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201706166

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,GU

CSC GU Aldesleukin (28D:5X Weekly) Clinic Administered VER 12-1-16 (HL 754)

CSC GU Aldesleukin (28D:5X Weekly) Clinic Administered VER 12-1-16 (HL 754) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU ALDESLEUKIN(28D5X/WEEK) CLINIC-ADMINISTERED VER 12-1-16 (HL 754) – Properties
Pre-Cycle – 6/7/2017 through 6/13/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S Approximate, Expires-S+365, Routine
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN starting S,
Local Printer
Cycle 1 – 6/14/2017 through 7/11/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 6/14/2017
Treatment Plan Information
Reference Information (1)
RENAL CANCER: Yang JC, et al. J Clin Oncol 2003;6:3127-32.
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 1 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 1 – Planned for 6/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 1 – Planned for 6/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 2 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 4, Cycle 1 – Planned for 6/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5, Cycle 1 – Planned for 6/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 1 – Planned for 6/21/2017
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 3 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 1 – Planned for 6/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 1 – Planned for 6/23/2017
Treatment Plan Information
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 4 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous
Day 1 through 5, weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or
until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 1 – Planned for 6/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 12, Cycle 1 – Planned for 6/25/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 5 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 1 – Planned for 6/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 1 – Planned for 6/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 6 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 1 – Planned for 6/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 1 – Planned for 7/1/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19, Cycle 1 – Planned for 7/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 7 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 7/12/2017 through 8/8/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 7/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+10 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+10 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 8 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 2 – Planned for 7/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 2 – Planned for 7/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 9 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 4, Cycle 2 – Planned for 7/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5, Cycle 2 – Planned for 7/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 2 – Planned for 7/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 10 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 2 – Planned for 7/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 2 – Planned for 7/21/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 11 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 2 – Planned for 7/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 12, Cycle 2 – Planned for 7/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 2 – Planned for 7/26/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 12 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 2 – Planned for 7/27/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 2 – Planned for 7/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 13 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 2 – Planned for 7/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19, Cycle 2 – Planned for 7/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 14 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Cycle 3 – 8/9/2017 through 9/5/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 8/9/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+10 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+10 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 15 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 3 – Planned for 8/10/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 3 – Planned for 8/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 4, Cycle 3 – Planned for 8/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 16 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5, Cycle 3 – Planned for 8/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 3 – Planned for 8/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 17 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 3 – Planned for 8/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 3 – Planned for 8/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 3 – Planned for 8/19/2017
Treatment Plan Information
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 18 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous
Day 1 through 5, weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or
until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 12, Cycle 3 – Planned for 8/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 3 – Planned for 8/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 19 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 3 – Planned for 8/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 3 – Planned for 8/25/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 20 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 3 – Planned for 8/26/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19, Cycle 3 – Planned for 8/27/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 – 9/6/2017 through 10/3/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 21 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+10 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+10 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 4 – Planned for 9/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 22 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 4 – Planned for 9/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 4, Cycle 4 – Planned for 9/9/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 23 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 5, Cycle 4 – Planned for 9/10/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 4 – Planned for 9/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 24 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 9, Cycle 4 – Planned for 9/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 4 – Planned for 9/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 4 – Planned for 9/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 25 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from
recorded weight), Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 12, Cycle 4 – Planned for 9/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 4 – Planned for 9/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 26 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 4 – Planned for 9/21/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 4 – Planned for 9/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 4 – Planned for 9/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 27 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19, Cycle 4 – Planned for 9/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 – 10/4/2017 through 10/31/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/4/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 28 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S+10 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+10 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 5 – Planned for 10/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 29 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 5 – Planned for 10/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 4, Cycle 5 – Planned for 10/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5, Cycle 5 – Planned for 10/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 30 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 5 – Planned for 10/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 5 – Planned for 10/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 31 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 5 – Planned for 10/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 5 – Planned for 10/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 32 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 12, Cycle 5 – Planned for 10/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 5 – Planned for 10/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 5 – Planned for 10/19/2017
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 33 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 5 – Planned for 10/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 5 – Planned for 10/21/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 34 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 19, Cycle 5 – Planned for 10/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 – 11/1/2017 through 11/28/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 11/1/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+10 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+10 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 35 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to
75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (1)
DAY 2, 3, 4, and 5; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 8 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (2)
DAY 9, 10, 11, and 12; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 15 FOLLOW-UP
RETURN TO CLINIC for LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30
minutes.
Treatment Plan Information
MULTIPLE DAY FOLLOW-UP (3)
DAY 16, 17, 18, and 19; RETURN TO CLINIC for CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) appointment(s) for RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally);
CHEMOTHERAPY ROOM APPOINTMENT: aldesleukin for 30 minutes.
Day 2, Cycle 6 – Planned for 11/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 3, Cycle 6 – Planned for 11/3/2017
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 36 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 4, Cycle 6 – Planned for 11/4/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 5, Cycle 6 – Planned for 11/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 37 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 6 – Planned for 11/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 6 – Planned for 11/9/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 38 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 10, Cycle 6 – Planned for 11/10/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 6 – Planned for 11/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 12, Cycle 6 – Planned for 11/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 39 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 6 – Planned for 11/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+3 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+3 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 6 – Planned for 11/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 40 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 17, Cycle 6 – Planned for 11/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 18, Cycle 6 – Planned for 11/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 41 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 19, Cycle 6 – Planned for 11/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cancer (Advanced); THERAPY: Aldesleukin (Interleukin-2) 7 million units/m2/day subcutaneous Day 1 through 5,
weeks 1 through 3 (week 4 is a week of rest); CYCLE LENGTH: 28 days; COURSE: 6 cycles or until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Medications
aldesleukin (PROLEUKIN) injection 13.7 Million Units
13.7 Million Units (rounded from 13.72 Million Units = 7 Million Units/m2 × 1.96 m2 Treatment plan BSA from recorded weight),
Subcutaneous, ONCE, 1 dose Starting when released, Administer over 120 Minutes
Do not administer IV push. Do not Filter.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
6/14/2017 3:49:54 PM Page 42 of 42
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org