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/clinical/cckm-tools/content/order-sets/inpatient/bmtoncologyhematology/name-97825-en.cckm

20170102

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

IP - BMT - Allogeneic Stem Cell Transplant - Adult - Post-Transplant Labs [1789]

IP - BMT - Allogeneic Stem Cell Transplant - Adult - Post-Transplant Labs [1789] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, BMT/Oncology/Hematology


SmartSet: IP - BMT - ALLOGENEIC STEM CELL TRANSPLANT - ADULT -
POST-TRANSPLANT LABS (ID:1789)
General Information
Display name: IP - BMT - Allogeneic Stem Cell Transplant Post-Transplant Labs - Adult -
Supplemental
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. BMT
2. ALLOGENIC STEM CELL TRANSPLANT
3. BMT ALLO
4. .BMT
SmartSet notes:
Description:
Web information: Title URL
1.
Questionnaire:
Configuration
Laboratory
Draw Daily - Start on Transplant Day 0
ELECTROLYTES NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
BUN NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
Page 1 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

CREATININE NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
GLUCOSE NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
MAGNESIUM NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
HEMOGLOBIN NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
PLATELET COUNT NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
Draw Daily - Start on Transplant Day +7
ELECTROLYTES NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
BUN NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
CREATININE NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
GLUCOSE NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
MAGNESIUM NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
Page 2 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

HEMOGLOBIN NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
PLATELET COUNT NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
WHITE CELL COUNT AND DIFFERENTIAL NEXT AM, Starting S+8 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
Draw Daily - Start on Transplant Day +14
ELECTROLYTES NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
BUN NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
CREATININE NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
GLUCOSE NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
MAGNESIUM NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
HEMOGLOBIN NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
Page 3 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

PLATELET COUNT NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
WHITE CELL COUNT AND DIFFERENTIAL NEXT AM, Starting S+15 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
Draw Daily - Start on Transplant Day +21
ELECTROLYTES NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
BUN NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
CREATININE NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
GLUCOSE NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
MAGNESIUM NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
HEMOGLOBIN NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
PLATELET COUNT NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
Page 4 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

WHITE CELL COUNT AND DIFFERENTIAL NEXT AM, Starting S+22 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
Draw Daily - Start on Transplant Day +28
ELECTROLYTES NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
BUN NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
CREATININE NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
GLUCOSE NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
MAGNESIUM NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
HEMOGLOBIN NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
PLATELET COUNT NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
WHITE CELL COUNT AND DIFFERENTIAL NEXT AM, Starting S+29 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
Draw Daily - Start on Transplant Day +35
Page 5 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

ELECTROLYTES NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
BUN NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
CREATININE NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
GLUCOSE NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
MAGNESIUM NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
HEMOGLOBIN NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
PLATELET COUNT NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
WHITE CELL COUNT AND DIFFERENTIAL NEXT AM, Starting S+36 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained
Fever of 38.0 Degrees Celsius for Greater than 1 Hour - Days 1-7
For First Fever Spike: ONCE, Starting S For 1 Occurrences, Routine, For
first fever spike, draw from all ports of line and
peripheral. To be placed with Culture, Blood,
Bacteria and Yeast order.
Page 6 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST CONDITIONAL - RN COLLECT For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1
hour.
Days 1-7.
CULTURE, BLOOD, BACTERIA AND YEAST CONDITIONAL - RN COLLECT For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1
hour.
Days 1-7.
URINALYSIS WITH MICROSCOPY CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1
hour. Days 1 - 7
CULTURE, URINE CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1
hour.
Days 1-7.
Draw Every Monday and Thursday - Start on Transplant Day 0
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
Page 7 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
GGT EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+1
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 0-6.
Draw Every Monday and Thursday - Start on Transplant Day +7
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
Page 8 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
GGT EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+8
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 7-13.
Draw Every Monday and Thursday - Start on Transplant Day +14
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
Page 9 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+15
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 14-20.
Draw Every Monday and Thursday - Start on Transplant Day +21
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
Page 10 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+22
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 21-27.
Draw Every Monday and Thursday - Start on Transplant Day +28
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
Page 11 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+29
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 28-34.
Draw Every Monday and Thursday - Start on Transplant Day +35
BILIRUBIN, TOTAL EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
AST/SGOT EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
ALT/SGPT EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
LD, TOTAL EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
Page 12 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

CYCLOSPORINE EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
TACROLIMUS EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
SIROLIMUS EVERY MONDAY AND THURSDAY, Starting S+36
with First Occurrence As Scheduled For 7 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Transplant days 35-41.
Draw Every Monday After Transplant Day 0
CALCIUM EVERY MONDAY, Starting S+1 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+1 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL EVERY MONDAY, Starting S+1 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+1 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday After Transplant Day +7
CALCIUM EVERY MONDAY, Starting S+8 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+8 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 13 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

PROTEIN, TOTAL EVERY MONDAY, Starting S+8 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+8 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday After Transplant Day +14
CALCIUM EVERY MONDAY, Starting S+15 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+15 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL EVERY MONDAY, Starting S+15 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+15 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday After Transplant Day +21
CALCIUM EVERY MONDAY, Starting S+22 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+22 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL EVERY MONDAY, Starting S+22 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+22 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday After Transplant Day +28
Page 14 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

CALCIUM EVERY MONDAY, Starting S+29 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+29 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL EVERY MONDAY, Starting S+29 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+29 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday After Transplant Day +35
CALCIUM EVERY MONDAY, Starting S+36 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE EVERY MONDAY, Starting S+36 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTEIN, TOTAL EVERY MONDAY, Starting S+36 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALBUMIN EVERY MONDAY, Starting S+36 with First
Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw on Transplant Day +7
WHITE CELL COUNT NEXT AM, Starting S+8 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +7.
PLATELET COUNT NEXT AM, Starting S+8 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +7.
Page 15 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

HEMOGLOBIN NEXT AM, Starting S+8 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +7.
CBC WITH DIFFERENTIAL NEXT AM, Starting S+8 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +7.
Draw on Transplant Days +1, +3, +6, +11
BILIRUBIN, TOTAL NEXT AM, Starting S+2 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +1.
BILIRUBIN, TOTAL NEXT AM, Starting S+4 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +3.
BILIRUBIN, TOTAL NEXT AM, Starting S+7 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +6.
BILIRUBIN, TOTAL NEXT AM, Starting S+12 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +11.
AST/SGOT NEXT AM, Starting S+2 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +1.
AST/SGOT NEXT AM, Starting S+4 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +3.
AST/SGOT NEXT AM, Starting S+7 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +6.
Page 16 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

AST/SGOT NEXT AM, Starting S+12 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Transplant Day +11.
Draw After Transplant Day +21
CMV QUANTITATIVE BY PCR NEXT AM, Starting S+22 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw After Transplant Day +28
CMV QUANTITATIVE BY PCR NEXT AM, Starting S+29 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw After Transplant Day +35
CMV QUANTITATIVE BY PCR NEXT AM, Starting S+36 at 5:00 AM For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Criteria
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Page 17 of 17
Printed by STRAKA, KEVIN F [KFS1] at 12/28/2016 10:40:00 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org