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201606170

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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Cardiology/CT Surgery

Destination Therapy Mechanical Circulatory Device Evaluation - Adult - Supplemental [5448]

Destination Therapy Mechanical Circulatory Device Evaluation - Adult - Supplemental [5448] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Cardiology/CT Surgery


Destination Therapy Mechanical Circulatory Device Evaluation - Adult - Supplemental [5448]
Qualifications
Qualifications [152090]
MCD Destination Therapy Qualifications [COR0081] Normal, Routine, Qty-1
Diagnostic Tests and Imaging
Cardiopulmonary EVO2 Stress Test (Single Response) [152089]
Cardiopulmonary EVO2 Stress Test (ADULT) [181449]
Most commonly ordered for heart failure or cardiopulmonary transplant patients. This specialized exercise test includes
measurements of oxygen uptake (VO2), carbon dioxide output (VCO2), minute ventilation (VE), and other variables during an
exercise stress test. Test performed in the Echo Vascular Lab at UW Hospital. Please call Preventive Cardiology at 263.6630 with
questions.
Cardiopulmonary EVO2 Stress Test (Adult) (Order 1 of 2)
[EKG0023]
Status: Future, Expires: 11/1/16, Normal, Routine
Cardiopulmonary EVO2 Stress Test (Adult) (Order 2 of 2)
[EKG0028]
Status: Future, Expires: 11/1/16, Normal, Routine
Cardiopulmonary EVO2 Stress Test Not Needed [COR0071] Normal, Routine, Qty-1
Carotid Ultrasound (Single Response) [152092]
Order a carotid ultrasound if patient has a bruit, history of CAD, ischemic cardiomyopathy, age >60, or history of stroke/TIA.
Ultrasound Carotid Duplex (UW Hospital, East Clinic)
[VASC0002]
Status: Future, Expires: 11/1/16, Normal, Routine, Qty-1
Carotid Ultrasound Not Needed [COR0072] Normal, Routine, Qty-1
Right Heart Catheterization (Single Response) [152093]
Right Heart Cath O2 Saturation & Cardiac Output [93451] Normal, Routine, Qty-1
Right Heart Catheterization Not Needed [COR0073] Normal, Routine, Qty-1
Chest CT (Single Response) [152094]
CT chest w/o IV contrast: Order if patient has a history of congenital heart disease, previous open heart surgery, or a history of
chemotherapy or radiation treatment affecting the thoracic cavity.
CT Chest w/o IV Contrast [R71250] Status: Future, Expires: 12/1/16, Normal, Routine
Chest CT Not Needed [COR0074] Normal, Routine, Qty-1
Pulmonary Function Tests (Single Response) [152097]
Pulmonary Lab Testing [999992] Routine
Reason for Exam: Destination therapy mechanical circulatory
device evaluation
Specify Test: Spirometry, Bronchodilator if indicated (Albuterol
MDI x 4 Puffs)
Specify location (if desired):
Pulmonary Function Tests Not Needed [COR0075] Normal, Routine, Qty-1
Transthoracic Echocardiogram (Single Response) [152098]
Transthoracic Resting Echocardiogram (Performed in
Hospital Vascular Lab) [ECH0003]
Status: Future, Expires: 11/1/16, Normal, Routine
Transthoracic Echocardiogram Not Needed [COR0076] Normal, Routine, Qty-1
Consults
Consult Cardiac Surgery (Single Response) [152099]
Consult to Cardiothoracic Surgery - INSIDE UW Health
[1009343]
What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mechanical circulatory device evaluation
Consult Cardiac Surgery Already Completed [COR0077] Normal, Routine, Qty-1
Consult Cardiology - Heart Failure (Single Response) [152100]
Consult to Cardiology - INSIDE UW Health [1009017] What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mechanical circulatory device evaluation
Consult Heart Failure Already Completed [COR0078] Normal, Routine, Qty-1
Consult Mechanical Circulatory Device (MCD) Coordinator (Single Response) [152102]
Consult to Mechanical Circulatory Device (MCD) Coordinator
- INSIDE UW Health [1009478]
Reason for consult:
Urgency:
Consult Mechanical Circulatory Device (MCD) Coordinator
Already Completed [COR0079]
Normal, Routine, Qty-1
Consult Gastroenterology (GI) (Single Response) [194859]
Consult to Gastroenterology - INSIDE UW Health [1009031] Details
Consult Gastroenterology Not Needed [COR0085] Normal, Routine, Qty-1
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Pr i nt ed by LIND, JANNA S [JSL237] at 10/1/2015 9:50:58 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Consult Social Work (Single Response) [152103]
Consult to Social Services (Social Worker) - INSIDE UW
Health [1009273]
What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mchanical circulatory device evaluation
Consult to Social Work Not Needed [COR0066] Normal, Routine, Qty-1
Additional Consults [152104]
Consider ordering the following consults if clinically indicated.
Consult to Health Psychology (OUTPT) - INSIDE UW Health
[9138]
Request Type: Consultation(opinion/advise) plus procedure if
needed
Reason for this request: Destination therapy mechanical
circulatory device evaluation
Consult to Palliative Care Medicine - INSIDE UW Health
[1009427]
What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mechanical circulatory device evaluation
Consult to Pulmonary - INSIDE UW Health [1009117] What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mechanical circulatory device evaluation
Consult to Nephrology - INSIDE UW Health [1009059] What question regarding the patient's medical care would you like
the specialist to answer? (REQUIRED): Destination therapy
mechanical circulatory device evaluation
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END OF SMARTSET [4852]
Other Chief Complaint
Page 2 of 2
Pr i nt ed by LIND, JANNA S [JSL237] at 10/1/2015 9:50:58 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison