/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/hospital-wide/,

/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98226-en.cckm

20170235

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP - Pediatric - General Care - Admission [1325]

IP - Pediatric - General Care - Admission [1325] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Pediatric - General Care - Admission [1325]
Admission Status
Admission Status (Single Response) [20869]
Admit To Inpatient Status [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, an inpatient-only
surgery, or a previously-authorized inpatient stay. Rationale
listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Admit To Observation Status [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Isolation Status
If patient requires Isolation, please search for isolation in the additional orders section below.
Contact Isolation [105424]
Isolation - Contact - Clostridium Difficile - Panel [116351]
Isolation - Enhanced Contact - Clostridium Difficile
[ISO0010]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Isolation - Contact - MRSA - Panel [116332]
Isolation - Contact - MRSA [ISO0039] CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Isolation - Contact - Gastroenteritis-Viral - Panel
[116357]
Isolation - Enhanced Contact - Gastroenteritis-Viral
[ISO0162]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Respiratory Isolation [105425]
Isolation - Contact And Droplet - Respiratory Infection -
Acute, Infant/Child - Panel [116343]
Isolation - Contact and Droplet - Respiratory Infection -
Acute [ISO0045]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Patient Care Orders
Vital Signs [105426]
Rectal Temperatures Preferred for Patients Less Than 2 Years of Age
Vital Signs [NURMON0013] SEE COMMENTS, Starting today with First Occurrence As
Scheduled For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Every hour times 4, then every 2 hours times 4, then every 4
hours.
Vital Signs [NURMON0013] SEE COMMENTS, Starting today with First Occurrence As
Scheduled, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 2 hours times 4, then every 4 hours.
Vital Signs [NURMON0013] EVERY 4 HOURS, Starting today For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Vital Signs [NURMON0013] EVERY 8 HOURS, Starting today For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Activity [17527]
Bedrest [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Chair [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR: other (comment)
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Ambulate [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE: other (comment)
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Ad Lib [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition [17528]
For Tube Feeding Orders, Refer to Tube Feeding Order Set
NPO Except Medications [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
General Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet: GENERAL;
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Clear Liquid Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24): CLEAR LIQUID;
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Breast Milk Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
BREAST MILK
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Breast Feeding Mom [DIE0008] Please Provide Tray for Breast Feeding Mom: Yes
Routine, CONTINUOUS, Starting today
Pediatric Formula (please specify) [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Room Service Class:
Respiratory [17526]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified, Routine
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device:
Attempt to Wean Off Oxygen?
Intake and Output [105427]
Measure Intake And Output [NURMON0005] EVERY 1 HOUR, Starting today For Until specified, Routine
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified, Routine
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine
Patient Monitoring [17525]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[139419]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do NOT
require rhythm analysis. Please complete the Notify
Provider order below, including specification for apnea >
*** seconds. If indicated, order pulse oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in Rhythm
Notify [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Notify provider for apnea > 20 seconds
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[139420]
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[NURMON0074]
ONCE, Routine, Please complete the Notify Provider order
below, including specification for apnea > *** seconds. If
indicated, order pulse oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider:
Notify [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If urine output < (mL):
Other:
Notify provider for apnea > 20 seconds
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Starting today with First Occurrence As
Scheduled For Until specified, Routine, Every hour times 4,
then every 2 hours times 4, then every 4 hours.
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Starting today with First Occurrence As
Scheduled For Until specified, Routine, Every 2 hours times
4, then every 4 hours.
Assess Neurologic Status [NURMON0006] EVERY 4 HOURS, Starting today For Until specified, Routine
Assess Neurologic Status [NURMON0006] EVERY 8 HOURS, Starting today For Until specified, Routine
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, Routine
Pulse Oximetry [NURMON0009] EVERY 4 HOURS, Starting today For Until specified, Routine
Pulse Oximetry [NURMON0009] EVERY 8 HOURS, Starting today For Until specified, Routine
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today For Until specified, Routine
Measure Height - On Admission [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine, On
Admission
Measure Weight - On Admission [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
On Admission
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Measure Weight [NURMON0015] SEE COMMENTS, Starting today For Until specified, Routine
Weigh With?
Weigh when?
First occurrence now Until Specified, Routine, 2 times per
week
Non-Categorized Patient Care Orders [17539]
Urinary Catheterization-Intermittent [NURELM0018] ONCE, Starting today For 1 Occurrences, Routine
Contingency Parameters for Patients 7 to 11 Years of Age [125641]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 110
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): ***
If blood glucose < (mg/dL): ***
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): *** mL/hour
Other: Central venous pressure less than *** mmHg
Post-Op/Phase II
Contingency Parameters - Notify Pediatric Hospitalist [139440]
Notify Pediatric Hospitalist [NURCOM0022] SEE COMMENTS For Until specified, If unsure which
resident physician to contact about this patient on the
Pediatric Hospitalist Service, page the Pediatric Admitting
Resident., Post-Op/Phase II
Intravenous Therapy
IV Fluids [18098]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Peripheral IV Size:
Peripheral IV Location:
Peripheral IV Device:
Peripheral IV Status: Capped
Flush Solution:
Does this need to be inserted/placed?
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.9% infusion [51641] Intravenous, CONTINUOUS
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L infusion
[44904]
Intravenous, CONTINUOUS
sodium chloride 0.9% IV BOLUS - NOTE: Suggested
dose 10-20 mL/kg [730003]
Intravenous, ONCE For 1 Doses
NOTE: Suggested dose 10-20 mL/kg
Premedication for Needle Insertion (Single Response) [30232]
lidocaine 4% (LMX) topical dressing kit - NOTE: Order
for patients 5 Kg or less [66882]
Topical, EVERY 1 HOUR PRN, apply 20 to 30 minutes prior
to needle insertion - see Admin Instructions
Do NOT apply to area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6 times per
day). For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do NOT leave
on longer than 2 hours
lidocaine 4% (LMX) topical dressing kit - NOTE: Order
for patients 5.1-10 kg [66882]
Topical, EVERY 1 HOUR PRN, apply 20 to 30 minutes prior
to needle insertion - see Admin Instructions
Do NOT apply to area greater than 100 square centimeters.
(maximum 1 g/site; maximum 2 sites per hour, 6 times per
day). For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do NOT leave
on longer than 2 hours
lidocaine 4% (LMX) topical dressing kit - NOTE: Order
for patients greater than 10 Kg [66882]
Topical, EVERY 1 HOUR PRN, apply 20 to 30 minutes prior
to needle insertion - see Admin Instructions
Do NOT apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6 times per
day). For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do NOT leave
on longer than 2 hours
Medications - General
For Seizure Orders, Refer to IP - Seizure/Video EEG - Pediatric Supplemental order set
Analgesics/Antipyretics [18102]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS PRN, pain/fever, fever
Temperature greater than *** C or pain
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
acetaMINOPHEN (TYLENOL) suppository - NOTE:
Suggested dose 10-15 mg/kg /dose (Maximum 650
mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain/fever
Temperature greater than *** C or pain
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
ibuprofen (MOTRIN) susp - NOTE: Suggested dose 10
mg/kg/dose (Maximum 600 mg/dose) [45376]
10 mg/kg, Oral, EVERY 6 HOURS PRN, pain
Temperature greater than *** C or pain
NOTE: Suggested dose 10 mg/kg/dose (Maximum 600
mg/dose)
Laboratory
Laboratory [17542]
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW, 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?
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


ELECTROLYTES [LYTE] NEXT DRAW, 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?
GLUCOSE [GLU] NEXT DRAW, 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?
BUN [BUN] NEXT DRAW, 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?
CREATININE [CRET] NEXT DRAW, 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?
CALCIUM [CA] NEXT DRAW, 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?
ALT/SGPT [ALT] NEXT DRAW, 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?
AST/SGOT [AST] NEXT DRAW, 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?
GGT [GGT] NEXT DRAW, 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?
ALBUMIN [ALB] NEXT DRAW, 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?
PROTEIN, TOTAL [TP] NEXT DRAW, 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?
MAGNESIUM [MAG] NEXT DRAW, 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?
PHOSPHATE [PHOS] NEXT DRAW, 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?
ESR [ESR] NEXT DRAW, 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?
C REACTIVE PROTEIN [CRPN] NEXT DRAW, 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?
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] ONCE, Starting today For 1 Occurrences, 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,
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
If Conditional, What Condition?
CULTURE, URINE [URC] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY [UA] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
RESPIRATORY VIRUS DETECTION [130093]
RESPIRATORY VIRUS PANEL, PCR [HCRVPPCR] ONCE For 1 Occurrences, Routine, The Respiratory Virus
Panel test includes detection of: Influenza A, Influenza A
subtype H1, Influenza A subtype H3, Influenza A subtype
2009 H1N1, Influenza B, RSV A, RSV B, Parainfluenza 1,
Parainfluenza 2, Parainfluenza 3, human
metapneumovirus (nMPV), human rhinovirus, Adenovirus
B/E, Adenovirus C.
This test is most appropriate for transplant and select other
immunocompromised patients. All others should consider
'Influenza A, Influenza B, and RSV by PCR'- [HCFLURSV].
During peak influenza season consider ordering 'Influenza
A, Influenza B, and RSV by PCR'- [HCFLURSV].
For UWHC only: Collect Nasopharyngeal Minitip swab
(flocked swab) and place in UTM. BAL is also acceptable.
Room temperature M4 (M4RT) is not acceptable.
For UWMF only: Collect Nasopharyngeal (flocked swab)
and place in refrigerated M4 viral media. BAL is also
acceptable. Room temperature M4 (M4RT) is not
acceptable.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Isolation - Contact and Droplet - Respiratory Infection
[ISO0045]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Diagnostic Test and Imaging
Studies [17543]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
X-RAY ABDOMEN >= 2 VIEWS [R74020] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on signing.
Page 11 of 11
Pr i nt ed by STRAKA, KEVIN F [KFS1] at 8/27/2014 4:22:31 PM
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