/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98399-en.cckm

20180126

page

100

UWHC,UWMF,

Tools,

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

IP - Cardiology - Adult - Discharge [3328]

IP - Cardiology - Adult - Discharge [3328] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Cardiology - Adult - Discharge [3328]
Skilled Nursing Facility Orders
This Patient is going to a skilled nursing facilty, directly below is a group of orders commonly
associated with this patient population. Please review the orders below and select the appropriate
ones for this patient. If this patient is not going to a SNF, contact Case Management to update the
discharge plan. Updating the discharge plan will remove this set of SNF orders from the order set.
Skilled Nursing Facility Certification Statement [114940]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Certification Statement [118260]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Admit Order [114941]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Admit Order [118261]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Patient Care Orders [111713]
For dyspnea, Oxygen at 2 L/minute per nasal
canula; If this is an acute change for the patient
call PCP with assessment ASAP after oxygen is
started. Suction PRN to clear airways.
[NURCOM0022]
Routine
DME - Home Oxygen [1009468] Length of Need:
Patient's O2 Requirements Assessed and Meets
Criteria for Home O2:
Delivery Device:
Equipment Needed:
Continuous (liters/min):
Continuous (FiO2):
With Activity (liters/min):
With Activity (FiO2):
With Sleep (liters/min):
With Sleep (FiO2):
Length of Need:
Vendor:
DME - CPAP [1009443] Length of Need:
Formal Sleep Study Completed:
Diagnosis:
CPAP Pressure (cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Page 1 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DME - BiPAP (S) [1009441] Length of Need:
Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S):
Diagnosis:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
DME - BiPAP (S/T) [1009442] Length of Need:
Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S/T):
Diagnosis:
Respiratory Rate:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Patient may self administer medication per RN
assessment [NURCOM0022]
Routine
Patient medications (per Skilled Nursing Facility
policy) may be left at bedside [NURCOM0022]
Routine
Facility Therapy Needs [113391]
Physical Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Occupational Therapy to Evaluate and Treat at
Next Facility [NURCOM0022]
Routine
Speech Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Communicable Diseases [111717]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Page 2 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Communicable Diseases [118262]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Analgesics [111708]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, 1 tab, 1, starting 1/26/18, No Print
acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, 1 suppository, 1, starting 1/26/18, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 mg, 1 each, 1, starting 1/26/18, No Print
Glucose 40 % oral gel [118089] 10 g, 1 Tube, 1, starting 1/26/18, No Print
Nursing Communication [NURCOM0022] Routine, Notify {Notify for Blood Glucose:3004146} if
blood glucose is greater than 400 mg/dL or less than
40 mg/dL
Diabetes Care Instructions [NURCOM0112] Routine, - Patient's blood glucose goal range before
meals is *** mg/dL.
- Monitor patient's blood glucose {Glucose Monitoring
Frequency:25242}.
- If your patient's blood glucoses are uncontrolled
contact provider.
- "Uncontrolled" blood glucoses mean:
* Blood glucose above 150 mg/dL more than half the
time during a week.
* Blood glucose over *** mg/dL.
* Blood glucose less than 70 mg/dL two or more times
per week (or if having signs/symptoms of low blood
glucose such as shaking, sweating, or light-
headedness).
Bowel Management [111709]
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, 1 suppository, 1, starting 1/26/18, No Print
Senna-Docusate Sodium 8.6-50 MG per tab
[70181]
1-2 tab, 1 tab, 1, starting 1/26/18, No Print
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, 1 Bottle, 1, starting 1/26/18, No Print
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, 1 Bottle, 1, starting 1/26/18, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN
DM) syrup [51568]
10 mL, 1 Bottle, 1, starting 1/26/18, No Print
carbamide peroxide (DEBROX) 6.5% otic soln
[35545]
3 drop, 1 Bottle, 1, starting 1/26/18 until 1/31/18, No
Print
alum-mag-simeth (MYLANTA ES) susp [44073] 30 mL, 1 Bottle, 1, starting 1/26/18, No Print
Page 3 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Quality Measure Documentation
Quality Measure Documentation - Beta Blocker - This Does NOT Generate a Medication Order (Use Med
Reconciliation To Prescribe Medications) (Single Response) [235125]
indicated in all post AMI patients. -Beta Blocker
blockers also indicated in HF patients with < EF 40%. NOTE: Your patient may have other -Beta
blockers not captured in the quality measure.-indications for beta
include metoprolol evidence based beta blockers for patient with heart failure with EF The
bisoprolol. succinate, carvedilol, and
Beta-Blocker Reason Not Ordered [COR0002] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
Beta-Blocker Already Ordered [COR0002] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comment Required)
Quality Measure Documentation - ACE Inhibitor/ARB - This Does NOT Generate a Medication Order (Use
Med Reconciliation To Prescribe Medications (Single Response) [235127]
indicated in all post AMI patients with < EF 40%. -ACEI/ARB
ACEI/ARB also indicated in HF patients with EF < 40%. NOTE: Your patient may have other
indications for ACEI/ARB not captured in the quality measure.
ACE Inhibitor/ARB Reason Not Ordered
[COR0001]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
ACE Inhibitor/ARB Already Ordered [COR0001] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comments required for
not ordering BOTH an ACEI and an ARB)
Statins (Single Response) [235129]
indicated in all post AMI patients-Statin
Statins Already Ordered. This does NOT
generate a medication order. Please be sure you
have ordered the Statin in Med Record.
[COR0039]
ONCE For 1 Occurrences, Routine
Statins Not Ordered [COR0035] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
atorvastatin (LIPITOR) 80 MG tab [65225] 80 mg, 30 tab, 2, starting 1/26/18, Normal
Aspirin (Single Response) [235131]
indicated in all post AMI patients-Aspirin
Aspirin Already Ordered. This does NOT
generate a medication order. Please be sure you
have ordered the Aspirin in Med Record.
[COR0037]
ONCE For 1 Occurrences, Routine
Aspirin Not Ordered [COR0033] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
aspirin 81 MG chew tab [34786] 81 mg, 30 tab, 3, starting 1/26/18, Normal
Platelet ADP-Receptor Antagonists (Single Response) [235308]
treated or with indicated in all AMI patients (medically -Receptor Antagonists -ADPPlatelet
year.PCI/stenting). ADP inhibitors recommended for at least one
Platelet ADP-Receptor Antagonist Already
Ordered. This does NOT generate a medication
order. Please be sure you have ordered the
Platelet ADP-Recptor Antagnoist in Med Record
[COR0089]
ONCE, Routine
Reason Not Ordered: Platelet ADP-Receptor
Antagonist Already Ordered
Platelet ADP-Receptor Antagonist Reason Not
Ordered [COR0089]
ONCE, Routine
Reason Not Ordered:
clopidogrel (PLAVIX) 75 MG tab [58345] 75 mg, 30 tab, 11, starting 1/26/18, Normal
Aldosterone Blockers (Single Response) [190451]
Page 4 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Aldosterone blockade (i.e. spironlactone or eplerenone) is indicated in post myocardial infarction
(MI) patients with an ejection fraction (EF) < 40%, diabetes, OR heart failure who are already in
therapeutic doses of ACEI/ARB and beta blockers. Contraindications for aldosterone blockade
include significant renal dysfunction (Cr > 2.5 mg/dL in men or 2.0 mg/dL in women) or
hyperkalemia (K > 5 mEq/L).
Aldosterone Blocker Already Ordered. This does
NOT generate a medication order. Please be
sure you have ordered the aldosterone blocker in
Med Record. [COR0054]
ONCE For 1 Occurrences, Routine
Aldosterone Blocker Not Ordered [COR0055] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
spironolactone (ALDACTONE) 25 MG tab [42320] 25 mg, 30 tab, 3, starting 1/26/18, Normal
eplerenone (INSPRA) 25 MG tab [74239] 25 mg, 30 tab, 3, starting 1/26/18, Normal
Discharge Orders
Confirmed Discharge Date/Time [151653]
Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Reason for Hospitalization [132322]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, You were hospitalized for ***. Your
treatments included ***.
Hospital Course [132324]
Discharge instructions for Post Femoral Cath and Post Radial/Brachial Cath are added to the
cath order sets. -After Hospital Care Plan (AHCP) via the post
General [132325]
Activity [NURACT0008] Routine
Discharge Activity:
Symptom Management - Angina [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, If your heart symptoms return
(chest, arm, neck pain or pressure, sweatiness, or
breathlessness), sit or lie down. If prescribed, take
nitroglycerin as directed. If the symptoms have not
gone away within 15 minutes, call 911.
Wound Care [NURWND0015] Routine
Page 5 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, For questions or concerns, call the
UW Health Heart and Vascular Clinic at (608) 263-
1530 (Monday - Friday, 8am - 5pm). After hours,
nights, weekends, and holidays, this same number is
answered by the message center. Ask for the
cardiology fellow on call. Give the operator your full
name and phone number with the area code. The
doctor will call you back. If you live out of the area,
please call 1-800-323-8942.
Post EP Study [132330]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Activity restriction - For the next 5 days:
- Do not lift more than 10 pounds
- Do not strain or participate in vigorous activity
- Do not sit in a bathtub, hot tub or go into a
swimming pool.
Symptom Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, What to expect: Soreness or
tenderness at the site that may last 1 week; Bruising
at the site that may take 2-3 weeks to go away; A
small lump (dime to quarter size) which may last up
to 6 weeks.
For MINOR pain: You may take acetaminophen
(Tylenol®) 325 mg tablets every 4-6 hours; You may
place an ice pack or warm pack over the site for 20
minutes every 2 hours. Gently wipe the site after
you remove the pack if it is wet.
Wound Care [NURWND0015] Routine, You may shower 24 hours after the study.
Remove the Band-Aid over the site before taking a
shower. For 3 days, gently clean the site with soap
and water, pat dry, and leave open to air. Keep the
site dry. Inspect the site daily for redness, swelling,
or drainage.
Page 6 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, - If bleeding or sudden swelling
should occur at the site, apply direct pressure. If the
bleeding does not stop after 10 minutes of placing
constant pressure on the site, call 911 for
emergency help. Keep pressure on the site until
help arrives.
- If your extremity becomes numb, cold, or turns
blue, call 911 for emergency help.
- If you have severe pain, chest pain, increased
shortness of breath, notice any signs of infection
including: Redness, swelling, or drainage at the
site/Prolonged pain/Fever over 101.0°F for two
readings taken a few hours apart or have any other
questions/concerns, call the UW Health Heart and
Vascular Clinic at (608) 263-1530 (Monday - Friday,
8am - 5pm). After hours, nights, weekends, and
holidays, this same number is answered by the
message center. Ask for the cardiology fellow on
call. Give the operator your full name and phone
number with the area code. The doctor will call you
back. If you live out of the area, please call 1-800-
323-8942.
Post Pacemaker Insertion [132332]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Activity restriction - For the first 3 months:
- On the side your device was put in, do not raise
your elbow above your shoulder or any other
movements that cause you to stretch.
- Do not lift over 5 pounds of weight on your surgical
side.
- Do not reach above your head or out to the side.
- No swimming, over-head motions, or golfing.
-Wear a sling on the arm of device placement at
night for the first week.
Please refer to "Home Care After Permanent
Pacemaker Placement" given to you by a device
clinic nurse the morning after your pacemaker was
placed for more detailed instructions. You may also
access this document at www.uwhealth.org, search
"HFFY 5094".
Page 7 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Symptom Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, If you have pain at the site, you
may take any mild pain reliever, such as
acetaminophen. If you were prescribed a narcotic
pain reliever, use as directed.
Wound Care [NURWND0015] Routine, - If DermaBond "Clear Glue" was applied to
your incision, you may shower the day after your
procedure.
- If a dressing was applied over your incision - Leave
the current bandage on and keep clean and dry for
72 hours; You may shower after you take the
bandage off. When you shower, let the soap and
water run down the incision. Do not scrub or rub the
site; If you have steri strips (thin pieces of tape over
the incision), they should be left in place until they
fall off on their own or until they are removed by a
nurse at your first visit.
- Do not use any lotions or ointments over the
incision. As the site heals, you may feel itching (this
is normal). Do not scratch or rub the site. Inspect the
site daily for redness, swelling, drainage, increased
warmth, or increased tenderness.
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, - If you have a pacemaker, call the
UW Health Heart and Vascular Clinic the same day if
your heart rate drops below the pacemaker's
programmed rate, you develop
dizziness/lightheadedness or feel like you might
pass out, have a return of the symptoms you had
before your pacemaker was inserted, or notice any
signs of infection including: redness, swelling, active
drainage, warmth at the site, or a fever (101.0°F or
greater).
- If you have chest pain, call the UW Health and
Vascular Clinic or report to the emergency
department.
- For the issues above or any other
questions/concerns, call the UW Health Heart and
Vascular Clinic at (608) 263-1530 (Monday - Friday,
8am - 5pm). After hours, nights, weekends, and
holidays, this same number is answered by the
message center. Ask for the cardiology fellow on
call. Give the operator your full name and phone
number with the area code. The doctor will call you
back. If you live out of the area, please call 1-800-
323-8942.
Page 8 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Pacemaker and/or ICD Medical Device Card
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, You have been given a
temporary ID card. Carry your card with you at all
times. The device company will mail your
permanent card in about 2 months. Be sure to let all
people that you see for health and dental care know
that you have a permanent pacemaker and/or
implantable cardioverter defibrillator (ICD) . This
includes all doctors, nurses, dentists, chiropractors,
or any other person you see for your health care.
Post ICD Insertion [144564]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Activity restriction - For the first 3 months:
- On the side your device was put in, do not raise
your elbow above your shoulder or any other
movements that cause you to stretch.
- Do not lift over 5 pounds of weight on your surgical
side.
- Do not reach above your head or out to the side.
- No swimming, over-head motions, or golfing.
-Wear a sling on the arm of device placement at
night for the first week.
Please refer to "Home Care After Implanted
Cardioverter Defibrillator (ICD) Placement" given to
you by a device clinic nurse the morning after your
ICD was placed for more detailed instructions. You
may also access this document at
www.uwhealth.org, search "HFFY 5722".
Symptom Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, If you have pain at the site, you
may take any mild pain reliever, such as
acetaminophen. If you were prescribed a narcotic
pain reliever, use as directed.
Wound Care [NURWND0015] Routine, - If DermaBond "Clear Glue" was applied to
your incision, you may shower the day after your
procedure.
- If a dressing was applied over your incision - Leave
the current bandage on and keep clean and dry for
72 hours; You may shower after you take the
bandage off. When you shower, let the soap and
water run down the incision. Do not scrub or rub the
site; If you have steri strips (thin pieces of tape over
the incision), they should be left in place until they
fall off on their own or until they are removed by a
nurse at your first visit.
- Do not use any lotions or ointments over the
incision. As the site heals, you may feel itching (this
is normal). Do not scratch or rub the site. Inspect the
site daily for redness, swelling, drainage, increased
warmth, or increased tenderness.
Page 9 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, - If you have an implantable
cardioverter defibrillator (lCD), call the UW Health
Heart and Vascular Clinic if you notice any signs of
infection including: redness, swelling, or drainage at
the site, warmth over the site, increased tenderness,
fever (101.0°F or greater), or you notice you have
received a shock from your defibrillator.
- Call 911 to take you to the closest emergency room
if you receive repeated shocks from your defibrillator,
or if you receive a shock and feel that you are not
back to your baseline condition a few minutes later.
- For the issues above or any other
questions/concerns, call the UW Health Heart and
Vascular Clinic at (608) 263-1530 (Monday - Friday,
8am - 5pm). After hours, nights, weekends, and
holidays, this same number is answered by the
message center. Ask for the cardiology fellow on
call. Give the operator your full name and phone
number with the area code. The doctor will call you
back. If you live out of the area, please call 1-800-
323-8942.
Pacemaker and/or ICD Medical Device Card
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, You have been given a
temporary ID card. Carry your card with you at all
times. The device company will mail your
permanent card in about 2 months. Be sure to let all
people that you see for health and dental care know
that you have a permanent pacemaker and/or
implantable cardioverter defibrillator (ICD). This
includes all doctors, nurses, dentists, chiropractors,
or any other person you see for your health care.
Sternotomy [139999]
Lifting Restriction- Sternotomy [NURACT0011] Routine, Do not lift greater than 8 pounds for ***
weeks from surgery. Then do not lifter greater than
15-20 pounds until *** weeks from surgery.
Driving Restrictions - Sternotomy [NURACT0011] Routine, No driving for *** weeks or while on narcotic
pain medications.
Page 10 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Wound Care [NURWND0018] Routine, - No tub baths for 30 days or until incision is
completely healed.
- Patient may shower but keep back to shower head.
- Monitor your wound(s) for signs and symptoms of
infection, including redness, swelling, drainage, and
odor. If you notice these symptoms, call your
surgeon.
- Wash incision daily with soap and water. Do not
rub the site. Do not use lotions and/or ointments on
incision.
- Change dressing daily or more often if saturated
For Patients with Heart Failure [190454]
Weigh yourself daily or as directed.
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, Call the UW Health Heart and
Vascular Clinic if you have:
- more shortness of breath
- cough or chest congestion
- swelling in your belly or legs
- weight gain of more than 3 pounds in one day or 5
pounds total
- any other questions or concerns
The number for the UW Health Heart and Vascular
Clinic is (608) 263-1530. The toll free number is
1-800-323-8942. The clinic is open Monday thru
Friday from 8 AM to 5 PM. For nights, weekends,
and holidays, this number is answered by the
Message Center. You should tell the Message
Center that you need the “Cardiology Fellow On
Call”. Tell the Message Center your full name and
phone number with area code. The doctor will call
you back.
Vital Signs [100202]
Measure Weight [NURMON0015] Routine
Frequency: Daily
Call your {provider:4002838} if weight increases by
2-3 pounds in one day or 5 pounds in one week.
Measure Blood Pressure and Pulse
[NURMON0019]
Routine, Measure and record blood pressure and
pulse daily until next clinic visit.
Activity [100199]
Return to Work Recommendations:
Uncomplicated cath: may return to work in 3 days
Uncomplicated MI: may return to work in 14 days
Complicated MI: may return to work with MD approval
Page 11 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Return to Work [DC0014] Routine
Return to Work:
Was work release letter provided to patient?
Activity Recommendations [NURACT0011] Routine, Exercise Type: ***
Duration: ***
Frequency: ***
Intensity: ***
Driving Instructions [101236]
Do Not Drive Until Given Permission By Doctor
[NURACT0011]
Routine, Do Not Drive Until Given Permission By
Doctor
Driving Instructions - Post Cath/EP Study
[NURACT0011]
Routine, No driving for 24 hours after your procedure
Driving Instructions - After MI or Angioplasty
[NURACT0011]
Routine, Limit long distance driving in first 2 weeks
after MI or angioplasty
Driving Instructions - Post Pacemaker/ICD
Placement [NURACT0011]
Routine, No driving for 2 weeks after your procedure.
Return to driving as normal [NURACT0011] Routine
Diet [100200]
Recommendations:
C, CAD/MI - DASH Diet for Diabetes, Metabolic Syndrome, Low HDL
C alone - American Heart Association TLC/Step II for CAD, High LDL
DASH Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy: DASH
Metabolic:
Renal:
Sodium Controlled:
NPO:
Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications:
Page 12 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

2 Gram Sodium Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled: 2000 mg
NPO:
Calorie Restriction [NURDIE0013] Routine, Reduce daily calorie intake by 500 - 1,000
Kcal below current
Respiratory [100204]
DME - Home Oxygen [142943]
Both of the following orders MUST be completed in order for this DME to be delivered to the
patient.
-to-CNS has a facereimbursement requirements in 2013 require that a physician, PA, NP, or New
durable medical equipment (DME). It also face encounter with a patient prior to ordering certain
face encounter -to-provided with the documentation of the facerequires that the DME supplier be
order prior to delivery of the DME.and a signed
DME - Home Oxygen [1009468] Length of Need:
Patient's O2 Requirements Assessed and Meets
Criteria for Home O2:
Delivery Device:
Equipment Needed:
Continuous (liters/min):
Continuous (FiO2):
With Activity (liters/min):
With Activity (FiO2):
With Sleep (liters/min):
With Sleep (FiO2):
Length of Need:
Vendor:
DME - Home Oxygen Justification [1009463] Details
Bowel Care [123353]
Bowel Care [NURELM0068] Routine
Bladder Care [123365]
Bladder Care [NURELM0067] Routine
Other Patient Care Instructions [123383]
Other Discharge Patient Care Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Medications
Vasoactive Agents [137842]
NITROGLYCERIN 0.4 MG SL SUBL [40283] 0.4 mg, 25 tab, , starting 1/26/18, Normal
Follow Up Care - Cardiac Rehab
Page 13 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Follow-Up Appointments - Cardiac Rehab (Single Response) [112507]
Referral to Cardiac Rehab - Phase II (Outpatient)
[CON0174]
All patients being discharged from UWHC IP CVM
with the following diagnoses should receive a referral
to cardiac rehab: Acute Myocardial Infarction (i.e. all
STEMI or NSTEMI patients), Stable Angina, Coronary
Artery Bypass Surgery, Valve Surgery (repair or
replacement), Percutaneous Coronary Angioplasty or
Stenting, or Heart Transplant, or Stable Congestive
Heart Failure.
Typically, outpatient cardiac rehab follow-up
appointments occur 3-4 weeks post-hospitalization.
Inpatient Preventive Cardiology staff clinicians will
refer and make arrangements for the patient. If you
have further questions, you may call them at 263-
6630.
Routine
Has this patient been seen by inpatient Cardiac
Rehab/Preventive Cardiology during this encounter?
Reason Cardiac Rehab Not Ordered [COR0027] Routine
Reason Not Ordered:
Follow Up Care - Anticoagulation Monitoring (Patients on Warfarin Only)
Follow-Up Appointments Note: Direct verbal communication with the provider or clinic responsible for
anticoagulation monitoring after discharge is required. (Single Response) [120524]
Schedule Follow-Up Appointment with UW Health
Anticoagulation Clinic (Within UW Health
Network) [NURCOM0026]
Reason for Hospital Follow Up Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow-Up Appointment with Primary
Care Provider (Outside of UW Health Network)
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Follow Up Care
Discharge Cardiology Appointments. -See Guidelines for Post-
no cardiology appointment needed. Refer back to PCP.-No cardiac diagnoses -
consider referral back to PCP without -Stable disease (e.g. stable CAD, controlled arrhythmias) -
cardiology appointment
8 weeks after discharge. -cardiology appointment 6-Unstable angina or uncomplicated MI -
cardiology appointment when medically appropriate.-Complex cardiac issues -
Follow Up Appointments - Within UW Health Network [100206]
Schedule Follow Up Appointment with Primary
Care Provider (Within UW Health Network) 1-2
Weeks After Discharge [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider:
Schedule Follow Up Appointment with Cardiology
(Within UW Health Network) 6-8 Weeks After
Discharge [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider:
If Cardiology follow-up appointment is required before
standard 6-8 weeks, attending MD approval required
Schedule Follow Up Appointment (Within UW
Health Network) [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider:
Patient to Schedule Follow Up Appointment with
Primary Care Provider (Within UW Health
Network) 1-2 Weeks After Discharge
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Page 14 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Patient to Schedule Follow Up Appointment with
Cardiology (Within UW Health Network) 6-8
Weeks After Discharge [NURCOM0056]
Routine
Purpose:
With whom:
For when:
Follow Up Appointments - Outside UW Health Network [100819]
Patient to Schedule Follow Up Appointment with
Primary Care Provider (Outside UW Health
Network) 1-2 Weeks After Discharge
[NURCOM0056]
Routine
Purpose:
With whom:
For when:
Patient to Schedule Follow Up Appointment with
Cardiology (Outside UW Health Network) 6-8
Weeks After Discharge [NURCOM0056]
Routine
Purpose:
With whom:
For when:
Schedule Follow Up Appointment (Outside UW
Health Network) [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider:
Follow Up Appointments - Diabetes (Single Response) [148552]
*** RESPONSE REQUIRED *** This order facilitates documentation (only) about follow-up
appointments for patients with diabetes. Scheduling an appointment before discharge with a
provider who will manage a patient’s diabetes care (e.g., primary care physician, endocrinologist,
etc.) is a Joint Commission requirement. Exclusions are allowed based upon patient situation
(e.g., discharge to a skilled nursing facility, patient refusal, etc.). Only select “Appointment
Scheduled” if an appointment has already been scheduled, and use the Schedule Appointment
order as needed to request assistance in scheduling
No appointment: Patient does not have diabetes
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
does not have diabetes
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 15 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Appointment scheduled (with provider who can
manage diabetes) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled
(with provider who can manage diabetes)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment scheduled per patient report
(ENTER DATE IN COMMENTS) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled per
patient report (ENTER DATE IN COMMENTS)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment pending: patient discharged on
weekend; follow-up information provided
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment pending:
patient discharged on weekend; follow-up information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 16 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Free clinic information provided [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Free clinic information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient discharging to a facility
(e.g., skilled nursing facility, correctional facility,
etc.) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
discharging to a facility (e.g., skilled nursing facility,
correctional facility, etc.)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient refusal [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
refusal
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Follow Up Diagnostic Tests and Imaging [100207]
ECG - 12 Lead [EKG0008] Status: Future, Expires: 1/26/19, Normal, Routine
Holter Monitor - 24/48 Hour Monitor [EKG0026] Status: Future, Expires: 1/26/19, Normal, Routine
EVENT MONITOR/RECORDING [EKG5004] Status: Future, Expires: 1/26/19, Normal, Routine
Page 17 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Exercise Stress Test - Non Imaging [EKG0006] Status: Future, Expires: 1/26/19, Normal, Routine
NM Myocardial Perfusion Rest and Stress
[117124]
Stress Test order. Nuclear routine This panel is the OP Level II Chest Pain and
Both orders are required for stress testing. Do not remove the orders.
NM MYOCARDIAL PERFUSION REST &
STRESS (SPECT) W WALL MOTION &
EJECTION FRACTION [R78452]
Status: Future, Expires: 1/26/19, Normal, Routine
Exercise or Drug Stress Test (with Nuclear
Medicine) [EKG0007]
Status: Future, Expires: 1/26/19, Normal, Routine
Dobutamine Stress Echocardiogram [116808]
Dobutamine Stress Echocardiogram (Echo)
(Order 1 of 2) [ECH0031]
Status: Future, Expires: 2/26/2019, Normal, Routine
Dobutamine Stress Echocardiogram (Stress)
(Order 2 of 2) [ECH0002]
Status: Future, Expires: 2/26/2019, Normal, Routine
Exercise Stress Echocardiogram [116810]
Exercise Stress Echocardiogram (Echo) (Order 1
of 2) [ECH0033]
Status: Future, Expires: 2/26/2019, Normal, Routine
Exercise Stress Echocardiogram (Stress) (Order
2 of 2) [ECH0007]
Status: Future, Expires: 2/26/2019, Normal, Routine
Follow Up Diagnostic Tests and Imaging - Zio Patch (Single Response) [235123]
Zio-Patch (TAC) [240344]
Zio-Patch (TAC) [EKG0024] ONCE, Routine
Reason for exam:
Place Zio-Patch on day of Discharge
[NURCOM0022]
ONCE For 1 Occurrences, During Clinic Hours:
Page 4345, including MRN, Room #, Call back #,
ETA of D/C (pages should be sent no later than
4:00). Please ensure patient has showered prior to
placement.
Zio-Patch (UW) [236886]
Zio-Patch (UW) [EKG0024] ONCE, Routine
Reason for exam:
Place Zio-Patch on day of Discharge
[NURCOM0022]
ONCE For 1 Occurrences, Call the Heart
Station/EKG Lab (263-6609) 1 hour prior to
discharge to coordinate time of attachment. Ensure
patient has showered prior to calling the Heart
Station/EKG Lab.
Left Ventricle Assessment (Single Response) [111352]
Transthoracic Resting Echocardiogram
[ECH0003]
Status: Future, Expires: 2/26/2019, Normal, Routine
Reason ECHO Not Ordered [COR0028] Normal, Routine, Qty-1
Anticoagulation Follow Up [100211]
PROTHROMBIN TIME/INR [PT] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn on ***
Discuss Follow Up Plans Based on INR Results
[NURCOM0055]
Routine, Contact {provider:4002838} after INR drawn
to discuss follow up plans based on results.
Discharge Labs [134929]
Page 18 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Please use the table below to determine what type of order to use to place discharge lab
orders.
Who is Responsible for the
Result?
Where Will Labs be
Completed?
What Order Should You
Use?
Current Attending Provider UW Health Lab Specific lab orders (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
(B)
Current Consulting Provider
UW Health Lab
Specific lab orders with
AUTHORIZING PROVIDER
CHANGED TO
CONSULTANT (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
and AUTHORIZING
PROVIDER CHANGED TO
CONSULTANT (B)
Another Provider
UW Health Lab
Recommended Discharge
Labs (C)
Non-UW Health Lab
Recommended Discharge
Labs (C)
(A) SPECIFIC LAB ORDERS:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have the labs completed at a
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient's care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
(B) SPECIFIC LAB ORDER WITH ORDER CLASS CHANGED TO OUTSIDE:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have labs completed at a NON-
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient’s care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
The patient will receive a paper order to take to the lab.
(C) RECOMMENDED DISCHARGE LABS:
This order should be used to recommend to another provider labs that a patient should have
completed after discharge. The provider designated in the 'Send Recommendations To' field is
responsible for PLACING the lab orders AND will be responsible for the RESULTS of any
ordered labs.
Page 19 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Discharge Labs Workflow URL: https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/inpatient-
discharge-consult/resources/name-82993-en.file
Recommended Discharge Labs [NURCOM0075] Details
Follow Up Labs - To Be Drawn in 2 Weeks [100212]
Consulting Provider will lab orders should only be used if the current Attending Provider or These
lab.be responsible for the result of the
BUN [BUN] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 2 weeks
CBC WITH DIFFERENTIAL [CBC] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 2 weeks
CREATININE [CRET] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 2 weeks
ELECTROLYTES [LYTE] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 2 weeks
MAGNESIUM [MAG] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 2 weeks
Follow Up Labs - To Be Drawn in 6 Weeks [100214]
responsible for the lab orders should only be used if the current Attending Provider will be These
result of the lab.
ALT/SGPT [ALT] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
AST/SGOT [AST] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
BUN [BUN] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
CBC WITH DIFFERENTIAL [CBC] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
C REACTIVE PROTEIN, HIGH SENSITIVITY
[HSCRP]
Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
CREATININE [CRET] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
ELECTROLYTES [LYTE] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
LIPID PANEL [LIPID] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
LIPOPROTEIN (A) [XLPA] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
LIPOPROTEIN PROFILE, NMR [NMRLIP] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
MAGNESIUM [MAG] Status: Future Approximate, Expires: 3/12/18, Normal,
Routine, To be drawn in 6 weeks
Page 20 of 20
Printed by LIND, JANNA S [JSL237] at 1/26/2018 8:52:45 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org