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IP – Neuromuscular Disorders – Pediatric – Admission [6110]

IP – Neuromuscular Disorders – Pediatric – Admission [6110] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Neuromuscular Disorders - Pediatric - Admission [6110]
Admission Status
Level of Care (Single Response) [186484]
*An admit patient order has already been written, but the level of care at which the patient should be placed still needs to
be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Place Patient on Intermediate Care (IMC) [ADT0018] Intermediate Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order will
ensure that the patient is placed at the appropriate level of
care.
Admit to Inpatient (Single Response) [188296]
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:
Admit to Observation (Single Response) [188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit to Outpatient Short Stay (Single Response)
[188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [82665]
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:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
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Service:
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, 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:
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 [204814]
Rectal Temperatures Preferred for Patients Less Than 2 Years of Age
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 4, then every 2 hours times 4, then every 4
hours
Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified, Routine
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Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every hour 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:
Patient Monitoring [204820]
Order Cardio-Respiratory Monitor - Pediatric - Without Rhythm only if patient has a trach.
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[139420]
Cardio-Respiratory Monitor - Pediatric - Without Rhythm
[NURMON0074]
CONTINUOUS, 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
Notify based on:
Notify provider for apnea > 20 seconds
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 - Once Daily [NURMON0015] 1X DAILY, Routine
Weigh With?
Weigh when?
Measure Weight - See comments [NURMON0015] SEE COMMENTS, Routine
Weigh With?
Weigh when?
***
Measure Intake And Output (Every 1 hour)
[NURMON0005]
EVERY 1 HOUR, Routine
Measure Intake And Output (Every 4 hours)
[NURMON0005]
EVERY 4 HOURS, Routine
Measure Intake And Output (Every 8 hours)
[NURMON0005]
EVERY 8 HOURS, Routine
Activity [204815]
Ad Lib [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB: ad lib
AMBULATE:
Page 3 of 13
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CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Chair-Ad Lib [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR: ad lib
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bedrest - with bathroom privileges [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: with bathroom privileges
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Ambulate - with assistance [NURACT0008] CONTINUOUS, Starting today For Until specified, 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:
Nutrition [204816]
For Parenteral Nutrition Management Orders, Refer to the Parenteral Nutrition - Supplemental
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:
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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:
Diet - Strict NPO [NUT0001] EFFECTIVE NOW, Starting today For Until specified, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
STRICT NPO
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:
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:
Page 5 of 13
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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:
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):
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:
Page 6 of 13
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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):
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:
Consult Pediatric Nutrition Support (Inpatient)
[CON0176]
ONCE
Intent: Consult and Recommend (Write Orders)
Reason for Consult: Initiate Parenteral Nutrition
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Can this consult be done via video?
Respiratory [204817]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type: Neuromuscular
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine
Biphasic Positive Airway Pressure (BIPAP) [RT0004] CONTINUOUS, Routine
Mode:
IPAP (cm H2O):
EPAP (cm H2O):
FiO2 (%):
Set Rate/Min:
Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
IP - Panel - BiPAP Night / Nap - UWIP [197547]
Biphasic Positive Airway Pressure - Overnight (BIPAP)
[RT0079]
OVERNIGHT AND NAP, Routine
Therapy Settings: Per RT
Mode:
IPAP (cm H2O):
EPAP (cm H2O):
FiO2 (%):
Set Rate/Min:
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
Oximetry for Sleep Disordered Breathing [RT0091] CONTINUOUS, Starting today, Routine, Attention:
Confirmed or Suspected Sleep Disorder. Must have
continuous oximetry adapted to the nurse call system
during sleep/naps.
Mechanical Ventilation - Pediatric [205984]
For patients 6 years and older SELECT the order for Chlorhexidine.
chlorhexidine (PERIDEX) 0.12 % soln MULTIDOSE -
NOTE: For Patients 6 years of age or older [792004]
15 mL, Mouth/Throat, 2 X DAILY
Use to swab oral cavity. D/C when patient no longer on
ventilation.
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine
Mechanical Ventilation - Peds [RT0090] CONTINUOUS, Routine, For ADULT patients order
chlorihexidene gluconate (PERIDEX) 0.12% soln 15 mL to
swab oral cavity 2x daily while on ventilation.
Ventilator Management:
Wean Peds:
Mode:
Set Rate/Min:
Tidal Volume Multiplier: 7
PEEP (cmH2O):
FiO2 (%):
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
artificial tears PF ophthalmic ointment [157764] Eyes (Each), PRN, Irritation
Adminster to each eye every 2-4 hours as needed. For use
while patient is mechanically ventilated and sedated.
Please refer to ocular care algorithm.
Ventilator Associated Pneumonia (VAP Precautions)
[NURCOM0022]
SEE COMMENTS, Ventilator Associated Pneumonia
Precautions
Suction Airway [NURTAD0017] PRN, Routine
Location: Tracheal
ETCO2 Monitoring [RT0006] CONTINUOUS, Routine
Page 8 of 13
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Contingency Parameters - Notifiy Pediatric Pulmonologist [195212]
Contingency Parameters - Notify Pediatric
Pulmonologist [NURCOM0022]
SEE COMMENTS For Until specified, If unsure which
resident physician to contact about this patient on the
Pediatric Pulmonary Service, page the Pediatric Admitting
Resident.
Intravenous Therapy
If IV Nutrition is needed for 3 or more days (e.g. Orthopedic hardware insertion) please refer to the IP - Venous Access
Team - PICC Placement Request - Pediatric - Supplemental order set
IV Fluids [204821]
Order Cardio-Respiratory Monitor - Pediatric - Without Rhythm only if patient has a trach.
Consult Venous Access Team (Inpatient) [CON0124] ONCE, Routine
Reason for consult: Assist with difficult peripheral IV
placement
Can this consult be done via video?
dextrose 10%-NaCl 0.45% BOLUS [700593] Intravenous
dextrose 10%-NaCl 0.45% with KCl 20 meq/L [710000] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L infusion
[44904]
Intravenous, CONTINUOUS
sodium chloride 0.9% BOLUS [730003] Intravenous
Premedication for Needle Insertion [30232]
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
LMX Use Instructions for Premedication Prior to Needle
Insertion [NURCOM0095]
Details
Laboratory
Laboratory [204822]
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] NEXT DRAW 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 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
Page 9 of 13
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previous specimen?
If Conditional, What Condition?
CREATININE [CRET] NEXT DRAW 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 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 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BILIRUBIN, TOTAL [TBIL] NEXT DRAW 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 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] NEXT DRAW 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 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CARNITINE [CARNIT] NEXT DRAW For 1 Occurrences, Routine, Test includes total
carnitine, free carnitine, and carnitine esters.
Clinical History/ Reason for Testing:
Is infant on formula?
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
VITAMIN D, 25-HYDROXY BY HPLC [HCLCD25] NEXT DRAW For 1 Occurrences, Routine, Screening for
Vitamin D deficiency is not covered by Medicare. If this is the
reason for the test, please advise the patient of non-coverage
via the ABN process. Coverage is allowed in some other
circumstances. If one of these diagnoses is appropriate for
your patient, please associate the corresponding code with
this order.
252.00 (ICD-9); E21.3 (ICD-10) Hyperparathyroidism,
unspecified
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252.01 (ICD-9); E21.0 (ICD-10) Primary Hyperparathyroidism
252.02 (ICD-9); E21.1 (ICD-10) Secondary
Hyperparathyroidism, Non-Renal
252.08 (ICD-9); E21.2 (ICD-10) Other Hyperparathyroidism
252.1 (ICD-9); E20.9 (ICD-10) Hypoparathyroidism
268.0 (ICD-9); E55.0 (ICD-10) Rickets Active
268.2 (ICD-9); M83.9 (ICD-10) Osteomalacia Unspecified
268.9 (ICD-9); E55.9 (ICD-10) Established Vitamin D
Deficiency (monitoring efficacy of replacement therapy)
275.3 (ICD-9); E83.30 (ICD-10) Disorders of Phosphorus
Metabolism
275.41 (ICD-9); E83.51 (ICD-10) Hypocalcemia
275.42 (ICD-9); E83.52 (ICD-10) Hypercalcemia
585.3 (ICD-9); N18.3 (ICD-10) Chronic Kidney Disease,
Stage III (Moderate)
585.4 (ICD-9); N18.4 (ICD-10) Chronic Kidney Disease,
Stage IV (Severe)
585.5 (ICD-9); N18.5 (ICD-10) Chronic Kidney Disease,
Stage V
585.6 (ICD-9); N18.6 (ICD-10) End Stage Renal Disease
588.81 (ICD-9); N25.81 (ICD-10) Secondary
Hyperparathyroidism (of Renal Origin)
733.00 (ICD-9); M81.0 (ICD-10) Osteoporosis Unspecified
733.01 (ICD-9); M81.0 (ICD-10) Senile Osteoporosis
733.02 (ICD-9); M81.8 (ICD-10) Idiopathic Osteoporosis
733.03 (ICD-9); M81.8 (ICD-10) Disuse Osteoporosis
733.09 (ICD-9); M81.8 (ICD-10) Other Osteoporosis
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
FATTY ACID PROFILE, ESSENTIAL [HCESSFA] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PREALBUMIN [XPRALB] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
IRON AND TRANSFERRIN W/ TIBC, SATURATION
[FETRANS]
NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
Page 11 of 13
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 11:14:19 AM
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

previous specimen?
If Conditional, What Condition?
FERRITIN [FER] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
LACTATE [GM2255] NEXT DRAW For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BLOOD GASES [HCBGAS] NEXT DRAW For 1 Occurrences, Venous, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
AMINO ACIDS, QUANTITATIVE [AMINOA] NEXT DRAW For 1 Occurrences, Routine
Clinical History/ Reason for Testing:
Is infant on formula?
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Consults
Consults [204823]
Consult Palliative Care - Pediatric (Inpatient) [CON0172] ONCE, Routine
Reason For Consult:
Can this consult be done via video?
Consult Pediatric Rehab (Inpatient) [CON0138] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE, Routine
Reason for Physical Therapy Consult:
Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE, Routine
Reason for Occupational Therapy Consult:
Consult Pediatric General Surgery (Inpatient)
[CON0112]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
CONSULT TO PEDS ORTHOPEDICS [1009219] Details
Consult Pediatric Health Psychology (Inpatient)
[CON0202]
ONCE, 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?
Consult Child Life Specialist (Inpatient) [CON0014] ONCE, Routine
Activity Level:
Reason for Consult:
Can this consult be done via video?
Consult Speech Therapy (Inpatient) Eval and Treat
[CON0077]
ONCE, Routine
Patient Type:
Consult Swallow Therapy (Inpatient) [CON0079] ONCE, Routine
Reason for Consult:
May the Speech Pathologist and Registered Dietician place
diet orders on your behalf?
Is this a potential new stroke patient?
Page 12 of 13
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 11:14:19 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

Consult Communication Specialist (Inpatient)
[CON0016]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult:
Is this a STAT consult?
Can this consult be done via video?
Consult Nutrition (Inpatient) [CON0043] ONCE, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
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 13 of 13
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 11:14:19 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org