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20180238

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CSC SARCOMA INPT Doxorubicin(21D:1-3) Olaratumab(21D:1,8) VER 2-6-18 (HL 6035)

CSC SARCOMA INPT Doxorubicin(21D:1-3) Olaratumab(21D:1,8) VER 2-6-18 (HL 6035) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Sarcoma


CSC SARCOMA INPT DOXORUBICIN(21D:1-3)/OLARATUMAB(21D:1,8) VER: 2-6-18 –  Properties
Cycle 1 –  2/7/2018 through 2/27/2018 (21 days), Planned
Days 1 through 3, Cycle 1 –  Planned for 2/7/2018 through 2/9/2018
Treatment Plan Information
Reference Information (1)
SOFT TISSUE SARCOMA: Tap WD, et al. Lancet 2016;388(10043):488-97.
Reference Information (2)
SOFT TISSUE SARCOMA: Mack LA, et al. Ann Surg Oncol 2005;12(8):646-53.
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 1 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
Pre-Labs (delete all that do not apply)
HCG, QUANTITATIVE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Treatment Condition A
Verify patient has obtained pretreatment MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, ONCE, 1 dose Starting when released, Administer over 1 Minutes
Day 1. Administer prior to chemotherapy.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 2 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if
unable to tolerate PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE, 1 dose Starting when released
Day 1. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 2 doses Starting S+1 at 0000
Day 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, EVERY 24 HOURS PRN, For 72 hours Starting S+1 at 0000, nausea/vomiting, if unable to take PO
Day 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Take Home Medications
famotidine (PEPCID) 20 MG tab
Take 1 tab by mouth 2 times daily., 20 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 3 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

ondansetron (ZOFRAN) 8 MG tab
Take 1 tab orally 2x daily for 2 days after doxorubicin chemotherapy then every 8h as needed for
nausea, Disp-30 tab, R-7, starting S, Local Printer
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 1 –  Planned for 2/14/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S 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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 4 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 1 –  Planned for 2/21/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 5 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  2/28/2018 through 3/20/2018 (21 days), Planned
Days 1 through 3, Cycle 2 –  Planned for 2/28/2018 through 3/2/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 6 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 7 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 2 –  Planned for 3/7/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 8 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 9 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 2 –  Planned for 3/14/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  3/21/2018 through 4/10/2018 (21 days), Planned
Days 1 through 3, Cycle 3 –  Planned for 3/21/2018 through 3/23/2018
Treatment Plan Information
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 10 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1,
2 and 3 continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72
hours); CYCLE LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of
doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 11 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 12 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 3 –  Planned for 3/28/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 13 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Expected: S Approximate, Expires: S+365, Routine
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 14 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 3 –  Planned for 4/4/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 –  4/11/2018 through 5/1/2018 (21 days), Planned
Days 1 through 3, Cycle 4 –  Planned for 4/11/2018 through 4/13/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 15 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 WITHOUT DIFFERENTIAL
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 16 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 17 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV
over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 4 –  Planned for 4/18/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
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.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 18 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 4 –  Planned for 4/25/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 19 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 –  5/2/2018 through 5/22/2018 (21 days), Planned
Days 1 through 3, Cycle 5 –  Planned for 5/2/2018 through 5/4/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 20 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 21 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 22 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 5 –  Planned for 5/9/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 23 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 5 –  Planned for 5/16/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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,Edward E [2435061]
2/7/2018 11:53:07 AM Page 24 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 –  5/23/2018 through 6/12/2018 (21 days), Planned
Days 1 through 3, Cycle 6 –  Planned for 5/23/2018 through 5/25/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 25 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 26 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 27 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 6 –  Planned for 5/30/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 28 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 6 –  Planned for 6/6/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 7 –  6/13/2018 through 7/3/2018 (21 days), Planned
Days 1 through 3, Cycle 7 –  Planned for 6/13/2018 through 6/15/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 29 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 30 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 31 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  Admission to B6/6 for olaratumab and doxorubicin.
Day 8, Cycle 7 –  Planned for 6/20/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 32 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Expected: S Approximate, Expires: S+365, Routine
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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 33 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 7 –  Planned for 6/27/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 8 –  7/4/2018 through 7/24/2018 (21 days), Planned
Days 1 through 3, Cycle 8 –  Planned for 7/4/2018 through 7/6/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 34 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 WITHOUT DIFFERENTIAL
ONCE Starting when released, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
PHOSPHATE
ONCE Starting when released
MAGNESIUM
ONCE Starting when released
PTT
ONCE Starting when released
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 35 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate
PO, Administer over 3 Minutes
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE PRN, For 96 hours Starting when released, nausea/vomiting, if unable to tolerate PO
Day 1, 2 and 3. Give 30 minutes prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Day 1. Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk.
See Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) 25 mg/m2 in sodium chloride 0.9 % 500 mL infusion
25 mg/m2, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day 1, 2 and 3. Continuous infusion over 24 hours for a total of 72 hours. Total dose = 75 mg/m2 IV over 72 hours.
Conditional Orders
ondansetron (ZOFRAN) tab 8 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 36 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If unable to
tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, if unable to
tolerate PO
IV push slowly, max rate 5 mg/minute.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab for 90 minutes
Day 8, Cycle 8 –  Planned for 7/11/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S 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 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 37 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 8 –  Planned for 7/18/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 38 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 9 –  7/25/2018 through 8/14/2018 (21 days), Planned
Day 1, Cycle 9 –  Planned for 7/25/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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
ONCE Starting S+14 at 0000, Routine
ABSOLUTE NEUTROPHIL COUNT
ONCE Starting S+14 at 0000, Routine
ELECTROLYTES
ONCE Starting S+14 at 0000
GLUCOSE
ONCE Starting S+14 at 0000
BUN
ONCE Starting S+14 at 0000
CREATININE
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 39 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ONCE Starting S+14 at 0000
BILIRUBIN, TOTAL
ONCE Starting S+14 at 0000
AST/SGOT
ONCE Starting S+14 at 0000
ALT/SGPT
ONCE Starting S+14 at 0000
ALKALINE PHOSPHATASE
ONCE Starting S+14 at 0000
PHOSPHATE
ONCE Starting S+14 at 0000
MAGNESIUM
ONCE Starting S+14 at 0000
PTT
ONCE Starting S+14 at 0000
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 40 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab for 90 minutes
Day 8, Cycle 9 –  Planned for 8/1/2018
Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 41 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 9 –  Planned for 8/8/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 42 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 25 mg/m2 IV Day 1, 2 and 3
continuous infusion over 24 hours for a total of 72 hours (Total dose = 75 mg/m2 over 72 hours); CYCLE LENGTH: 21
days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Edward E [2435061]
2/7/2018 11:53:07 AM Page 43 of 43
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org