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And i think that that is something that as a city and we as a Health Department with be proud of because we are leading the way for good and really appropriate transgender healthcare and with that i actually have a question. And it is really about the role map that that you have mentioned at the end. And the providers of the surgeries and i believe that there are some conversations happening before, and at ucsf which is teaching institute. And so, creating a center of excellence through this par...

California in healthy San Francisco including hiv will not have to change providers and that will give us time to look at the impact of the transition of d into c to see how that will impact them before we make the changes to that population. I just want to note that there was any Public Comment at this point and we will go on to the commission comments. I have not received any at this time. Commissioner karshmer . So i have a question about the jail, when you leave the jail is that one of those...

And i think that that is something that as a city and we as a Health Department with be proud of because we are leading the way for good and really appropriate transgender healthcare and with that i actually have a question. And it is really about the role map that that you have mentioned at the end. And the providers of the surgeries and i believe that there are some conversations happening before, and at ucsf which is teaching institute. And so, creating a center of excellence through this par...

And that will give us time to look at the impact of the transition of d into c to see how that will impact them before we make the changes to that population. I just want to note that there was any Public Comment at this point and we will go on to the commission comments. I have not received any at this time. Commissioner karshmer . So i have a question about the jail, when you leave the jail is that one of those life qualifying events . Yes. Open enrollment any time. Yes. Have you said that. Tr...

You have obviously the costly it is. So i would encourage you to really think this true, and possibly under the umbrella of the department. And i greatly appreciate that is in the alignment on it and it is in alignment with the chiefs that i have spoken to at San Francisco general great. Commissioner taylormcghee . Thank you. And clearly there was a paradigm shift in 2010 when medical cited that transgender surgery or sexual reassignment surgeries were medically necessary. So obviously that obvi...

Those criteria as evidence based and sensible as they could be. We have developed guidelines and trainings that we have been rolling out across the Healthcare Centers both the dph and the Health Centers and the jail Health Service and to help and providers understand what our criteria are and how do we access those services. And we are currently developing a and we will start this week, our first series of education and preparation sessions for the patients who are planning on under going transg...

Health not being a provider on coverage california, they were not able to keep the provider with the department of Public Health and other healthy San Francisco providers and so at least for 2014, and people eligible for healthy San Francisco, or i am sorry, people elible for coverage california in healthy San Francisco including hiv will not have to change providers and that will give us time to look at the impact of the transition of d into c to see how that will impact them before we make the...

California in healthy San Francisco including hiv will not have to change providers and that will give us time to look at the impact of the transition of d into c to see how that will impact them before we make the changes to that population. I just want to note that there was any Public Comment at this point and we will go on to the commission comments. I have not received any at this time. Commissioner karshmer . So i have a question about the jail, when you leave the jail is that one of those...

Incredible and the stake holders and i want to thank him as well. And i want to join garcia to give dr. Zevin the accolades because we recently celebrated. And i think that that is something that as a city and we as a Health Department with be proud of because we are leading the way for good and really appropriate transgender healthcare and with that i actually have a question. And it is really about the role map that that you have mentioned at the end. And the providers of the surgeries and i b...

And i think that that is something that as a city and we as a Health Department with be proud of because we are leading the way for good and really appropriate transgender healthcare and with that i actually have a question. And it is really about the role map that that you have mentioned at the end. And the providers of the surgeries and i believe that there are some conversations happening before, and at ucsf which is teaching institute. And so, creating a center of excellence through this par...