/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/neurosciences/,

/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-98156-en.cckm

201710293

page

100

UWHC,UWMF,

Tools,

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

IP - Neurosurgery - Pediatric - Discharge [4944]

IP - Neurosurgery - Pediatric - Discharge [4944] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neurosurgery - Pediatric - Discharge [4944]
Patient Care 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 [132222]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Surgical Procedure (Single Response) [132243]
Craniotomy [132242]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only. Walking is okay. No lifting, no
straining, no contact sports.
Wound Care [NURWND0015] Routine, • Leave dressing in place until follow up in
clinic.
• Staples and/or sutures will be removed at a follow
up clinic visit.
Wound Care [NURWND0015] Routine, • Remove dressing on ***.
• Wash incision gently but do not submerge under
water for one month.
• Wear clean hats only.
• Staples and/or sutures will be removed at a follow
up clinic visit.
Baclofen Pump Placement / Replacement
[132245]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• No extreme bending, twisting, or stretching of
trunk for one month following surgery.
• May use stander and/or gait trainer.
• Use abdominal binder as needed.
Wound Care [NURWND0015] Routine, • Leave gauze/tegaderm dressing in place.
• Ok to shower with dressing on. Remove dressing
immediately after showering and replace with new
gauze/tegaderm dressing.
• Do not submerge incisions under water for one
month.
• Steri-strips will fall off on their own.
Page 1 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Pump Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, While the pump is in place, your
child should avoid:
- extreme temperature and pressure changes
- saunas or hot tubs with temperatures over 102 F
- scuba diving under 2 atmospheres
- unpressurized aircraft
- bungee jumping
- sky diving
Dose: ***
Alarm date: ***. Schedule refill at least one week
before the alarm date.
ERI: ***
Always know the low reservoir alarm date and have
the pump refilled before that date. Do not depend on
hearing the low reservoir alarm (one beep once per
hour starting on the alarm date). The pump will
automatically stop working exactly 7 years after the
date of implant. The ERI (elective replacement
indicator) is on each printout and should be noted
with every refill and dose adjustment. Please watch
the ERI and schedule a pump replacement when the
ERI reaches 6 months.
Baclofen Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, Baclofen withdrawal can cause
greatly increased spasticity/tone and posturing,
sweating, seizures, fever, agitation/irritability,
hallucinations/delirium and itching without a rash.
People who are non-verbal and cannot tell
caregivers that they are itching will be very agitated
and often scratch themselves or grab at their
clothes. If you see signs of baclofen withdrawal,
please give baclofen pills orally or by G-tube as
prescribed up to every 4 hours and make
arrangements to be seen that day.
Signs of too much baclofen include floppiness,
sleepiness, low respirator rate, or decreased
alertness. In an emergency the pump can be
emptied using a needle placed into the reservoir and
withdrawing all the baclofen; this will effectively stop
the pump.
Tethered Cord Release [132247]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only. No extreme bending, twisting,
pushing, pulling or stretching of trunk for one month
following surgery.
Page 2 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Wound Care - Diapered Patients
[NURWND0015]
Routine, • Keep gauze/tegaderm dressing in place
until ***.
• Check dressing with each diaper change. Remove
immediately if soiled. Gently clean incision, pat dry,
and replace gauze/tegaderm dressing.
• Do not submerge under water for one month.
Wound Care - Non-Diapered Patients
[NURWND0015]
Routine, • Remove dressing on ***.
• Remove dressing immediately if soiled, gently
wash area and replace dressing.
• After dressing is removed, wash incision gently,
but do not submerge under water for one month.
Spinal Fracture [132248]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only.
Brace should be worn at all times except when
sleeping or showering [NURCOM0022]
Routine
Brace should be worn at all times
[NURCOM0022]
Routine
Wound Care [NURWND0015] Routine, • Bandage will stay on until follow up in
clinic next week.
• You may wash around the area, keeping the
bandage clean and dry.
• Protect incision site, do not touch except to wash
gently.
• No soaking or swimming.
• Do not use harsh spray on the incision.
• Use mild soap, pat dry.
• Dissolvable sutures will gradually disappear or fall
off on their own. Steri-strips will fall off on their own.
Wound Care [NURWND0015] Routine, • You may shower and get the incision wet
{number of days:3022343} after the surgery.
• Protect incision site, do not touch except to wash
gently.
• No soaking or swimming.
• Do not use harsh spray on the incision.
• Use mild soap, pat dry. D
• Dissolvable sutures will gradually disappear or fall
off on their own. Steri-strips will fall off on their own.
Shunt Placement / Shunt Revision or Endoscopic
Third Ventriculostomy (ETV) [132249]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only. Walking is okay. No lifting, no
straining, no contact sports.
Wound Care [NURWND0015] Routine, • Keep dressing in place.
• Keep dressing clean and dry.
• Showering/bathing ok as long as dressing remains
dry.
• Do not submerge incisions under water for one
month.
• Sutures/staples will be removed at follow up clinic
visit.
• Steri-strips will fall off on own.
Page 3 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Signs/symptoms of Shunt Malfunction
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Headache
• Nausea or vomiting
• Irritability
• Sleepiness or sleeping more than normal.
• Change in behavior, alertness, coordination,
balance or gait.
• Call the Pediatric Neurosurgery Clinic at 608-263-
6420 Option 3 for any concerns of shunt malfunction.
After hours, on weekends or on holidays, call the
hospital operator at 608-262-0486 and ask for the
neurosurgery resident on call to be paged.
Signs/Symptoms of Increased Intracranial
Pressure or Failed Endoscopic Third
Ventriculostomy (ETV) [NURCOM0071]
Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Headache
• Nausea or vomiting
• Irritability
• Sleepiness or sleeping more than normal.
• Change in behavior, alertness, coordination,
balance or gait.
• Call the Pediatric Neurosurgery Clinic at 608-263-
6420 Option 3 for any concerns of shunt malfunction.
After hours, on weekends or on holidays, call the
hospital operator at 608-262-0486 and ask for the
neurosurgery resident on call to be paged.
Programmable Valve [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, Type: ***
Setting: ***
Chiari Decompression [132250]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only. Walking is okay. No lifting, no
straining, no contact sports. You are encouraged to
do gentle range of motion stretches several times
daily.
Wound Care [NURWND0015] Routine, • Leave dressing in place until follow up in
clinic.
• Keep dressing clean and dry. Showering/bathing
ok as long as dressing stays dry.
• Staples/sutures will be removed at follow up clinic
visit.
• Do not submerge incision under water for one
month after surgery.
Craniosynostosis [132251]
Activity [NURACT0008] Routine
Discharge Activity: Up As Tolerated
Wound Care [NURWND0015] Routine, • Five days after surgery, may wash
incision gently with mild soap and pat dry.
• Do not submerge incision under water for one
month after surgery.
• Steri-strips will fall off on their own.
Intracranial Pressure Monitoring [194349]
Page 4 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only.
Wound Care [NURWND0015] Routine, • May wash hair and incision 3 days after
ICP monitor was removed.
• Call the pediatric neurosurgery team at 608-263-
6420 option 3 if there is any clear drainage from
incision.
• Staple/suture will be removed at follow up clinic
appointment.
Vagal Nerve Stimulator / Neurectomy / Tenotomy
[194350]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Light activity only.
Wound Care [NURWND0015] Routine, • Leave dressings in place.
• Ok to shower/bathe with dressing on. Remove
dressing immediately after showering and replace
with new dressing.
• Do not submerge for one month after surgery.
Head Trauma [194351]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
See Brain Care instructions.
Wound Care [NURWND0015] Routine
General [132252]
Activity [NURACT0008] Routine
Discharge Activity:
Wound Care [NURWND0015] Routine
Nutrition [132224]
Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications:
Bladder Care [132227]
Bladder Care [NURELM0067] Routine, Resume home bladder management.
Bowel Care [132228]
Bowel Care [NURELM0068] Routine, Resume home bowel management.
Narcotics (pain medication) can be constipating. Use
stool softeners/laxatives when taking these
medications. Hold for loose stools.
Other Patient Care Instructions [132229]
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
When to Call Your Doctor [132230]
Page 5 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@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, • Any redness, swelling or drainage
from incision.
• Fever greater than 100.4 F within 2 months of
surgery.
• Pain that is worsening or uncontrolled.
• Nausea or vomiting.
• Any other questions or concerns.
• FOR EMERGENCIES, CALL 911
• Call the Pediatric Neurosurgery Clinic at 608-263-
6420, Option 3. After hours or on weekends or
holidays, call the hospital operator at 608-262-0486
and ask to have the neurosurgery resident on call
paged.
Follow-Up Care
Follow-Up Apoointments [132233]
Schedule Appointment With Physical Therapy
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Physical Therapy
Schedule Appointment With Occupational
Therapy [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Occupational Therapy
Schedule Appointment With Speech Therapy
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Speech Therapy
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Patient to Schedule Appointment [NURCOM0056] Routine
Purpose:
With whom:
For when:
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
Page 6 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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.
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.
Page 7 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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.
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.
Page 8 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

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.
Facility Therapy Needs [132234]
Continue Physical Therapy at Next Facility
[NURCOM0022]
Routine
Continue Occupational Therapy at Next Facility
[NURCOM0022]
Routine
Continue Speech Therapy at Next Facility
[NURCOM0022]
Routine
Discharge Labs [134929]
Page 9 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Please use the table below to determine what type of order to use to place discharge lab
orders.
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
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 10 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Labs [132235]
Consulting Provider will lab orders should only be used if the current Attending Provider or These
lab.be responsible for the result of the
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
BASIC METABOLIC PANEL [BMET] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:11/17/18 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:11/17/18 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
PROTEIN, TOTAL [TP] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
ALBUMIN [ALB] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:2/15/18 MANUAL,Count:1,
Normal, Routine
AST/SGOT [AST] Status: Standing, Expires:11/17/18 MANUAL,Count:1,
Normal, Routine
ALT/SGPT [ALT] Status: Standing, Expires:11/17/18 MANUAL,Count:1,
Normal, Routine
Imaging [132236]
X-RAY CHEST AP VIEW [R71010] Status: Future, Expires: 12/16/2018, Normal, Routine
CT HEAD W & W/ O IV CONTRAST [R70470] Status: Future, Expires: 12/16/2018, Normal, Routine
CT ABDOMEN PELVIS W & W/ O IV CONTRAST
[R07033]
Status: Future, Expires: 12/16/2018, Normal, Routine
Page 11 of 11
Printed by O'BRIEN, RYLEY P [RPO249] at 10/16/2017 3:07:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org