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201606170

page

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Neurosciences

IP - Neurosurgery - General - Pediatric - Postoperative [2973]

IP - Neurosurgery - General - Pediatric - Postoperative [2973] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neurosurgery - General - Pediatric - Postoperative [2973]
Admission Status
Admission Status [84057]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary because
of either an anticipated LOS >2 midnights, complexity and/or
severity of illness, 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:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Patient Care Orders
Vital Signs [91888]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Once on arrival, then every 4 hours., Post-Op/Phase II
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every hour times 12, then every 2 hours., Post-Op/Phase II
Patient Monitoring [91889]
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Starting today, Routine, Once on arrival,
then every 4 hours., Post-Op/Phase II
Assess Neurologic Status [NURMON0006] SEE COMMENTS, Starting today, Routine, Every hour times
12, then every 2 hours., Post-Op/Phase II
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[139419]
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Cardio-Respiratory Monitor - Pediatric - With Rhythm
[NURMON0014]
ONCE, 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,Serious
Arrhythmia
Post-Op/Phase II
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Post-Op/Phase II
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:
Post-Op/Phase II
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Post-Op/Phase II
Activity [91890]
Bed Rest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-Op/Phase II
Ambulate with Assistance [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: with assistance
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
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Ad Lib [NURACT0008] CONTINUOUS, Starting today, 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:
Post-Op/Phase II
Nutrition [91891]
For Tube Feeding Orders, Refer to "IP - Tube Feeding - Pediatric - Supplemental [4293]" order set
Pediatric Enteral Nutrition Guidelines for Tube Feeding URL: https://uconnect.wisc.edu/clinical/references/clinical-
nutrition-resources/nutrition-guidelines-and-enteral-
formularies/resources/name-33916-en.file
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:
Post-Op/Phase II
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General Diet [NUT0020] EFFECTIVE NOW, Starting today, Routine
Diet Type: General (as Tolerated)
Diet Modifications:
Food Allergies:
Serving Size:
Method of Delivery:
Preferences (Check all that Apply):
Additional Needs:
Feeding Tube (Dietary Consult Needed within 48 Hours):
Tube Feeding:
Post-Op/Phase II
Respiratory [91892]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Surgical Site Care [91893]
Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Closed - Incision
Wound Site: Head/Neck
Wound Location:
Assess Frequency: EVERY 4 HOURS
Care Frequency: SEE COMMENTS (Call neurosurgery if
dressing needs to be changed)
Wash With:
Irrigate/Rinse With: Do Not Irrigate
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing:
Secondary Dressing:
Call neurosurgery if drainage is noted or dressing becomes
loose, Post-Op/Phase II
Leave Dressing in Place [NURWND0018] SEE COMMENTS, Starting today, For *** hours., Post-
Op/Phase II
Intake and Output [91894]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today, Routine, Post-Op/Phase II
Contingency Parameters - Patients 3 through 6 Years [134779]
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Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 118
If systolic blood pressure < (mmHg): 87
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 140
If heart rate < (bpm): 75
If respiratory rate >: 30
If respiratory rate <: 18
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL): 1mL/kg per hour for 3 hours
Other: Mean arterial pressure is less than *** or greater than
*** mmHg,Patient requires 6 liters/minute of oxygen to
maintain saturation,Patient is unresponsive,Any deterioration
in neurological status,Pain not controlled with ordered
analgesics or ordered interventions,Dressing becomes loose
or saturated,Drainage from wound
Post-Op/Phase II
Intravenous Therapy
IV Fluids (Single Response) [91897]
sodium chloride 0.9% with KCl 20 mEq/L infusion
[46261]
Intravenous, CONTINUOUS For 12 Hours, Post-Op/Phase II
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS For 12 Hours, Post-Op/Phase II
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L infusion
[44904]
Intravenous, CONTINUOUS For 12 Hours, Post-Op/Phase II
Premedication for Needle Insertion [84317]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks to
reduce pain. See "LMX Use Instructions" order in Active
Orders report or the Admin Instructions for application
details
FOR PATIENTS 5 Kg OR LESS: 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 5.1-10 Kg: 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 GREATER THAN 10 Kg: 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
Post-Op/Phase II
LMX Use Instructions for Premedication Prior to Needle
Insertion [NURCOM0095]
Post-Op/Phase II
Surgical Prophylaxis
First Line [146321]
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses, Post-
Op/Phase II
MRSA / Documented MRSA History [195586]
Cefuroxime - Vancomycin [195680]
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cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses,
Post-Op/Phase II
Immediate / Severe Reaction to Penicillin or Known Cephalosporin Allergies [195598]
vancomycin (VANCOCIN) intraVENOUS - Maximum
Dose = 2000 mg [800084]
15 mg/kg, Intravenous, EVERY 6 HOURS For 3 Doses, Post-
Op/Phase II
Medications
Analgesics - Alternating Scheduled Acetaminophen/NSAID (Single Response) [91900]
Acetaminophen - Ibuprofen [195785]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
Oral, EVERY 4 HOURS
Alternate with ibuprofen, NOTE: Suggested dose 10-15
mg/kg/dose (Maximum 650 mg/dose)
Post-Op/Phase II
ibuprofen (MOTRIN) 100 mg/5 mL susp - NOTE:
Suggested dose 10 mg/kg/dose (Maximum 600
mg/dose) [45376]
Oral, EVERY 4 HOURS
Alternate with acetaminophen, NOTE: Suggested dose 10
mg/kg/dose (Maximum 600 mg/dose)
Post-Op/Phase II
Acetaminophen - Ketorolac [196243]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
Oral, EVERY 6 HOURS
Alternate with ketorolac, NOTE: Suggested dose 10-15
mg/kg/dose (Maximum 650 mg/dose)
Post-Op/Phase II
ketOROLAC (TORADOL) injection [800050] 0.5 mg/kg, Intravenous, EVERY 6 HOURS For 5 Days
Alternate with acetaminophen
Post-Op/Phase II
Analgesics - Opioid [91901]
oxycodone soln RANGE (Maximum 20 mg/dose)
[750031]
0.1-0.2 mg/kg, Oral, EVERY 4 HOURS PRN, pain, Administer
for severe pain
Administer for severe pain (Maximum 20 mg/dose)
Post-Op/Phase II
MORPHine PF injection RANGE - NOTE: Suggested
dose 0.05-0.1 mg/kg/dose (Maximum 2 mg/dose)
[750057]
Intravenous, EVERY 2 HOURS PRN, pain, Administer for
severe pain
Administer for severe pain if unable to tolerate oral
medication
for 4 Minutes
NOTE: Suggested dose 0.05-0.1 mg/kg/dose (Maximum 2
mg/dose)
Post-Op/Phase II
Non-Categorized Medications [91902]
diazepam (VALIUM) injection [36675] Intravenous, EVERY 6 HOURS PRN, Pain / Muscle Spasms
Administer as first line agent
Post-Op/Phase II
lorazepam (ATIVAN) injection [800053] 0.05 mg/kg, Intravenous, EVERY 4 HOURS PRN, Muscle
spasms
Administer as second line agent
Post-Op/Phase II
For Craniotomy Patients [91903]
dexamethasone (DECADRON) intraVENOUS [800037] Intravenous
Anti-emetics [91904]
ondansetron (ZOFRAN) injection - NOTE: Suggested
dose 0.1 mg/kg/dose (Maximum 4 mg/dose) [800202]
0.1 mg/kg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
NOTE: Suggested dose 0.1 mg/kg (Maximum 4 mg/dose)
Post-Op/Phase II
Bowel Management [91905]
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senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
1 tab, Oral, 2 X DAILY
Hold for loose stools
Post-Op/Phase II
sennosides (SENNA) 8.8 MG/5ML syrup [50880] Oral, Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder - NOTE:
Suggested dose 0.8 g/kg/dose (Maximum 17 g/dose)
[61353]
0.8 g/kg, Oral, 1 X DAILY
Dissolve in 4-8 ounces of water
NOTE: Suggested dose 0.8 g/kg/dose (Maximum 17 g/dose)
Post-Op/Phase II
bisacodyl (DULCOLAX) EC tab [49076] Oral, 1 X DAILY PRN, constipation
Give as a first line agent
Post-Op/Phase II
docusate sodium (COLACE) cap [36859] Oral, 2 X DAILY PRN, constipation
Give as a second line agent
Post-Op/Phase II
lactulose (CEPHULAC) soln [75426] Oral, 2 X DAILY PRN, constipation
Give as a third line agent
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository [35231] Rectal, 1 X DAILY PRN, constipation
Give as a fourth line agent
Post-Op/Phase II
Laboratory
Draw on Arrival [91907]
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?
Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
Post-Op/Phase II
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?
Post-Op/Phase II
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?
Post-Op/Phase II
HEMATOCRIT [HCT] 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?
Post-Op/Phase II
Draw on Postoperative Day 1 [91908]
CBC WITH DIFFERENTIAL [CBC] NEXT 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?
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT 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?
Post-Op/Phase II
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HEMATOCRIT [HCT] NEXT 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?
Post-Op/Phase II
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [91910]
CT HEAD W & W/ O IV CONTRAST [R70470] 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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Post-Op/Phase II
CT HEAD W/ O IV CONTRAST [R70450] 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?
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value in
comment):
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
Post-Op/Phase II
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MRI QUICK BRAIN W/ O CONTRAST [R70551C] 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?
Does patient have a pacemaker or defibrillator?
Relevant Surgical History (Select all applicable or None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or None):
Has patient had a colonoscopy/endoscopy in the last 8
weeks?
For Scheduling purposes, is the patient claustrophobic or
require any form of sedation? Note: ordering provider is
responsible for prescribing oral anxiolytic or ordering sedation
services.
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
Post-Op/Phase II
MRI HEAD W & W/ O CONTRAST [R70553] 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?
Does patient have a pacemaker or defibrillator?
Allergy to Gadolinium (MRI) contrast?
For Scheduling purposes, is the patient claustrophobic or
require any form of sedation? Note: ordering provider is
responsible for prescribing oral anxiolytic or ordering sedation
services.
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
Relevant Surgical History (Select all applicable or None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or None):
Has patient had a colonoscopy/endoscopy in the last 8
weeks?
Last creatinine value? (will auto pull in date and value in
comment):
Last e-GFR value? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
Post-Op/Phase II
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MRI HEAD W/ O CONTRAST [R70551] 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?
Does patient have a pacemaker or defibrillator?
Allergy to Gadolinium (MRI) contrast?
For Scheduling purposes, is the patient claustrophobic or
require any form of sedation? Note: ordering provider is
responsible for prescribing oral anxiolytic or ordering sedation
services.
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
Relevant Surgical History (Select all applicable or None):
Implanted Devices? (Select all applicable or None):
History of Metal in Body? (Select all applicable or None):
Has patient had a colonoscopy/endoscopy in the last 8
weeks?
Last creatinine value? (will auto pull in date and value in
comment):
Last e-GFR value? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
Last patient height? (will auto pull in value and date in
comment):
Transport Method:
Post-Op/Phase II
Consults
Consults [91912]
Consult Pediatric Rehab [CON0138] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE For 1 Occurrences, Routine
Reason for Consult:
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE For 1 Occurrences, Routine
Reason for Consult:
Post-Op/Phase II
Consult Speech Pathology [CON0077] ONCE For 1 Occurrences, Routine
Reason for Consult:
Post-Op/Phase II
Consult Pediatric Health Psychology (Inpatient)
[CON0202]
ONCE For 1 Occurrences, Routine, Please notify consulting
provider if patient needs to be seen same day (Monday-
Friday) or if special assessment needs.
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
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Consult Social Work (Inpatient) [CON0076] ONCE For 1 Occurrences, Routine
Reason for Consult:
Is this a STAT consult?
Can this consult be done via video?
Post-Op/Phase II
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