/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/gu/,

/clinical/cckm-tools/content/beacon-protocols/gu/name-96720-en.cckm

201706166

page

100

UWHC,UWMF,

Tools,

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

CSC GU Sorafenib(28D:1-28) VER 12-1-16 (HL 936)

CSC GU Sorafenib(28D:1-28) VER 12-1-16 (HL 936) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU SORAFENIB(28D:1-28) VER: 12-1-16 (HL 936) – Properties
Pre-Cycle – 6/8/2017 through 6/14/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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
CREATININE
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+365, Routine
CALCIUM
Expected-S Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S Approximate, Expires-S+365, Routine
Cycle 1 – 6/15/2017 through 7/12/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 6/15/2017
Treatment Plan Information
Reference Information (1)
RENAL CELL CANCER: Kane RC, et al. Clin Cancer Res 2006;15:7271-78.
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 cycles or until disease progression.
Consent
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 1 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

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 and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): sorafenib (dispensed on Day 1 of Cycle 1 only
- subsequent refills will be ordered through the medication activity).
Take Home Medications
sorafenib (NEXAVAR) 200 MG tab
Take 2 tabs by mouth 2 times daily., 400 mg, Disp-120 tab, R-0, 2 X DAILY starting S
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 2 – 7/13/2017 through 8/9/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 7/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 2 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 3 – 8/10/2017 through 9/6/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 8/10/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 3 of 15
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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 4 – 9/7/2017 through 10/4/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 cycles or until disease progression.
Consent
Verify Consent
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 4 of 15
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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 5 – 10/5/2017 through 11/1/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/5/2017
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 5 of 15
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 Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 6 of 15
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) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 6 – 11/2/2017 through 11/29/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 11/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 7 of 15
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 or Total Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than
140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 7 – 11/30/2017 through 12/27/2017 (28 days), Planned
Day 1, Cycle 7 – Planned for 11/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 8 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 8 – 12/28/2017 through 1/24/2018 (28 days), Planned
Day 1, Cycle 8 – Planned for 12/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 9 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 9 – 1/25/2018 through 2/21/2018 (28 days), Planned
Day 1, Cycle 9 – Planned for 1/25/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 10 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 10 – 2/22/2018 through 3/21/2018 (28 days), Planned
Day 1, Cycle 10 – Planned for 2/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 11 of 15
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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 11 – 3/22/2018 through 4/18/2018 (28 days), Planned
Day 1, Cycle 11 – Planned for 3/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 cycles or until disease progression.
Consent
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 12 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Cycle 12 – 4/19/2018 through 5/16/2018 (28 days), Planned
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 13 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Day 1, Cycle 12 – Planned for 4/19/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Cancer (Advanced); THERAPY: sorafenib 400 mg by mouth twice daily for 28 days; CYCLE LENGTH: 28
days; COURSE: 12 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+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Platelets, Total Bilirubin, Urine Protein.
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 or Total
Bilirubin greater than ULN or Urine protein greater than 100 mg/dL or Blood Pressure greater than 140/90 mmHg.
Treatment Medications
Oral Chemotherapy Order Management
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Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 14 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

For this regimen, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
Day 1 of next cycle) appointment(s) have been scheduled: RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC
(DIFF if done locally), Creatinine, Calcium, Alkaline Phosphatase, AST, ALT, Albumin and Total Bilirubin, Phosphate, Urinalysis
without microscopy, TSH.
Actions
Actions
Zztestonc,Jeff J [2507481]
6/15/2017 8:03:18 AM Page 15 of 15
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org