Evidence-Based Care
Bidwell Health clinicians follow published, peer-reviewed guidelines from national professional societies. This page summarizes our public, guideline-based clinical scope: the standards, first-line medications, and referral criteria for our core online visit types. It is not a substitute for clinician judgment, and individual prescribing decisions depend on each patient's history, symptoms, contraindications, and state-specific requirements.
Guidelines
ICD-10: N39.0 · Primary source: Infectious Diseases Society of America (IDSA)
For uncomplicated lower UTIs in non-pregnant adult women with classic symptoms, IDSA guidelines support empirical antibiotic treatment without requiring a urine culture. Our clinicians follow this empiric-treatment pathway, selecting first-line agents based on local resistance patterns and patient history.
We refer patients to in-person care with any of: fever of 100.4°F (38°C) or higher, flank pain, visible blood in urine, nausea or vomiting, pregnancy, recurrent UTIs (two or more UTIs in six months or three or more in twelve months), history of stones or urologic surgery, immunosuppression, or male patient. These situations require urine culture and often imaging.
Read the IDSA UTI guideline → How Bidwell decides if UTI antibiotics are appropriate →
ICD-10: B37.3 · Primary source: CDC STI Treatment Guidelines · American College of Obstetricians and Gynecologists (ACOG)
Our online visit asks about symptoms, pregnancy, fever, pelvic pain, severe symptoms and STI concerns, and collects medications and allergies for clinician review. First suspected episodes are eligible for assessment. No pelvic exam is performed during your online visit. A licensed clinician reviews your symptoms and health information and determines whether online treatment is appropriate. If testing or an in-person examination is needed, we explain the next step.
We refer for in-person evaluation if the patient is pregnant, is immunosuppressed, has uncontrolled diabetes, has unusual discharge suggesting a different diagnosis, or has failed prior empiric therapy. Fever of 100.4°F (38°C) or higher, pelvic pain, severe symptoms and STI concerns also require in-person care. Three or more symptomatic yeast infections in less than a year are considered recurrent. Repeated infections warrant clinical evaluation and testing and may require a longer treatment plan. Recurrent infections are considered individually by your clinician. Depending on your history and symptoms, testing, an in-person evaluation or a longer treatment plan may be recommended.
Read the CDC Candidiasis guideline → Read the ACOG Vaginitis bulletin →
ICD-10: N76.0 · Primary source: CDC STI Treatment Guidelines
CDC recommends treating symptomatic BV. Symptoms and history can guide an online assessment, but they do not confirm the diagnosis. Your clinician decides whether treatment is reasonable or an examination or laboratory testing is needed.
Pregnancy, fever, pelvic pain, concerning bleeding, STI concerns or symptoms following a gynecologic procedure need an appropriate in-person assessment. Recurrent BV receives individual clinician review. Persistent symptoms or repeated treatment failure may need testing and ongoing care; long-term suppression is outside this routine visit.
Bidwell offers a separate $45 online evaluation for eligible adult male partners of someone with clinician-diagnosed BV. This pathway is intended to reduce recurrence in the diagnosed partner, especially recurrent symptomatic BV; it is not a diagnosis of vaginal BV in the male patient. A first or uncertain episode and treatment timing require individual review. Each partner needs their own assessment.
When appropriate, the regimen combines metronidazole 500 mg orally twice daily for 7 days with clindamycin 2% cream applied externally to the penile head and shaft twice daily for 7 days. External use of the cream is off-label. Do not substitute vaginal metronidazole gel or clindamycin 1% acne products. NYSDOH partner-treatment guidance and the 2025 ACOG update explain the evidence supporting this pathway.
The partner intake screens symptoms/STI concerns, medication risks and relevant medical history before payment. Positive safety answers stop this online pathway and give an in-person care recommendation; they are not all absolute drug contraindications. Coordinate both partners' treatment, avoid sexual contact until both finish, and avoid alcohol and oral propylene glycol during metronidazole and for at least 72 hours afterward. Follow the clindamycin latex-barrier precautions. Full partner eligibility and patient instructions.
ICD-10: F52.21 · Primary source: American Urological Association (AUA)
AUA guidelines call for cardiovascular risk assessment before prescribing PDE5 inhibitors. Our intake screens for nitrate use, recent cardiovascular events, uncontrolled hypertension, and significant comorbidities before any PDE5 inhibitor is prescribed.
We refer for in-person urology or cardiology workup if the patient has new ED under age 40, chest pain or shortness of breath on exertion, known cardiovascular disease with uncontrolled status, Peyronie's disease symptoms, priapism history, or has failed maximum-dose PDE5 trial.
ICD-10: L64.9 · Sources: AAD resources and medication labeling
Bidwell's current hair-loss service is for adult men with a pattern consistent with androgenetic alopecia. History and photos support clinical assessment; sudden, patchy, inflamed or uncertain hair loss may require examination or tests. AAD resources describe finasteride and topical minoxidil as treatment options. That does not make all formulations FDA-approved or suitable for every patient.
Available visit paths are finasteride only, finasteride with oral minoxidil, dutasteride with oral minoxidil, dutasteride only, and oral minoxidil only. Selection is subject to clinician review, not a promise of a prescription. The visit requests two scalp photos: front hairline and crown.
We refer for in-person assessment for patchy or scarring loss, sudden shedding, scalp inflammation, suspected systemic causes or an uncertain diagnosis. Significant cardiac disease or uncontrolled blood pressure needs in-person assessment before oral minoxidil is considered. Chest pain, trouble breathing or fainting requires emergency care, not a portal message. New swelling, rapid weight gain or a racing heartbeat needs prompt medical assessment.
Your visit includes 21 days of follow-up messaging, starting when we first confirm delivery of your care-summary email or you first view the summary in your portal, whichever happens first. You do not need to open the email for that period to start. Further clinical care after that period requires a new $45 visit. Your records and authorized pharmacy refills remain available after messaging ends.
AAD hair-loss resources · Finasteride label · Dutasteride label · Oral minoxidil label · Men's 5% foam label
ICD-10: H02.729 · Primary source: DailyMed/FDA prescribing information for Latisse (bimatoprost ophthalmic solution) 0.03%
DailyMed labeling describes bimatoprost ophthalmic solution 0.03% as a prescription treatment for hypotrichosis of the eyelashes, increasing eyelash growth including length, thickness, and darkness. Bidwell reviews eyelash growth visits for eligible adults ages 18 and older and does not guarantee treatment.
We refer for in-person eye care or primary care if the patient has glaucoma or elevated eye-pressure history requiring ophthalmology management, active eye redness or pain, vision changes, eye infection, eyelid inflammation, recent eye surgery, uncertain diagnosis, pregnancy or breastfeeding, or any symptom pattern suggesting the visit is not cosmetic eyelash hypotrichosis.
ICD-10: B00.9 · Primary sources: CDC STI Treatment Guidelines and DailyMed valacyclovir labeling
CDC guidance supports antiviral therapy for recurrent genital herpes and describes episodic and suppressive treatment approaches. Bidwell treats only adults ages 18 and older who already have a prior oral or genital herpes diagnosis from a healthcare provider. Bidwell does not diagnose new herpes infections online and does not provide STI testing.
We refer for in-person care for a first-ever outbreak, uncertain diagnosis, lesions near the eye, eye redness or vision changes, severe illness, neurologic symptoms, immunocompromising conditions, pregnancy or breastfeeding, severe genital pain, urinary retention, suspected STI exposure needing testing, or any presentation that requires exam or lab confirmation. Call 911 for new confusion, a seizure, new weakness, difficulty speaking or loss of consciousness. A severe headache with a stiff neck needs emergency care now. Do not wait for an online visit or portal reply.
Read the CDC Herpes guideline → · NHS: encephalitis emergency symptoms Read the Valtrex prescribing information →
Patient pages: cold sore and oral herpes treatment and genital herpes treatment.
Not a diagnosis · Primary source: American Academy of Family Physicians (AAFP) continuity-of-care standards
AAFP continuity standards recognize that short-term bridge refills are appropriate when a patient with a stable chronic condition is temporarily without access to their regular prescriber (travel, insurance gap, primary-care transition). Bridge refills are short, documented, and explicitly time-limited.
We require the patient to establish or re-establish a primary care relationship for ongoing management. We refer back to primary care or specialty care for any dose change, any new or uncontrolled symptoms, any medication outside the bridgeable list, or any sign that the underlying chronic condition needs reassessment.
Travel medicine
Bidwell Cranage is a Member of the International Society of Travel Medicine and shares personal travel experience on some destination pages, but every prescribing decision here follows the clinical guidelines, drug labels, and licensure below, not lived experience. We prescribe only what is appropriate for an asynchronous visit and refer the rest to a travel clinic. The same scope is published in machine-readable form at /data/travel-medicine-scope.json.
ICD-10: T75.3 · Primary source: CDC Yellow Book · DailyMed (Transderm Scop label)
For adults who get seasick, carsick, or airsick, we prescribe a transdermal scopolamine patch for prevention, started before travel. We screen for anticholinergic contraindications and the FDA June 2025 heat warning, and prescribe only to adults 18 and older, which excludes the children 17 and younger whom the FDA flagged as highest heat risk. Patients over 60, the other group the FDA flagged, are counseled on the heat risk and attest to watching for heat-related symptoms.
We refer for allergy to scopolamine or belladonna alkaloids, narrow-angle glaucoma, significant prostate or urinary-retention problems, bowel obstruction, myasthenia gravis, pregnancy or breastfeeding, or anyone who must drive or operate a boat, aircraft, or machinery while wearing it. We counsel on the FDA heat and reduced-sweating warning.
ICD-10: T70.20 · Primary source: Wilderness Medical Society 2024 Acute Altitude Illness guidelines · CDC Yellow Book · DailyMed (acetazolamide label)
For travel to sleeping altitudes above roughly 8,000 ft, especially with rapid ascent or prior altitude illness, we prescribe acetazolamide to speed acclimatization. Gradual ascent remains the primary prevention; the medication supplements it and does not replace descent when warning signs appear.
We refer for the contraindications above, significant heart or lung disease, pregnancy or breastfeeding, or active warning signs of severe altitude illness (confusion, trouble walking, breathlessness at rest, cough with frothy spit). Those mean descend and seek emergency care, not more medication.
Read the WMS 2024 altitude guideline → Altitude sickness service →
ICD-10: A09 · Primary source: CDC Yellow Book · DailyMed (azithromycin label)
For travel to higher food-and-water-risk regions, we prescribe a standby azithromycin course to carry and start only for moderate-to-severe illness. Following CDC guidance, antibiotics are reserved for significant illness, not every loose stool, and oral rehydration is the primary treatment.
We refer for macrolide allergy, long-QT or QT-prolonging medicines, myasthenia gravis, severe liver disease, pregnancy, or anyone currently sick with bloody diarrhea, high fever, inability to keep fluids down, or diarrhea during or after a recent course of antibiotics (possible C. difficile). Those need in-person care.
ICD-10: Z29.8 · Primary source: CDC Yellow Book and CDC Malaria Information by Country · DailyMed
We match the drug to current CDC guidance for the patient's exact destination and dates, and offer doxycycline or atovaquone-proguanil within Bidwell's service scope. Other prevention medicines may be appropriate through a travel clinic; they are not universally unsuitable for remote care. Pills do not replace mosquito-bite avoidance, which we counsel on every visit.
We refer any trip where the CDC does not list doxycycline or Malarone for a stop, any itinerary needing mefloquine, primaquine, or tafenoquine, and pregnancy or breastfeeding. Drug selection: avoid doxycycline with isotretinoin and avoid Malarone in severe kidney disease. An allergy or contraindication to one does not automatically make the other appropriate; the clinician checks the alternative against the full itinerary, history and medication list.
CDC Yellow Book → Malaria prevention service → How we decide →
ICD-10: Z87.892 · Primary source: DailyMed (epinephrine auto-injector label) · AAAAI anaphylaxis guidance
A refill, replacement, or travel-backup service for adults with a diagnosed severe allergy or a prior auto-injector prescription. It is not for diagnosing a new allergy or for an active reaction.
We refer anyone with no prior diagnosis or device, an active reaction now (use epinephrine and call 911), a wish for allergy testing or a new diagnosis, or pregnancy or breastfeeding (we refer the refill, though epinephrine remains first-line in anaphylaxis regardless). Asthma and stable heart disease do not disqualify a patient; asthmatics are at highest risk and most need the device.
Process
Every intake is read by a licensed clinician, never auto-approved by a rules engine. The intake collects the information a clinician needs, organized around the decision criteria above. The prescribing decision is always made by the licensed clinician reviewing the individual case, using their independent clinical judgment, and never by the form or a rules engine. When a patient does not fit the empirical-treatment protocol, the clinician refers them to the right level of care.
If anything in the intake falls outside protocol (a symptom pattern that suggests something we don't treat, a contraindication, a red-flag finding, a medication interaction) the provider messages you inside your portal or refunds the visit. We don't prescribe outside protocol to force a fit.
Conditions, medications, and red flags — all handled per the protocols above.
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