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UWHC,UWMF,

Tools,

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

OP/FDS - Urologic Surgery - Pediatric - Preoperative [2960]

OP/FDS - Urologic Surgery - Pediatric - Preoperative [2960] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Urology


OP/FDS - Urologic Surgery - Pediatric - Preoperative [2960]
Pre-Day of Procedure
Laboratory [91622]
URINALYSIS WITH MICROSCOPY AND
CULTURE IF >5 WBC/HPF [HCUACULT]
Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
ALBUMIN [ALB] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
PROTEIN, TOTAL [TP] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
AST/SGOT [AST] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
ALT/SGPT [ALT] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
Labs - Blood Bank [91701]
Antibody Screen
Use to prescreen patient for alloantibodies to red blood cell components. Order if specimen collection will
be greater than 72 hours prior to surgery. Blood products cannot be issued on the basis of this test.
Antibody Screen should be ordered with the ABO and Rh Typing.
ABO and Rh Typing
Use to determine patient blood type. Order if specimen collection will be greater than 72 hours prior to
surgery. Blood products cannot be issued on the basis of this test. ABO and Rh Typing should be
ordered with the antibody screen.
Type and Screen
Order if specimen collection will be less than 72 hours prior to surgery. Patient is required to have an ID
band in place at the time of Type and Screen blood specimen collection and remain in place throughout
admission.
TYPE AND SCREEN [HCTS] Status: Standing, Expires:5/8/17 MANUAL,Count:1,
Normal, Routine
Antibody Screen and ABO and Rh Typing
[192516]
ANTIBODY SCREEN [ABSCR] Status: Standing, Expires:7/24/17
MANUAL,Count:1, Normal, Routine
ABO AND RH TYPING [ABO] Status: Standing, Expires:7/24/17
MANUAL,Count:1, Normal, Routine
Consults [91624]
Page 1 of 5
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/24/2017 1:42:37 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

CONSULT TO AFCH PRE-ANESTHESIA
[1009483]
Please indicate Surgical/Procedural Service (if not in
case request):
Who is Surgeon or Proceduralist? (if not in case
request):
Service contact + Pager/Phone. Essential for follow-
up!!:
If you want patient to be seen IN-PERSON at AFCH
PASS Clinic, please select one of these three
reasons:
CARDIOVASCULAR, chart review only:
PULMONARY or AIRWAY, chart review only:
METABOLIC or RENAL, chart review only:
OTHER REASONS, chart reivew only:
ANESTHESIA PHONE CONSENT NEEDED:
Who will complete the H&P?
If H&P to be done by non-UWH provider, what
facility?
Approximately when will H&P be completed, from
today? (Reminder - H&Ps are required by CMS to be
done within 30 days):
Pre-Op Day of Procedure
Nursing Communication [105629]
No Pre-op Day of Surgery Orders Needed
[NURCOM0059]
CONTINUOUS, Starting today, Pre-Op Day Of
Procedure
Isolation Status [136644]
Isolation - Contact - Clostridium Difficile
[ISO0010]
CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Contact - MRSA [ISO0039] CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Contact - VRE [ISO0051] CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Protective Precautions - Panel [116356]
Protective Precautions [ISO0001] CONTINUOUS
Reason for Protective Precautions:
Pre-Op Day Of Procedure
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation - Airborne - TB-Pulmonary
Confirmed/Suspect [ISO0003]
CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Tests [91574]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine, As good clinical practice and
for patient safety, the Transfusion Service will
automatically crossmatch 2 packed RBCs on all
patients with antibodies to ensure blood would be
available in the event it is needed. If you would like to
opt out of this automatic order for this patient please
contact the UWHC Blood Bank at (608) 263-8367 or
The American Center Lab at (608) 234-6600 as
appropriate., Pre-Op Day Of Procedure
Laboratory - Pregnancy Test [81397]
surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
Page 2 of 5
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/24/2017 1:42:37 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

Urine, Pregnancy Test [UPREG] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line (Single Response) [142432]
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is less than 40 kg - Maximum Dose =
2000 mg [800000]
30 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is less than 40 kg and requiring
surgical flap, complex hypospadias or penile
repair - Maximum Dose = 2000 mg [800000]
40 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is 40-120 kg [800000]
2 g, Intravenous, ON CALL For 1 Doses, IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE:
Patient who is greater than 120 kg [800000]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
Patients with MRSA or High Risk of MRSA/MRSE (Implanted Device) [142433]
vancomycin (VANCOCIN) intraVENOUS - For
patients less than 40 kg - Maximum Dose =
1000 mg [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS - For
patients greater than 40 kg Maximum Dose =
2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies and MRSA
Negative [142434]
clindamycin (CLEOCIN) intraVENOUS - For
patients less than 40 kg [800033]
10 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
clindamycin (CLEOCIN) intraVENOUS - For
patients 40-80 kg [800033]
600 mg, Intravenous, ON CALL For 1 Doses, IntraOp
clindamycin (CLEOCIN) intraVENOUS - For
patients 80-160 kg [800033]
900 mg, Intravenous, ON CALL For 1 Doses, IntraOp
clindamycin (CLEOCIN) intraVENOUS - For
patients who are 160 kg [800033]
1,200 mg, Intravenous, ON CALL For 1 Doses,
IntraOp
gentamicin (GARAMYCIN) intraVENOUS - For
patients less than 40 kg [800049]
4 mg/kg, Intravenous, ON CALL For 1 Doses, IntraOp
gentamicin (GARAMYCIN) intraVENOUS - For
patients greater than 40 kg [800049]
5 mg/kg, Intravenous, ON CALL For 1 Doses, IntraOp
SBE Surgical Prophylaxis - Use ONLY if recommended by Cardiologist or Primary Care Physician
[142435]
ampicillin (OMNIPEN) intraVENOUS - For
patients less than 40 kg - Maximum Dose =
3000 mg [800009]
50 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
ampicillin (OMNIPEN) intraVENOUS - For
patients greater than 40 kg Maximum Dose =
3000 mg [800009]
Intravenous, ON CALL For 1 Doses, IntraOp
gentamicin (GARAMYCIN) intraVENOUS - For
patients less than 40 kg [800049]
4 mg/kg, Intravenous, ON CALL For 1 Doses, IntraOp
gentamicin (GARAMYCIN) intraVENOUS - For
patients greater than 40 kg [800049]
5 mg/kg, Intravenous, ON CALL For 1 Doses, IntraOp
IntraOp
Laboratory [107883]
Page 3 of 5
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/24/2017 1:42:37 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

BUN [BUN] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Have labs drawn while patient is asleep., IntraOp
CREATININE, WHOLE BLOOD [HCWBCRET] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Have labs drawn while patient is asleep., IntraOp
ELECTROLYTES, WHOLE BLOOD
[HCWBLYTS]
STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Have labs drawn while patient is asleep., IntraOp
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
IntraOp
GLUCOSE [GLU] STAT - RN COLLECT, Starting today For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Have labs drawn while patient is asleep., IntraOp
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Have labs drawn while patient is asleep., IntraOp
URINALYSIS WITH MICROSCOPY AND
CULTURE IF >5 WBC/HPF [HCUACULT]
NEXT AM, Starting today For 1 Occurrences, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IntraOp
Diagnosis
Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Level of Service
Office Visit - Established Patients [30779]
99211 - Level I LOS Code
99212 - Level II LOS Code
99213 - Level III LOS Code
Page 4 of 5
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/24/2017 1:42:37 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

99214 - Level IV LOS Code
99215 - Level V LOS Code
99211 - w/ Resident (GC) - Level I LOS Code
99212 - w/ Resident (GC) - Level II LOS Code
99213 - w/ Resident (GC) - Level III LOS Code
99214 - w/ Resident (GC) - Level IV LOS Code
99215 - w/ Resident (GC) - Level V LOS Code
Office visit - New Patients [30778]
99201- Level I LOS Code
99202- Level II LOS Code
99203- Level III LOS Code
99204- Level IV LOS Code
99205 - Level V LOS Code
99201- w/ Resident (GC) - Level I LOS Code
99202- w/ Resident (GC) - Level II LOS Code
99203- w/ Resident (GC) - Level III LOS Code
99204- w/ Resident (GC) - Level IV LOS Code
99205- w/ Resident (GC) - Level V LOS Code
Consults [30780]
If Medicare patient, do not use Consult LOS. Choose an Established or New Patient LOS. Add the
appropriate additional E/M Code of 99354-99359 for prolonged office consultations in the LOS
section of the Visit Navigator.
99241 - Level I LOS Code
99242 - Level II LOS Code
99243 - Level III LOS Code
99244 - Level IV LOS Code
99245 - Level V LOS Code
99241- w/ Resident (GC) - Level I LOS Code
99242 - w/ Resident (GC)- Level II LOS Code
99243 - w/ Resident (GC) - Level III LOS Code
99244 - w/ Resident (GC) - Level IV LOS Code
99245 - w/ Resident (GC) - Level V LOS Code
Preoperative Exam (Global) [1265]
Preoperative H&P, No Charge, Surgical Package LOS Code
Page 5 of 5
Printed by WILLIAMS, HEATHER R S [HRS0] at 3/24/2017 1:42:37 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org