2013 COMMUNITY SERVICE PLAN A CONNECTION TO WELLNESS AND BETTER HEALTH IN OUR COMMUNITY Brookhaven Memorial Hospital Medical Center (BMHMC) is a voluntary, not-for-profit community hospital in Patchogue, Suffolk County, New York. Brookhaven has maintained a commitment providing access to quality health care for since its founding in 1956. Since that time, Brookhaven has grown from a 100-bed hospital founded to meet the needs of the Village of Patchogue to a Medical Center with an operating license for 306 beds that serves the lives of more than 350,000 people living in 28 different communities. The 2013 Community Service Plan will provide an overview of the Medical Center and its plans for providing access to care for the community for the upcoming years. Mission Statement It is our mission is to deliver accessible, high-quality health services in a focused caring and teaching environment while providing health advocacy for the community and people we serve. Vision The vision for Brookhaven is delivering leading edge health care solutions through a focused and compassionate team in technologically advanced facilities. Achieving the capacity to invest in the future enables us to create recognized Centers of Excellence, provide a learning culture, and become the employees’ and patients’ provider of choice Core Values Quality – performing at the highest level of expertise to produce the best outcomes; Compassion – treating others with concern, interest, and caring; Integrity – honesty in all of our actions and interactions; Dignity- treating others with respect and courtesy; Responsibility and Accountability – owning one’s action and their consequences. We provide that care through a 306-bed acute-care hospital that’s part of a multidisciplinary, multi-campus, state-of-the-art healthcare complex, designed to meet the evolving needs of the 28 Suffolk County communities we serve.

BMHMC 2013 Community Service Plan While much has changed since we first opened our doors to the community in 1956, our patient-centered approach to healthcare remains as strong as ever. Today, we are home to some of the finest centers for specialized care along with a Level II Trauma Center/Emergency Room, two Community Health Centers in partnership with Suffolk County and more. The Medical Center also was the first in the county to establish a Certified Home Health Care Department, a Hospice and an outpatient Hemodialysis unit and is a leader in health education throughout the community.

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For more information about the programs and services offered by BMHMC, please call 631.654.7708 or visit www.brookhavenhosptial.org.

BMHMC 2013 Community Service Plan Community Service Plan-At-A- Glance The chart below provides an overview of the scope of the 2013-2015 Community Service Plan for BMHMC. The areas of focus are for community and employees. BMHMC will be reaching out to a wide variety of organizations within the community to offer educational programs as well as services to assist in living healthier lives and making better health choices.

BMHMC Community Service Plan 2013-2015 Objective: Provide programs and services that address Diabetes and Obesity in the communities served by the Medical Center Areas of Focus

2013

2014

2015

Develop Communication Survey Plan and Initial Assessment Process

Conduct Survey and Assessment

Conduct Survey and Assessment

Employee Based

Wellness Benefit Programs

Nutritional Services

Shops and Vending Options

Report Findings

Community Outreach

Community Awareness and Education

Market CSP Internally and Externally

Report on Findings

At-Large BOCES School Districts Medical Lecture Series Self Awareness Education Programs Types I & II

Program Plan Development

Update CSP

Community Partners

Patient Council

Provide Service Links

Modify Implementation Plan

Service Clubs YMCA's

Implementation

Boys and Girls Clubs Continue with Implementation

Houses of Worship Libraries NFP Organizaitons

Community Benefit

Maintain Service Links Charity Care Bad Debit

Continue with Classes and Lectures Provide Class and Lectures

Time/Talent

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BMHMC 2013 Community Service Plan

Community Served We serve the needs of 28 towns and villages in Suffolk County. The Medical Center’s primary and secondary service area census is 350,000 persons and includes Brookhaven (one of the fastest growing towns in New York), and expands from west to east from Sayville to Moriches and north to Coram and Selden. Currently the current highest number of visits originate from the town of Patchogue, which has a large number of minorities (28% Latinos and Blacks), and an individual median income that on average is approximately $37,000 less than other Suffolk County residents, and is even lower than the New York State median income. While the County has areas of wealth, the population served by the Medical Center contains 7 out of 10 communities with the lowest median income in Suffolk County. Approximately 85,162 individuals in Suffolk County live below the federal poverty level. Brookhaven operates the South Brookhaven Family Health Center in Patchogue and Shirley on a contractual basis with Suffolk County Department of Health. There is an Advisory Council for these Health Centers comprised of public health advocates and patients.

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BMHMC 2013 Community Service Plan Public Participation The Medical Center has established a leadership position in health promotion, prevention and education throughout the community. Regional health planning is accomplished through a number of Agency contacts including the Suffolk County Department of Health, Mental Health Agencies and the New York State Department of Health. Brookhaven Memorial Hospital Medical Center is dedicated to communicating with key staff and community members, as the Hospital prepares to plan for the future health care needs of the people we serve. Brookhaven Memorial Hospital Medical Center was founded by a community focused Board of Directors and continues with more than 25 members from the community serving on the governing Board. In addition, the Medical Center established an Advisory Council to receive further input of the needs of the community’s residents. There are more than 30 members on the Advisory Council. Members are typically active in other areas of the community and including: civic leaders, members of the clergy, school representatives, public health advocate; business leaders and service club members. Community Outreach has long been a mainstay for Brookhaven Memorial Hospital Medical Center. Brookhaven’s outreach program participates in community health fairs in senior and community centers as well as civic associations throughout the region. The Medical Center is also an active member of eight Chambers of Commerce in the community. Membership with these chambers affords Brookhaven the opportunity to learn of the needs of the workforce and business leaders in the community. Brookhaven has a strong presence in the civic and service Clubs,(e.g. Kiwanis, Rotary Club, Lions,) houses of worship, the YMCAs and Boys and Girls Clubs, local government health and social service programs, the social service agencies. senior living communities and public libraries. Through its Emergency Management program, Brookhaven Memorial Hospital Medical Center communicates on a regular basis with the 28 voluntary EMS, EMT and Fire Departments in its service area. These volunteer departments provide an invaluable service to the community. As the 911 responders in the community, they are intimately familiar with the needs of the community. Through regular dialogue, Brookhaven learns of the unmet needs in the community and is able to assess its ability to meet those needs or provide connections to available services. BMHMC provides a wide variety of programs and services in our community. The most encompassing of these is its county-wide recognized Home Health Agency. Our certified Home Health Care is a successful means of providing high-quality healthcare services. The need for service will be determined by the patient’s physician, in consultation with the professional nurse coordinator, the patient and the family. These services bring to your home the same professional care you receive at the hospital.

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BMHMC 2013 Community Service Plan These services may: • Shorten or prevent an inpatient stay in the hospital. • Provide a smooth transition from the hospital to the home. • Prevent or delay placement in a nursing facility. • Help reduce the stress on the patient and family. Home Care makes it possible for patients to continue their recuperation at home with the availability of services provided by skilled professionals. It is also available to individuals who have not been recently hospitalized if they still meet the eligibility criteria. Home Care also provides a Telehealth program for its home care patients. Telemonitoring involves collecting and sending biometric and symptom data from patients’ homes to nurse care coordinators. Daily readings enable nurses and physicians to intervene early, resolving health problems before they become crises. Nurses also counsel patients, teaching them to live successfully with chronic diseases. Telemonitoring improves quality of care and health, and reduces the cost of care. Telemonitoring functions through several mechanisms. First, it gives clinicians insight into a patient’s condition when the patient is at home, without a lengthy phone call or home visit. Blood pressure, temperature, weight, blood glucose, blood oxygen, selfreported symptoms and other biometric data can be measured by patients at home and uploaded automatically. If a patient’s health is deteriorating, our clinicians know about it early, often early enough for a home or office visit instead of a trip to the ER or a hospital admission. In addition to improving the transition from hospital to home, it helps people with chronic diseases such as diabetes become better patients. When readings are outside an acceptable range, care coordinators help patients understand how their health behaviors— skipping a few pills, eating a high salt meal, etc.—create the adverse readings that threaten their health. Telehealth offers powerful ‘teachable moments’ to show patients how their self-care behaviors affect their health. Our Behavioral Health Home Care Program can support those in the community with Behavioral Health illnesses who are also learning to manage Diabetes. There can often be high levels of non-compliance in this patient population. Through this program we can provide home visits by a Registered Nurse, Nutritional Therapist, Social Worker and Physical and Occupational Therapy if needed.

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BMHMC 2013 Community Service Plan Assessment and Selection As an active member of the Nassau-Suffolk Hospital Council, Brookhaven has been an extremely engaged participant in assessing the needs of the community at large and the region. BMHMC collaborated with the Council as well as the Suffolk County Department of Health to select Prevention of Chronic Disease as the priority for Suffolk County. The Community Health Assessment indicated there were substantial needs for addition programs and services for the prevention and chronic disease management of diabetes and for the reduction of obesity in the community. Through our assessment efforts, BMHMC has learned some very salient facts that were provided tremendous influence in selecting diabetes and obesity as the areas of focus for the Community Service Plan. Suffolk County Population 12% of the residents are uninsured, which is greater that then national percentage of 11%. 22% of youth live in single family households compared to a national average of 20% . According to the Robert Wood Johnson Foundation and the University Wisconsin Population Health Institute, 22% of children living in Suffolk County have inadequate social supports. Their data reveals that the US, the average rate is 14%. Fewer people --13 out of every 100,000 individuals-- have access to recreational facilities in Suffolk County as compared to other counties in America: 16 out of every 100,000 people. There are more fast food restaurants in Suffolk County per person, in comparison to the rest of the country; there are 48 restaurants per 100,000 people vs. 27 out of every 100,000 persons. 70 (out of every 100,000) people living in Suffolk County had preventable hospital admissions in 2012. This overall number for the US per 100,000 people was much lower at 47 (Robert Wood Johnson Foundation). 74% of Suffolk County residents are at risk for pre-mature deaths because they don’t have access to or don’t eat enough fruits and vegetables. 28% of Suffolk County residents are at risk for pre-mature deaths because they don’t get enough exercise. Diabetes Diabetes is one of the leading causes of death in New York State, (excluding New York City), according to the New York State Department of Health’s Vital Statistics. Diabetes mortality rates are 14% of all deaths in Suffolk County and are the highest in the region.

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BMHMC 2013 Community Service Plan Diabetes hospitalization rates in Suffolk County are also highest in the region at 15.9%. The percentage of adults diagnosed with diabetes in Suffolk County is 9%, compared to Nassau County, which is 5.9%. Fewer adults in Suffolk County have undergone diabetic screenings than throughout the entire nation. 6.3% of Suffolk County residents are at risk for pre-mature death due to diabetes. Obesity 20% of Suffolk County residents are at risk for pre-mature death due to obesity. 16.5% of all school children—elementary, middle and high school youth-- are obese in Suffolk County. In Nassau County, 13.6% are obese.. 26% of adults eat 5 or more fruits or vegetables per day. The Nassau County percentage is 27.3. Age-adjusted percentage of adults who did not participate in leisure time physical activity in last 30 days—latest available data (2008-2009): 79% in Suffolk County. New York State County overall average is 76%. 23.4% of pregnant women in WIC were pre-pregnancy obese (BMI 30 or higher). 26% of individuals in Suffolk County are obese. In the US at large, 25% of individuals are obese. BMHMC Employees BMHMC employs more than 2,300 full and part time and per diem workers. More than 65% of these employees live within the hospital’s primary and secondary service area. As such, through a focused effort with specific initiative opportunities, there is a unique opportunity to provide for a healthier workforce and improve the overall health of our community. Discharges In 2012, among the BMHMC patient population, the number of hospital discharges with diabetes listed as the first diagnosis exceeds 400 patients with more than 25% being readmitted. In the same period (2012) the number of patients at BMHMC with a secondary diagnosis of diabetes exceeded 1713 with more than 38% of those patients being readmitted has increased by more than 50% over the last 10 years to more than 688,000 lives. In the same people, hospital discharges with diabetes as any-listed diagnosis increased from 2.8 million to nearly 5.5 million in the last primary diagnosis of Diabetes

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BMHMC 2013 Community Service Plan Readmissions Readmission rates for patients who suffer from diabetes and other comorbidities is much higher, especially for patients with chronic obstructive pulmonary disease, heart failure, cardiac arrhythmias, renal failure and red blood cell disorders.

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BMHMC 2013 Community Service Plan The focus of BMHMC’s Community Service Plan is to provide resources and services to at-risk members of the community who are dealing with diabetes and obesity and other health related issues. Diabetes Wellness Center BMHMC hosts free education programs provided by the Suffolk County Department of Health Services (through the NYS Diabetes Prevention Program) regarding Pre – Diabetes. Prediabetes is a serious health condition that can lead to diabetes, heart disease, and stroke. Most people with prediabetes don’t know that they have the condition. The New York State Diabetes Prevention Program (NYS DPP) has proven to prevent diabetes in people who have prediabetes or who are at high risk for diabetes. Over 16 weeks, a trained lifestyle coach leads one-hour weekly sessions to help participants improve their food choices, increase physical activity, and learn coping skills to maintain weight loss. By making small lifestyle changes, participants can reach the two main goals of the NYS DPP: • Lose 5-7% of body weight and keep it off • Be more physically active In 2006, BMHMC developed the Diabetes Wellness Center with the support of the Suffolk County Lions Diabetes Education Foundation http://sclionsdiabetes.org/ and Lions International. The Center has a Diabetes Self-Management Education Program and offers a series of educational programs “Living Well While Managing Your Diabetes” for those learning to manage with diabetes in their life. The classes are held at the Brookhaven Diabetes Wellness Center located at 33 Medford Ave, Patchogue, NY 11772. For more information please call 631.687.4188. School-Based Programs As a component of the 2013-2015 CSP, BMHMC will be seeking funding to provide diabetes and obesity educational programs through a program called “Creating Health Communities – One Family at a Time” (CHC). CHC will identify patient populations that are at risk within the BMHMC service area. It will assess the resources currently available within boundaries of the school district and then develop systems for coordinated and continuous high quality care. Once implemented the program will evaluate outcomes and make modifications as necessary. In addition, the BOCES – Bellport Academic Center is located within the BMHMC services area. The Center is an educational cooperative that provides educational leadership, direct instruction, management, and support through quality, cost-effective instructional programs and shared services. These programs and services maximize educational and career opportunities.

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BMHMC 2013 Community Service Plan BMHMC has a contractual relationship to provide health care services to the students at the Center. Educational material about diabetes and obesity will be distributed to the students as a component of BMHMC’s outreach program and this Community Service Plan. Bellport Primary Care Center BMHMC is constructing a primary care center in Bellport which is less than 2 miles from the main hospital. There is not a single physician office located within the community of the new center. Previously, residents rely on Brookhaven’s Emergency Department for primary care services, and more often than not, are hospitalized for conditions that could have been prevented if the patients were served in their community by a primary care center. This proposed new primary care center with a heightened focus on prevention especially in the areas of diabetes, hypertension, tobacco cessation, obesity. women’s health and cardiovascular education. The Bellport Primary Care Center (BPCC)will be a major provider of education and information for patients and residents regarding diabetes and obesity. Located in close proximity to the BPPC is a new Boys and Girls Club facility. BPPC and the Club intend to collaborate to provide better health and lifestyle choices for the residents of the community. Health Centers The South Brookhaven Family Health Centers are a Community Health Partnership between the Medical Center and the Suffolk County Department of Health Services (SCDHS). In Shirley since 1972 and Patchogue since 1975, the Health Centers are funded through the Suffolk County Health Department by an annual budget approved by the Suffolk County Legislature. Health Center physicians provide ambulatory care in the fields of family medicine, internal medicine, obstetrics and gynecological, pediatric and behavioral healthcare to area residents who lack access to care. BMHMC will inform the patients at the Health Centers of the free programs and services it offers related to diabetes and obesity. Community-Based Patient Advisory Council BMHMC realizes the tremendous value of having a community-based patient advisory council (PAC). In 2014, BMHMC will select members of the community who have utilized the services of our medical center either themselves or as a family members to provide us information and feedback about the programs and services offered.

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For more information about the programs and services offered by BMHMC, please call 631.654.7708 or visit www.brookhavenhosptial.org.

BMHMC 2013 Community Service Plan The PAC will meet quarterly to provide BMHMC with insight to the effectiveness of its outreach programs as well as to apprise the hospital of the ongoing health needs of the community. The patient advisory council will be a multidisciplinary team and include representation from the targeted patient population. The PAC will have no more than 20 total members. This size allows for diverse representation but is small enough for effective communication and consensus development. To create a diverse patient membership for the council, patients' ages, genders, medical conditions, and cultural or racial backgrounds will be taken into consideration. Patient members on the council will provide the consumer perspective for the Community Service Plan. They do this through sharing their own opinions and expertise as well as experiential knowledge from personal, family member, or friends' encounters with the health care issue being addressed. Key characteristics of the patient representative include: Good communication skills. The ability to collaborate with diverse individuals in a group setting. Representation of the consumer base in which the council exists, including cultural, racial, or ethnic communities. Firsthand knowledge of the topic at hand. For example, if the council represents a group of clinics, patient representatives should receive care from one of the clinics. If the focus is on a clinical condition, patient representatives should either have the condition or have family members who have it. To recruit patients for the council BMHMC will be seeking referrals from health care providers including those practitioners in the Health Centers. Employee Health In addition to providing programs and services to the community, BMHMC recognizes the need to provide assistance to it employees. With more than 65% of its employees and their families living in the service area, BMHMC is the community hospital of its employees. BMHMC will be enhancing it Employee Health Programs that offer assistance in making lifestyle changes that an individual can agree to and incorporate into a routine. BMHMC encourages its employees to make full use of the wellness benefits offered through its health insurance provider. BMHMC encourages all its employees to complete a needs assessment which includes a thorough review of their current health status (i.e., cholesterol levels, body mass index (BMI), blood pressure) as well as

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BMHMC 2013 Community Service Plan understanding the implications of their lifestyle decisions (i.e., physical activity, diet); and The Nutritional Services Department at BMHMC has incorporated healthy food choices into its menus for the Employee Dining Room. During the course of the Community Service Plan, Nutritional Services will also implement changes to the vending machine and sundry shop choices available. Community Health Programs In addition to the many programs and services offered by BMHMC, there are many other community programs to help achieve better health. It is indisputable that exercise is an integral part of a healthy lifestyle. BMHMC encourage walking as a low-impact, low cost, relatively stress free way to get exercise. Below is a list of a few walking trails and programs available to members of the BMHMC service area: Benjamin Tallmadge Trail: http://www.brookhaven.org/Portals/13/Documents/Benjamin%20Tallmadge%20 Walking%20Guide.pdf The Brookhaven Trail - http://nysparks.com/parks/180/details.aspx Town of Brookhaven – Parks and Recreation http://www.brookhaven.org/tourism/OutdoorAdventures/NatureTrailsandHikingin Brookhaven.aspx

Dissemination of CSP to the Public An Executive Summary in Pamphlet form of this Community Service Plan is available on the BMHMC website: www.brookhavenhospital.org. For a complete copy please contact the External Relations office at 631.654.7708.

Process to Sustain Engagement Ongoing Focused conversations with service clubs Establishment of the Patient Advisory Council - The council involve patients, consumers, and a variety of practitioners and professionals from health care and community organizations to drive change for patient safety through education, collaboration, and consumer engagement. President’s Breakfast Council BMHMC is establishing the BMHMC President’s Breakfast Council (PBC) for business leaders and human resource administrators from the service area. The PBC provides an opportunity for an exchange of ideas regarding the health of the workforce in the service area.

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BMHMC 2013 Community Service Plan At the PBC, attendees with learn about programs and services offered through BMHMC which assist employees to live healthier lifestyles and make better choices about their health, e.g. exercise and food choices. In addition, members of the PBC will provide BMHMC with a greater understanding of the needs of the people who work in facilities that are within the 911 area that is served by the Emergency Department.

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BMHMC 2013 Community Service Plan Economic Impact Charity Care As a community based Hospital, Brookhaven provides a significant volume of care to the impoverished in our service area. Caring for all members of our community, regardless of their ability to pay is our mission. The Medical Center has a Charity Care Policy in place, as well as informational signage throughout the facility in both English and Spanish, which indicates that it is the policy of Brookhaven Memorial Hospital Medical Center to provide free care or care at a reduced rate to uninsured patients who meet the eligibility requirements of the Hospital’s Charity Care Policy. Applications for the Charity Care Program, as well as additional information, are available in the following areas of the Medical Center: • Admitting Department • Central Registration • Emergency Department Registration • Cashier’s Office • Credit and Collection Department During the registration process, should a patient indicate “self-pay” as a form of reimbursement for the Hospital, a Charity Care packet is provided. This packet includes a letter of explanation, as well as the Medical Center’s policy. The Medical Center has made available to the entire community all of its programs on a no-charge or sliding scale basis. These programs include all of our educational programs, health screenings, general hospital admissions, Health Center activities, Home Care, and Hospice. A charity care letter is provided at the time of admission. Charity care information is also available in the Home Health and Health Center sections of this document. In 2012, Charity Care provided by BMHMC was $15,411,577. In addition, the Hospital provides community service programs free or below cost and provides a variety of patient care services where reimbursement under Federal and State agreements is below costs. These services included, but are not limited to emergency department, renal dialysis and primary care clinics. Financial Aid Assistance Brookhaven Memorial Hospital Medical Center also joined the Nassau Suffolk Hospital Council Facilitator Program in 2009, where two bi-lingual representatives are in the Hospital four hours, two times per month. They come to the campus to help patients apply for Medicaid, Family Health Plus or Child Health Plus. If the applicant does not qualify, they in turn help them connect with the proper representatives in the Business Office for financial assistance or Charity Care. The challenge is that there are many undocumented patients who speak many languages who are not always willing to cooperate, many are transient. To assist in overcoming this obstacle, BMHMC does participate in a

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BMHMC 2013 Community Service Plan language translation telephonic service. The non-English speaking person can use a phone at the hospital and be connected to a person who speaks a language they understand and then have information translate to officials at the hospital. Community Benefit Activity Through the work of dedicated volunteers who serve as member of the Board Directors and the Advisory Council, BMHMC provides significant benefit to the community. Board and Council members annual donate an estimated 4,300 hours of service. Annually, Brookhaven offers several events free of charge for the community. More than 3,000 people attend the Family Fun Day that provides education and information about healthy choices and lifestyle choice as well as amusement rides, games and entertainment. The Brookhaven Medical Lecture Series provides monthly lectures on a variety of topics. The presenters are typically members of the BMHMC medical staff. The lectures are free to the public. BMHMC partners with the Spirit of Women hospital network to reach 85% of all household healthcare decisions--women. As a Spirit of Women member, we provide a customized package of programs and initiatives that focus on the power of women to impact the hospital's overall bottom line. Spirit of Women is a national coalition of hospitals and healthcare facilities in over 55 U.S. cities joined together to advance the cause and business of women’s health. By tailoring messages to women, BMHMC acknowledges the important role they play in the overall health of our community and creates opportunities to support this role. We encourage women to participate in free screenings for early diagnoses so that they may maximize their health status and better care for their families. We provide educational series so that women may become educated consumers of healthcare, as well as learn about illnesses that may affect those around them. We also coordinate events that bring women together to foster a support system. These events are held throughout the year and bring together women of all ages with physicians, other healthcare providers and pertinent community resources. Spirit of Women events include: • Peripheral Arterial Disease (PAD) screening and lecture. PAD is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs. This condition may reduce blood flow to the heart and brain, but can often be detected by a simple physical exam. (http://www.mayoclinic.com/health/peripheral-arterial-disease) • Day of Dance for Heart Health® is an interactive community event that brings together consumers, health care providers, hospitals and corporate partners for an

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BMHMC 2013 Community Service Plan educational celebration of the benefits of dance and exercise in the prevention of heart disease, the number one killer of women. Physicians will provide information and free screenings. • Spirit Girls' Night Out brings together women as friends for an evening of fun, excitement, and laughter. The emphasis is on health improvement to feel better than ever before, both physically and emotionally. Topics to be covered include What is Breast Cancer, Holistic Approach to Breast Cancer, Nutrition to prevent Breast Cancer, and Advances in Treatments for Breast Cancer. The focus is on wellness rather than disease. • Get What You Want Out of Life a four part series beginning with Stand up for Yourself Healthy Legs -Vascular Health lecture in October; New Year, New You – Gastrointestinal problems in Women in December and two additional platforms with topics depending on interest. • Your Best Self Now is a lunch and learn event for 36-40 people, with support from the United Breast Care Foundation. This dynamic series is geared for women in their 40s, 50s and beyond. The Diabetes Resource Coalition of Long Island http://longislanddiabetes.org/index.htm

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