P (254) 741-6832P (254) 235-9355 F (254) 741-0821F (254) 235-2135 Lance Gordon Oberg, MDDavid Stephen Myers, MD 213 A Old Hewitt RoadHillcrest Midway Clinic Waco, TX 767127702 Central Park Drive P (254) 772-6770Woodway, TX 76712 F (254) 772-8471P (254) 202-7700F (254) 202-7710 Ofobuike Okani, MD Texas Oncology - WacoLucinda Trippe Myers, MD 1700 W Hwy 6Scott & White Center for Waco, TX 76712Rehabilitative Medicine - Waco P (254) 399-07413000 Herring Ave F (254) 399-0779Waco, TX 76708P (254) 202-8494 Jamie M. Olejarski, MDF (254) 202-8649 120 Hillcrest Medical Ste 305-2 Waco, TX 76712-8948Gregory Stephen Newman, MD P (254) 297-0450Mid-Tex Anesthesia Associates, PA F (254) 297-0455405 Londonderry Drive, Suite 105Waco, TX 76712-7920P (254) 776-0266F (254) 776-2511 27

James Edward Olmsted, MD Benjamin F. Perry, MDWaco Radiology, PA Internal Medicine & Senior6901 Medical Parkway Health CenterWoodway, TX 76712 2201 Macarthur Drive, Suite 2200P (254) 751-4299 Waco, TX 76708F (253) 751-4549 P (254) 202-6500 F (254) 202-6510Danny P. Owens, MDHillcrest Trauma & Acute Care Scott Cy Peterson, DO100 Hillcrest Medical Boulevard Hillcrest Trauma & Accute CareWaco, TX 76712 50 Hillcrest Medical Blvd., Suite 105-1P (254) 202-7250 Waco, TX 76708-3239 P (254) 202-8599Ninad Dhanvantray Parekh, MD F (254) 202-8879Central Texas Nephrology Associates5940 Crosslake Parkway Darrell Ray Pietsch, MDWoodway, TX 76712 Cornerstone Medical GroupP (254) 666-2999 6600 Fish Pond Road, Suite 202AP (254) 420-2014 Waco, TX 76710-2582 P (254) 732-6789Courtney Blair Parker-Hudson, MD F (254) 732-6790Family Health Center1600 Providence Drive David M. Pinkstaff, MDWaco, TX 76707-2261 Central Texas UrologyP (254) 313-4213 601 W Hwy 6, Suite 105F (254) 313-4549 Waco, TX 76710-5592 P (254) 741-6113Dennis Leroy Parks, MD F (254) 741-6629Waco Readiology, PA6901 Medical Parkway William R. Pitts, MDWoodway, TX 76712 Waco Cardiology AssociatesP (254) 751-4299 7125 New Sanger, Suite AF (253) 751-4549 Waco, TX 76712-4054 P (254) 399-5400Jerod B. Patchin, DO F (254) 772-8669Providence Internal Medicine Clinic301 Richland West Circle Matthew Robert Porter, MDWoodway, TX 76712 Family Health CenterP (254) 537-6200 West Waco Community ClinicF (254) 537-6201 600 W Hwy 6 Waco, TX 76012Matt T. Pattillo, MD P (254) 313-6700Waco Lung Associates F (254) 313-6799340 Richland West CircleWaco, TX 76712 Jason R. Poteet, MDP (254) 537-6600 Central Texas UrologyF (254) 537-6601 601 W Hwy 6, Suite105 Waco, TX 76710-5592Rafael Jose Perez, MD P (254) 741-6113Intensivist Services of Wyoming F (254) 741-6629Wyoming Medical Center1233 E. Second St. Herman John Quinius, III, MDCasper,WY 82601 Waco Eye Associates, PAP (307) 577-2451 321 Richland West CircleF (307) 577-0479 Waco, TX 76712 P (254) 756-4457 28 F (253) 756-1718

Robert Craig Rainey, MD Kelley Margaret Reynolds, MDFamily Health Center Family Health CenterMeyer Center Community Clinic McGregor Community Clinic1226 Washington 500 Johnson DriveWaco, TX 76701 Mc Gregor, TX 76657-1441P (254) 313-6300 P (254) 313-5200F (254) 313-6349 F (254) 313-5299Stephen Paul Raley, MD Rodney Charles Richie, MDHillcrest Hewitt Clinic Waco Lung Associates1001 Hewitt Drive 318 Richland West CircleWoodway, TX 76712-8486 Waco, TX 76712-6163P (254) 202-7800 P (254) 537-6600F (254) 202-7856 F (254) 537-6601Samuel Warren Ralston, MD David Owen Risinger, MDProvidence Family Health Clinic Radiology Consultants of TexasWoodway Medical Plaza 100 Hillcrest Medical Boulevard6101 Woodway Drive, Suite 200 Waco, TX 76712Woodway, TX 76712 P (254) 202-4100P (254) 537-6300F (254) 537-6301 Joel Mark Rister, MD OB-GYN Associates of WacoMohamed Hussein Ramadan, MD 2501 Ambassador DriveCentral Texas Neprology Associates Woodway, TX 76712-89445940 Crosslake Parkway P (254) 752-4395Waco, TX 76712P (254) 666-2999 Claudius Emet Robinson, MDF (254) 420-2014 Central Texas Pathology Laboratory, PA 601 W Hwy 6, Suite 111Paul C. Redman, II, MD Waco, TX 76710Waco Center for Women’s Health P (254) 752-9621601 W State Highway 6, Suite 101 F (254) 752-8378Waco, TX 76710-5592P (254) 772-5454 Juan Jose Rodrigo, MDF (254) 772-6464 Southwest Sports Medicine 50 Hillcrest Medical Blvd., #303Phillip Hayward Reeder, MD Woodway, TX 76712Waco Gastroenterology Associates P (254) 741-1400364 Richland West Circle, Suite A F (254) 741-1428Waco, TX 76712-7919P (254) 537-0911 Deborah Neal Root, MDF (254) 537-0313 MHMR 110 S 12th StreetWoody J. Reese, MD Waco, TX 76701Central Texas Nephrology Associates P (254) 752-34515940 Crosslake Parkway F (254) 752-7421Waco, TX 76712-6986P (254) 666-2999 Maydee Annette Rosario Reglero, MDF (254) 420-2014 Waco Lung Associates 340 Richland West Circle 29 Waco, TX 76712-6163 P (254) 741-1688 F (254) 741-9767

Gerald Salinas, MD Marvin C. Schlecte, III, MDHillcrest Midway Clinic Waco Eye Associates PA7702 Central Park Drive 321 Richland West CircleWaco, TX 76712-6535 Waco, TX 76712-7919P (254) 202-7700 P (254) 756-4457F (254) 202-7710 F (254) 756-1718Roxann Migl Samples, MD Timothy J. Schmidt, MDMcLennan County Hospitalist Mid-Tex Anesthesia Associates, PAServices, PC/PHA 405 Londonderry Drive, Suite 1056901 Medical Parkway Waco, TX 76712-7920Waco, TX 76712 P (254) 776-0266P (254) 751-4551 F (254) 776-2511F (254) 751-4550 George Mark Schwartze, MDJeffrey Scott Sanders, MD 50 Hillcrest Medical Blvd, Ste 201-1Central Texas Urology Waco, TX 76712601 W Hwy 6 Ste 105 Phone (254) 297-0500Waco, TX 76710-5592P (254) 741-6113 Nicholas Schwedock, MDF (254) 741-6629 Family Health Center 1600 Providence DriveJennifer Lynn Sapp, DO Waco, TX 76707-2261Family Health Center P (254) 750-8200Sante Fe Community Clinic F (254) 750-83266005 25th Street, Suite 115P (254) 313-4316 Richard Elton Scott, Jr., DO Scott & White Center for RehabilitativeDavid John Schickner, MD Medicine at Hillcrest1105 Wooded Acres Drive, Suite 240 50 Hillcrest Medical Blvd., Suite 201Waco, TX 76710-4449 Waco, TX 76712-8954P (254) 292-1090 P (254) 297-0500F (254) 292-1100 F (254) 297-0506Timothy W. Schiller, DO Homayun Seirafi, MDHillcrest Bellmead Clinic 2410 Wycon Drive, Suite 204851 N Loop 340 Waco, TX 76712Waco, TX 76705-2592 P (254) 756-7770P (254) 202-7500 F (254) 757-2007F (254) 202-7599 John Buford Shelton, MDJohn Carlyle Schlabach, MD Providence Family Health Clinic1948 Rattler Hill Road Woodway Medical PlazaMcGregor, TX 76657 6101 Woodway Drive, Suite 200P (505) 879-1764 Woodway, TX 76712 P (254) 537-6300Marvin C. Schlecte, Jr., MD F (254) 537-6301Waco Eye Associates PA321 Richland West Circle Charles A. Shoultz, Jr., MDWaco, TX 76712-7919 Waco Cardiology AssociatesP (254) 756-4457 7125 New Sanger Road, Suite AF (254) 756-1718 Waco, TX 76712 P (254) 399-5400 30 F (254) 772-8669

Charles A. Shoultz, III, MD Sue Ellen Stanko, MDWaco Cardiology Associates 1201 Hewitt Drive, Suite 2047125 New Sanger Road, Suite A Woodway, TX 76712-8834Waco Cardiology Associates P (254) 741-9933Waco, TX 76712-4054 F (254) 741-9941P (254) 399-5400F (254) 772-8669 Kevin C. Steele, MD Family Health CenterBryce Copeland Shutt, MD Bellmead Community ClinicWaco Eye Associates PA 3400 Bellmead Drive321 Richland West Circle Waco, TX 76705Woodway, TX 76712-7919 P (254) 313-5400P (254) 756-4457 F (254) 313-5499F (254) 756-1718 Nicholas P. Steinour, MDDaniel Augustus Smith, III, DO Emergency Service Partners, LPCentral Texas Pathology Laboratory, PA 6901 Medical Parkway601 W Hwy 6, Suite 111 Woodway, TX 76712Waco, TX 76710 P (254) 751-4142P (254) 752-9621 F (254) 751-4177F (254) 752-8378 Charles Herbert Stern, MDScott Hatter Smith, MD Scott & White Clinic - WacoBrazos Valley Eye Physicians, PA 7700 Fish Pond Road5002 Lakeland Circle, Suite A Waco, TX 76710-1031Waco, TX 76710 P (254) 761-4444P (254) 752-2571 F (254) 761-4465F (254) 752-0699 Sharon Wright Stern, MDTed Ray Smith, MD Baylor University Health ServicesHillcrest Trauma & Acute Care 209 Speight Ave 2nd Floor50 Hillcrest Medical Blvd., Suite 105-1 Waco, TX 76706Waco, TX 76712-8946 P (254) 710-1010P (254) 202-7250 F (254) 710-2499F (254) 202-5349 Donald A. Stewart, MDKathleen Ann Sorensen, MD Central Texas UrologyWaco Radiology, PA 601 W Hwy 6, Suite 1056901 Medical Parkway Waco, TX 76710-5592Woodway, TX 76712 P (254) 741-6113P (254) 751-4299 F (254) 741-6629F (254) 751-4549 Stephen A. Stimson, MDLatrisha Faye Spain, MD Central Texas UrologyFamily Health Center 601 W Highway 6, Suite 105Bells Hill Community Clinic Waco, TX 76710-5592911 S 20th P (254) 741-6113Waco, TX 76706 F (254) 741-6629P (254) 313-5700F (254) 313-5749 Mark Walter Story, MD Central Texas UrologyJohn W. Speckmiear, MD 601 W Hwy 6, Suite 105Hillcrest Midway Clinic Waco, TX 76710-55927702 Central Park Drive P (254) 741-6113Waco, TX 76712-6535 F (254) 741-6629P (254) 202-7700F (254) 202-7710 31

George Alston Stovall, Jr., MD Elizabeth B. Turnage, MD405 Londonderry Dr Ste 303 Hillcrest Bosque ClinicWaco, TX 76712-7922 7300 Bosque BoulevardP (254) 399-6730 Waco, TX 76710F (254) 399-6738 P (254) 202-2600 F (254) 202-2694Taylor B. Strange, DOBrazos Eye Surgery of Texas William H. Turney, MD201 Londonderry Drive Waco Surgical Group, PAWaco, Texas 76712 6600 Fish Pond Road, Suite 101Phone (254) 772-4499 Waco, TX 76710-2582Fax (254) 772-4436 P (254) 776-3188 F (254) 776-3671Arthur Wayne Sudan, MDProvidence Internal Medicine Clinic Todd Brown Tyson, MD301 Richland West Circle Baylor Scot & White Health100 HillcrestWoodway, TX 76712-7932 Medical BoulevardP (254) 537-6200 Woodway, TX 76712-8897F (254) 537-6201 P (254) 202-2000Russell Eugene Swann, MD Edward Farley Verner, MDBrazos Eye Surgery of Texas Waco Infectious Disease Assoicates, PA201 Londonderry Drive 7030 New Sanger Road, Suite 202Woodway, TX 76712-7931 Waco, TX 76712-4074P (254) 772-4499 P (254) 772-4400F (254) 772-4436 F (254) 399-0247Michael P. Teichelmann, MD Gustavo G. Villarreal, Jr., MDMid-Tex Anesthesia Associates, PA Waco Radiology, PA405 Londonderry Drive, Suite 105 6901 Medical ParkwayWaco, TX 76712-7920 Woodway, TX 76712P (254) 776-0266 P (254) 751-4299F (254) 776-2511 F (254) 751-4549Ephraim I. Thaller, MD Thu P. Vo, DOAllergy & Asthma Center, PA Baylor Scott And White Clinic Gatesville333 Londonderry Drive, Suite 100 227 Memorial DriveWaco, TX 76712-7930 Gatesville, TX 76528P (254) 751-1144 P (254) 248-6500F (254) 751-1185 F (254) 248-6594Christopher N. Thompson, MD Hayley Suzanne Voige, DOCentral Texas Pathology Laboratory, PA Family Health Women’s Health Center601 W Hwy 6, Suite 111 120 Hillcrest Medical Blvd., Suite 300-2Waco, TX 76710 Woodway, TX 76712P (254) 752-9621 P (254) 313-6500F (254) 752-8378 F (254) 313-6599Reagan Tipton, DO Zoe M. Walker, MDLegends Clinic Hillcrest Bellmead Clinic50 Hillcrest Medical Blvd., Suite 104 851 N Loop 340Woodway, TX 76712 Waco, TX 76705P (254) 202-7300 P (254) 202-7500 F (254) 202-7599 32

Chia-Lien Wang, MD Darrell Stafford Wheeler, MD2410 Wycon, Suite 204 Waco Neonatal GroupWaco, TX 76712 100 Hillcrest Medical BoulevardP (254) 752-9221 Waco, TX 76712F (254) 755-7064 P (254) 202-2911 F (254) 714-0650Joshua J. Warren, MDProvidence Clinic DePaul Jeff R. White, MD301 Londonderry Drive Department of RadiologyWaco, TX 76712 6901 Medical ParkwayP (254) 751-4800 Waco, TX 76710F (254) 751-4885 P (254) 751-4299 F (254) 754-4549Russell Scott Warren, MDHeart of Brazos Oral & Facial Surgery PA Thomas Miller White, MD103 Burnett Court Mid-Tex Anesthesia Associates, PAWaco, TX 76712-3100 405 Londonderry Drive, Suite 106P (254) 399-9925 Waco, TX 76712-7920F (254) 399-9930 P (254) 776-0266 F (254) 776-2511Sonia Rosalin Watley, MDFamily Health Center Patricia Ann Wilcox, MDBells Hill Community Clinic Providence Family Health Clinic911 S 20th Street Sanger AvenueWaco, TX 76706 6614 Sanger AvenueP (254) 313-5700 Waco, TX 76710-4253F (254) 313-5749 P (254) 537-6100 F (254) 537-6101Floyd C. Watson, MDFamily Health Center Robert Wayne Wilcox, MDSouth 18th Street Community Clinic Providence Family Health Clinic1800 Gurley Lane Sanger AvenueWaco, TX 76706-4025 6614 Sanger AvenueP (254) 313-6000 P (254) 537-6100F (254) 313-6099 F (254) 537-6101Jose Vernon Watson, MD Linda Ann Williams, MDRadiology Consultants of Texas 1 Bear Pl Unit 97060100 Hillcrest Medical Boulevard Waco, TX 76798-7060Woodway, TX 76712 P (254) 710-1010P (254) 202-4100 F (254) 710-2499F (254) 752-3717 Roger T. Williams, MDJosephine E. Watson, MD Mid-Tex Anesthesia Associate, PAFamily Health Center 405 Londonderry Drive, Suite 105South 18th Street Community Clinic Waco, TX 76712-7920Waco, TX 76706 P (254) 776-0266P (254) 313-6000 F (254) 776-2511F (254) 313-6098 Benjamin A. Wilson, MDSally Pyle Weaver, MD Family Health CenterFamily Health Center Bellmead Community Clinic1600 Providence Drive 3400 Bellmead DriveWaco, TX 76707-2261 Waco, TX 76705P (254) 750-8200 P (254) 313-5400F (254) 750-8326 F (254) 313-5499 33

Rebekkah L. Wilson, MD Valerie K. Wright, MDFamily Health Center Aesthetic Surgery Center of WacoMadison Cooper Community Clinic 7030 New Sanger Road, Suite 2041601 Providence Drive Waco, Texas 76712-6163Waco, TX 76707-2261 P (254) 741-1711P (254) 313-4800 F (254) 751-6998F (254) 313-4899 Terriawkia Aurelia Woods, MDRonald Louis Wilson, MD Family Health CenterHillcrest Internal Medicine & Women’s Health CenterSenior Health Center 120 Hillcrest Medical Blvd., Suite 300-22201 MacArthur Drive, Suite 2200 P (254) 313-6500Waco, TX 76708 F (254) 313-6599(254) 202-7130 Adam W. Ylitalo, DORobert E. Wolf, MD Hillcrest UrologyElite Sports Medicine Center, PA 50 Hillcrest Medical Blvd., Suite 102-15100C Franklin Avenue, Suite C Waco, TX 76712Waco, TX 76710 P (254) 202-7900P (254) 754-0375F (254) 754-2667 Donald Jeffrey Young, MD Central Texas Cardiovasular, PARobert Max Wright, Jr., MD 405 Londonderry Drive, Suite 301Aesthetic Surgery Center of Waco Woodway, TX 76712-40547030 New Sanger Road, Suite 204 P (254) 741-6333Waco, Texas 76712-6163 F (254) 741-6364P (254) 741-1711F (254) 751-6998 T:7” T:4.625”my weapon against arthritis What’s your weapon? Visit FightArthritisPain.org 34

Robert T. Angel, MD Retired Physicians Donald Lester Risinger, MDMichael Attas, MD William N. Roddy, MDWilliam Robert Beaty, MD Robert Wynn Grayson, MD Dianne Waddell Sawyer, MDWilliam E. Blair, Jr., MD Stanley Hersh, MD J. Clay Sawyer, MDJames Alan Bowden, MD William Daniel Hillis, MD Robert Hibberd Saxton, MDRobert Gordon Brown, MD Horace Gibson Hinson, MD Terri Davis Schmidt, MDSimon Milford Bunn, Jr., MD Charles Engle Huffman, MD Erich W. Schwartze, MDJames V. Campbell, MD Thomas Henry Jackson, Jr., MD Ross F. Shipp, MDLawrence C. Canning, MD John Sid Jones, MD Ann Knight Sims, MDKaren Carmody, MD Edward Morris Lee, MD J. William Smith, MDPhilip George Cochran, MD Michael Gerard Leonard, MD Robert R. Springer, MDWilliam Pierce Coleman, Jr., MD Marcial G. Lewin, MD Bryan Stone, MDJames L. Copeland, Jr., MD Donald Kemp Lewis, MD Ronald J. Swift, MDRobert Francis Corwin, MD J. Hall Lindsey, MD Jacqueline Ann Torell, MDStephen Herbert Corwin, MD Thomas E. Lundeen, MD Lucy Konop Villarreal, MDDavid S. Dow, MD Hendley Austere McDonald, MD Jackson Kyle Walker, MDCharles Henry DuLaney, MD Edwin Bigger Morrison, MD Robert Wayne Walter, MDArthur F. Evans, MD Wilbur Gene Murff, MD May Y F Wang, MDJames William Ferguson, MD Kian Bing Oei, MD Eric J. Wilson, MDJose W. Galeano, MD Terry Lynn Parvin, DO Benjamin E. Wiseman, MDRobert A M Gardere, MD James Russell Patton, Jr., MD Jerry R. Wright, MDJose Manuel Garrido, MD Gerald Gene Pitman, MD Pat Pryor, MD Ross Burney Reagan, MD Residents1600 Providence Drive, Waco, TX 76707-2261 | P (254) 750-8200 | F (254) 313--4483Sheby S. Alexander, MD Grace M. Hecker, MD Jonathan D. Seale, MDCalvin Frank Bradley, MD Emily S. Hsu, DO Nicole R. Bussiere, MDEric Lyle Braun, MD Jay Matthew Jackson, MD Sherry C. Spacek-Llanas, MDSamantha Adriana Conroy, MD Mai Truc Lam, MD Joshua Brent Stake, DOShane Christopher Constable, MD Ryan David Laschober, MD Brandi Escalante Street, MDJoylin P. Cover, MD Candice Ji Eun Lee-Wang, MD Iris A. Tomas, MDKeri J. Cummings, MD Samuel Josiah Lindquist, MD Christopher D. Vera, DOCrystal Estrada, MD Isaiah Robert Logan, MD Burton Timothy Wang, MDMarissa Flores, MD Taylor Dale McCain, DO Thomas James Webb, MDRoss E. Hairgrove, MD Stephen McCall, MD Joshua David Wesley, MDRex Lee Harris, MD Lauren A. Riddle, MD Amanda Marie Ferguson Wood, MDJames Casey Heap, MD Jennifer M. Seale, MD Rachell Young, MD 35

Sports Medicine Fellows Jaeson Courseault, MD Jon-Michael G. Cline, DOSue Ellen Angel Alliance Members Diane SchlecteJody Barbin Sarah W. ScottJeanne Becker Tammy Hector Jane ScruggsBeth Boehm Diane Henderson Sue ShippTeresa Contreras Amanda Holland Franny ShoultzRusty Corwin Bradford W. Holland, MD Mary Louise SigtenhorstSandy Corwin Loeen Irons Mark Walter Story, MDSandra Covington Febes Kavanagh Norma TandyCarol Crosthwait Martin F. Kemper Sara TeichelmannMarjorie Edwards Sudhir Madisetty, MD Kay TurneyGeneva Gamble Denise Martindale Marta A. WatsonEdith Hill Gibney Sean D. McCarthy, MD Marjorie S. WentworthRosemary Goertz Roxanne E. Parks Lori WilliamsHilary Sharp Grant Betsy Reeder Christi YoungKathleen Guy Nancy ReidAllison Harkins Sara Richie Elsa Sanders Brooke Schlecte Rev. 7/21/16 36

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