/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---lymphoma/,

/clinical/cckm-tools/content/beacon-protocols/hem---lymphoma/name-96891-en.cckm

201708226

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100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Lymphoma

CSC HEM Vorinostat(28D:1-28 Oral) VER 10-3-16 (HL 4577)

CSC HEM Vorinostat(28D:1-28 Oral) VER 10-3-16 (HL 4577) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Lymphoma


CSC HEM VORINOSTAT(28D:1-28 ORAL) VER: 10-3-16 – Properties
Pre-Cycle – 8/4/2017 through 8/10/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 8/4/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
Treatment Condition A
Verify pretreatment ECG obtained.
Take Home Medications
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN starting S,
Local Printer
Take Home Medications (delete all that do not apply)
ondansetron (ZOFRAN) 8 MG tab
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 1 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

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 – 8/11/2017 through 9/7/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 8/11/2017
Treatment Plan Information
Reference Information (1)
NON-HODGKIN LYMPHOMA: Hymes KB. Oncology 2007;21(Suppl 1):18-23.
Reference Information (2)
NON-HODGKIN LYMPHOMA: Olsen EA, et al. J Clin Oncol 2007;25(21):3109-15.
Reference Information (3)
NON-HODGKIN LYMPHOMA: Duvic M, et al. Blood 2007;109:31-39.
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin, and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Condition A
Verify pretreatment ECG obtained.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medication section for the following treatment medication: vorinostat (dispensed on Day 1 of Cycle 1 only -
subsequent refills will be ordered through the medication activity).
Take Home Medications
vorinostat (ZOLINZA) 100 MG cap
Take 4 caps by mouth one time daily. Take with food. Do not crush or open capsules., 400 mg, Disp-120 cap, R-0, 1 X DAILY
starting S, Local Printer
Follow-Up
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Magnesium, Calcium, BUN, Creatinine, Glucose.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine; PROCEDURE: ECG.
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 2 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Lab Only - Day 15, Cycle 1 – Planned for 8/25/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 WITH DIFFERENTIAL
Expected-S+14 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+14 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+14 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+14 Approximate, Expires-S+365, Routine
BUN
Expected-S+14 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+14 Approximate, Expires-S+397, Normal
CALCIUM
Expected-S+14 Approximate, Expires-S+122
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 9/8/2017 through 10/5/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 9/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 3 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin, and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Condition A
Verify pretreatment ECG obtained.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, vorinostat will be ordered through the medication activity after the initial order.
Follow-Up
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Magnesium, Calcium, BUN, Creatinine, Glucose.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine; PROCEDURE: ECG.
Lab Only - Day 15, Cycle 2 – Planned for 9/22/2017
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 4 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 WITH DIFFERENTIAL
Expected-S+14 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+14 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+14 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+14 Approximate, Expires-S+365, Routine
BUN
Expected-S+14 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+14 Approximate, Expires-S+397, Normal
CALCIUM
Expected-S+14 Approximate, Expires-S+122
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 – 10/6/2017 through 11/2/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 10/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 WITH DIFFERENTIAL
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 5 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin, and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Condition A
Verify pretreatment ECG obtained.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, vorinostat will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine; PROCEDURE: ECG.
Cycle 4 – 11/3/2017 through 11/30/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 11/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
Consent
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 6 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin, and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Condition A
Verify pretreatment ECG obtained.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, vorinostat will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine.
Cycle 5 – 12/1/2017 through 12/28/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 12/1/2017
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 7 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin, and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Medications
Oral Chemotherapy Order Management
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 8 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

For this regimen, vorinostat will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine.
Cycle 6 – 12/29/2017 through 1/25/2018 (28 days), Planned
Day 1, Cycle 6 – Planned for 12/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Cutaneous T-cell Lymphoma; THERAPY: vorinostat 400 mg by mouth once daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression.
Note to All Staff (1)
Prolongation of QTc has been observed with vorinostat. Use with caution in patients with baseline prolongation of QTc interval,
patients on anti-arrhythymic medications, or medications with associated QTc interval prolongation.
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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
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
Treatment Conditions
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 9 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Magnesium, Total Bilirubin,
and AST.
Treatment Parameters
Hold and notify authorizing prescriber for Platelets less than 75K/µL or Potassium less than 3.6 mmol/L or Creatinine Clearance less
than 30 mL/min or Magnesium less than 1.7 mg/dL or Total Bilirubin greater than ULN or AST greater than ULN.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, vorinostat will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Magnesium, Calcium,
Glucose, BUN, Creatinine.
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Zztestonc,Ondra O [2507491]
8/11/2017 3:59:20 PM Page 10 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org