Planning patient flow in a clinic or pharmacy

Front desk to medical assistant to provider

We plan clinic layouts with our interior design partners around the sequence a visit follows. One entrance leads to check-in, where staff can see the waiting room. The medical assistant station sits between the waiting room and the exam rooms, with a vitals alcove or small triage room and a scale in a private spot rather than the corridor. The provider's workroom sits at the center of the exam pod, so the provider moves between rooms without crossing the waiting area. Where volume allows, check-out is separate from check-in, so departing patients do not queue behind arrivals.

• A staff-only back corridor, where the floor plate allows, keeps supplies, specimens and staff traffic out of patient circulation.
• Clean supply and soiled utility are separate rooms, placed at opposite ends of the clinical work path.
• The lab draw station sits near a patient toilet room, ideally with a specimen pass-through.
• Check-in windows are spaced or partitioned, and no screen showing patient information faces the waiting room.

Exam room pods

A common planning ratio is two to three exam rooms per provider working at one time. It is a rule of thumb, not a code requirement, and it only works if medical assistant staffing keeps the rooms turned over. If the lease allows, building one more exam room than today's schedule requires costs less now than opening finished walls later.

Identical, same-handed exam rooms put the sink, supplies and table in the same place in every room, so staff never search for them. Inside each room the hand sink sits near the door, the table is oriented so a door opening does not expose the patient, a curtain adds a second screen, and the provider's computer faces the patient rather than the wall.

Accessible exam rooms in an outpatient office

The medical care sections of the 2010 ADA Standards (opens an external site) (223 and 805) address patient sleeping rooms in facilities where stays exceed 24 hours. They do not set the number of accessible exam rooms in an outpatient office. For an outpatient practice, the general Standards govern the entrance, the route, toilet rooms and the reception counter, and the Department of Justice guidance on medical care (opens an external site) for people with mobility disabilities describes what an accessible exam room needs. The guidance does not fix a count; a small practice may meet the need with one accessible room.

Separately, HHS's 2024 Section 504 rule requires recipients of HHS federal financial assistance that use exam tables and weight scales to have at least one accessible table and one accessible scale, with a compliance date of July 8, 2026. Under the same rule, newly acquired diagnostic equipment must meet the accessible equipment standards until at least 10 percent of each type in use, and no fewer than one unit, does. The practice's counsel can confirm whether the rule applies.

• Clear floor space of at least 30 by 48 inches beside the exam table, preferably on both sides.
• A turning space of 60 inches in diameter, or a 60 by 60 inch T-shaped space.
• Doors with at least 32 inches of clear width when open to 90 degrees.
• Room for a height-adjustable table that lowers to about 17 to 19 inches, and for a patient lift.
• A level approach and clear space at the accessible scale.

The NYC Building Code and the New York State Uniform Code add their own accessibility chapters. The architect of record determines compliance, and accessibility remains the practice's legal obligation. Our part is to build the clearances as drawn and keep them clear: casework, stools and carts added after inspection are the usual reason an accessible room stops working.

New York pharmacy space rules

A pharmacy in New York must be registered with the State Education Department (opens an external site) under Education Law 6808 before it operates. A new pharmacy files the PH-200 and PH-210 forms with a floor plan drawn to scale (not blueprints), and an investigator from the Office of Professional Discipline inspects the premises before registration. A pharmacy moving to a new address (opens an external site) files an endorsement application, a new floor plan, the lease or deed, the Certificate of Occupancy and photographs, and the new location is inspected.

A plan that splits the registered area across rooms that do not connect fails the contiguity rule, and it is the first thing we check on a pharmacy floor plan. The working layout also needs a secure prescription department, a counseling area where patients can speak privately, will-call storage, controlled-substance storage arranged with the pharmacist-in-charge, and power and space for any vaccine refrigerators.

Compounding rooms

The compounding scope sets the room. Under USP chapter 797, Category 2 and 3 sterile preparations need an ISO-classified buffer room and ante-room with HEPA-filtered supply air and controlled pressure, while Category 1 preparations, with short beyond-use dates, may be made in a hood inside an unclassified segregated compounding area. Under chapter 800, hazardous drugs are compounded in negative-pressure rooms exhausted to the outdoors, either a classified buffer room or, for low volumes, a containment segregated compounding area with at least 12 air changes per hour. Nonsterile compounding under chapter 795 needs no classified room. Classified and negative-pressure rooms rarely fit under a standard office ceiling with landlord ductwork, because the hood exhaust, HEPA supply and pressure monitoring drive the ceiling height, power and roof access. The pharmacist-in-charge and a cleanroom certifier define the requirements, the engineer designs the room, and the room is certified after construction.

Our licensed partner contractors perform the electrical, plumbing, HVAC and low-voltage work on the pharmacies and clinics we build, coordinated with the cleanroom certifier's requirements where the project includes compounding.