/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/urology/,

/clinical/cckm-tools/content/order-sets/ambulatory/urology/name-114035-en.cckm

20170369

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Urology

OP - Prostate Biopsy Delegation Protocol - Adult [6302]

OP - Prostate Biopsy Delegation Protocol - Adult [6302] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Urology


OP - PROSTATE BIOPSY DELEGATION PROTOCOL - ADULT [6302]
Prostate Biopsy Delegation Protocol URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/delegationpractice-
protocols/ambulatory-delegation-protocols/name-
110644-en.cckm
Documentation
Documentation [104911]
Blank Progress Note BLANK PROGRESS NOTE
Prescriptions
Antibiotics - Pre and post procedure [219176]
ciprofloxacin (CIPRO) 500 mg tab - Administer 2
hours prior to procedure [61500]
500 mg, 1 tab, 0, starting 3/6/17 until 3/6/17, Normal
ciprofloxacin (CIPRO) 500 mg tab - Administer
12 hours post procedure [61500]
500 mg, 1 tab, 0, starting 3/6/17 until 3/6/17, Normal
Antibiotics - For patients allergic to fluoroquinolones - pre and post procedure [219216]
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, 1 tab, 0, starting 3/6/17 until 3/6/17, Normal
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, 1 tab, 0, starting 3/6/17 until 3/6/17, Normal
Bowel Prep [219243]
phosphate (FLEET) 7-19 GM/118ML enema
[37517]
1 enema, 118 mL, 0, starting 3/6/17 until 3/6/17,
Normal
Medications - In Clinic
Antibiotics - For patients who have taken ciprofloxacin in the last 3 months or are healthcare providers
[219209]
ceftriaxone (ROCEPHIN) 1 G injection [44581] 1 g, starting 3/6/17, No Print
Diagnosis
Prostate Biopsy Diagnosis [83533]
Elevated prostate specific antigen (PSA)
[790.93.ICD-9-CM]
Elevated prostate specific antigen (PSA)
Cancer of prostate [174324] Malignant neoplasm of prostate
Page 1 of 1
Printed by STRAKA, KEVIN F [KFS1] at 3/6/2017 10:47:14 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org