/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/bmtoncologyhematology/,

/clinical/cckm-tools/content/order-sets/ambulatory/bmtoncologyhematology/name-98503-en.cckm

201612351

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,BMT/Oncology/Hematology

OP - Year 1 Allogeneic Transplant Follow Up - Adult - Clinic Visit [5223]

OP - Year 1 Allogeneic Transplant Follow Up - Adult - Clinic Visit [5223] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, BMT/Oncology/Hematology


SmartSet: OP - YEAR 1 ALLOGENEIC TRANSPLANT FOLLOW UP - ADULT -
CLINIC VISIT (ID:5223)
General Information
Display name: OP - Year 1 Allogeneic Transplant Follow Up - Adult - Clinic Visit
Type: General
Merge priority:
Version comment:
Content source:
Synonyms:
SmartSet notes:
Description: Important Milestones needing to be documented on:
Karnofsky Performance Status
Clinical Assessments:
Pulmonary, smoking avoidance
Cardiac/Kidney Blood Pressure
Continue Immunization Process
Nervous system-cranial nerves, neuropathies, etc
Secondary Cancer Women's/Men's Health
Ophthalmology - Yearly Eye Exam
Psychosocial
GVHD
Bone Marrow Density Test
Web
information:
Title URL
1. Important
Milestones
needing to be
documented:
https://uconnect.wisc.edu/clinical/cckm-tools/content/order-
sets/ambulatory/bmtoncologyhematology/related/name-99691-en.cckm
2. Immunizations
Post
Hematopoietic
Stem Cell
Transplant
https://workspaces.uconnect.wisc.edu/download/attachments/24352278/F2.400
Immunizations Post Hematopoietic Stem Cell Transplant v3-1-13 v2.pdf?
version=1&modificationDate=1381857699027&api=v2
Questionnaire:
Configuration
Laboratory
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 12/12/2016 1:10:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Laboratory - General
CBC WITH DIFFERENTIAL Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
COMPREHENSIVE METABOLIC PANEL Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
MAGNESIUM Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
IMMUNOGLOBULIN G Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
IMMUNOGLOBULIN M Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
IMMUNOGLOBULIN A Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
FERRITIN Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
LIPID PANEL Status: Standing, Expires:T+397 MANUAL,Count:1,
Normal, Routine
T4, TOTAL Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
TSH Status: Standing, Expires:T+397 MANUAL,Count:1,
Normal, Routine
CYCLOSPORINE Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
TACROLIMUS LEVEL Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
SIROLIMUS Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
VITAMIN D, 25-HYDROXY BY HPLC Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
Laboratory - General
TESTOSTERONE, FREE, ADULT MALE Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
Laboratory - General
FSH Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
LH Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
Laboratory - Additional
RETICULOCYTE COUNT Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
STR ENGRAFTMENT SEPARATED LINEAGES,
POST-TX
Both tests must be ordered at same time and should NOT be ordered individually.
Lab Test Directory URL: https://uconnect.wisc.edu/clinical/tools-
resources/lab-test-directory/molecular-
diagnostics/name-68153-en.labtest
STR ENGRAFTMENT POPULATION 1 Status: Standing, Expires:T+122
MANUAL,Count:1, Normal, Routine
STR ENGRAFTMENT POPULATION 2 Status: Standing, Expires:T+122
MANUAL,Count:1, Normal, Routine
Laboratory - Titers
DIPTHERIA AND TETANUS AB, IGG Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 12/12/2016 1:10:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

POLIOVIRUS AB Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
INFLUENZA B VIRUS, IGG Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
RUBELLA AB, IGG Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
HEPATITIS B SURFACE AB Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
For Patients CMV +
CMV QUANTITATIVE BY PCR Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
For patients who have mismatched transplants or have received Anti-thymocyte Globulin
EBV QUANTITATIVE BY PCR Status: Standing, Expires:T+122 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging
Pulmonary Lab Testing Routine
Reason for Exam:
Specify Test: Spirometry
Specify location (if desired):
X-RAY CHEST PA & LAT VIEWS Status: Future, Expires: M+14, Normal, Routine
CT CHEST ABDOMEN PELVIS W IV
CONTRAST
Status: Future, Expires: M+14, Normal, Routine
Pulmonary Lab Testing Routine
Reason for Exam:
Specify Test: Oncology Profile without ABG
(Spirometry, Lung Volumes, Diffusion)
Specify location (if desired):
Consults
Consults
CONSULT TO SOCIAL SERVICES What barrier to medical care would you like the
specialist to address? (REQUIRED):
Criteria
Suggestions:
Filter: RESTRICTION LOCATOR - ONCOLOGY CSC IP AND OP - NOT IP DC[1017]
Restrict SmartSet:
Settings
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 12/12/2016 1:10:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 12/12/2016 1:10:53 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org