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UWHC,UWMF,

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IP – Asthma Exacerbation – Pediatric – Intensive Care – Admission [5592]

IP – Asthma Exacerbation – Pediatric – Intensive Care – Admission [5592] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Asthma Exacerbation - Pediatric - Intensive Care - Admission [5592]
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) [186388]
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: status asthmaticus
E - EVALUATIONS PLANNED: Labs and close monitoring
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED: Treatments Ordered: IV
Fluids, albuterol, steroids
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


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:
Service:
Isolation Status
Isolation Status [186390]
Isolation - Contact And Droplet - Respiratory Infection -
Acute - Panel [116343]
Isolation - Contact and Droplet - Respiratory Infection -
Acute [ISO0045]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
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
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Patient Care Orders
Vital Signs [186391]
Vital Signs [NURMON0013] EVERY 1 HOUR, Starting today For Until specified, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [186393]
Cardio-Respiratory Monitor - Pediatric - With Rhythm
[139419]
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
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine
Measure Height - On Admission [NURMON0052] ONCE For 1 Occurrences, Routine, On Admission
Measure Weight - Daily [NURMON0015] 1X DAILY, Starting today at 4:00 AM, Routine
Weigh With?
Weigh when? AM
Measure weight daily for: Infants under the age of 6 months
or less than 5 kilograms; patients on diuretics to achieve a
negative fluid balance; patients with acute renal; cardiac or
pulmonary disease, patients on dialysis or hemofiltration;
patients with vomiting, diarrhea, DI, SIADH.
Note: If nursing staff does not feel performing a weight on a
patient can be done safely or poses a risk to a patient, they
should communicate this direcly with the attending physician.
Activity [186394]
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:
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today
Nutrition [186396]
Tube Feeding Management - Refer to "Tube Feeding - Supplemental Order Set"
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Parenteral Nutrition Management - Refer to "Parenteral Nutrition - Supplemental Order Set"
NPO [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):
Room Service Class:
Respiratory [186349]
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Starting today For Until specified, Routine
Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
High Flow Nasal Cannula [RT0071] CONTINUOUS, Starting today For Until specified, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
Attempt to Wean Off Oxygen? Yes
CPAP Continuous [RT0009] CONTINUOUS, Starting today For Until specified, Routine
PEEP (cmH2O):
FiO2 (%):
Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
Biphasic Positive Airway Pressure (BIPAP) [RT0004] CONTINUOUS, Starting today For Until specified, Routine
Mode:
IPAP (cm H2O):
EPAP (cm H2O):
FiO2 (%):
Set Rate/Min:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
Mechanical Ventilation - Pediatric [147629]
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 Peneumonia (VAP Precautions)
[NURCOM0022]
SEE COMMENTS, Ventilator Associated Pneumonia
Precautions
Suction Airway [NURTAD0017] PRN, Routine
Location: Tracheal
ETCO2 Monitoring [RT0006] CONTINUOUS, Routine
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Routine, Instruct patient to do on their
own every 10 minutes while awake.
Chest Physiotherapy [RT0011] EVERY 4 HOURS, Routine
Affected Area: Side to Side
Intrapulmonary Percussive Ventilation (IPV) [RT0023] EVERY 4 HOURS, Routine
Intake and Output [186397]
Measure Intake And Output [NURMON0005] EVERY 1 HOUR For Until specified, Routine
Non-Categorized Patient Care Orders [186399]
RT to Provide Asthma Education to Patient [RT0125] ONCE For Until specified, Routine
Contingency Parameters [151617]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 100
If systolic blood pressure < (mmHg): 65
If diastolic blood pressure > (mmHg): 65
If diastolic blood pressure < (mmHg): 45
If temperature > (C): 38.2 or 38.0 sustained for over one hour
If heart rate > (bpm): 180
If heart rate < (bpm): 90
If respiratory rate >: 50
If respiratory rate <: 25
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 80
Pulse Oximetry < (%): 95
Other: Chest tube output is greater than *** mL/hour
Contingency Parameters [152663]
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Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 118
If systolic blood pressure < (mmHg): 85
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.2 or 38.0 sustained for over one hour
If temperature < (C):
If heart rate > (bpm): 160
If heart rate < (bpm): 80
If respiratory rate >: 40
If respiratory rate <: 20
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL):
Other: Chest tube output is greater than *** mL/hour
Contingency Parameters [152664]
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): 38.2 or 38.0 sustained for over one hour
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): 200
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL):
Other: Chest tube output is greater than *** mL/hour
Contingency Parameters [151621]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 125
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.2 or 38.0 sustained for over one hour
If heart rate > (bpm): 120
If heart rate < (bpm): 70
If respiratory rate >: 24
If respiratory rate <: 14
Pulse Oximetry < (%): 93
Other: Chest tube output is greater than *** mL/hour
If temperature < (C):
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 80
If pain score >:
If urine output < (mL):
Contingency Parameters [152665]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 140
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


If temperature > (C): 38.2 or 38.0 sustained for over one hour
If temperature < (C):
If heart rate > (bpm): 110
If heart rate < (bpm): 60
If respiratory rate >: 22
If respiratory rate <: 12
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 93
If urine output < (mL):
Other: Chest tube output is greater than *** mL/hour
Intravenous Therapy
Peripheral IV [187432]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Device:
Peripheral IV Location:
Peripheral IV Size:
Peripheral IV Status:
Does this need to be inserted/placed?
IV Fluids (Single Response) [186376]
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
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
Medications - Admission Specific
Corticosteriods [186378]
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS - Maximum Dose = 20 mg [800058]
0.5 mg/kg, Intravenous, EVERY 6 HOURS
Beta 2 Agonists [186379]
albuterol 5 mg/ml (0.5%) 60 mL neb soln bag [770018] Nebulization, CONTINUOUS
terbutaline (BRETHINE) 50 mg in sodium chloride 0.9 %
100 mL infusion [700839]
Intravenous, CONTINUOUS
Anti-cholinergics [186384]
ipratropium (ATROVENT) 0.02 % neb soln [47883] 500 mcg, Nebulization, RT EVERY 4 HOURS
Non-categorized Admission Specific [186385]
magnesium sulfate intraVENOUS (PEDS) - NOTE: Intravenous, ONCE For 1 Doses
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority


Suggested Dose 25-75 mg/kg - NOTE: Maximum Dose
= 2 grams [800194]
Infuse over 30 minutes
Medications
Analgesics/Antipyretics [186387]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 10-15 mg/kg/dose
(Maximum 650 mg/dose) [800005]
12 mg/kg, Oral, EVERY 4 HOURS PRN, pain/fever
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 - If unable to tolerate
PO
NOTE: Suggested dose 10-15 mg/kg/dose (Maximum 650
mg/dose)
Gastric (Single Response) [186382]
ranitidine (ZANTAC) injection - Maximum Dose = 50 mg
[800075]
1 mg/kg, Intravenous, EVERY 8 HOURS
ranitidine (ZANTAC) tab - NOTE: Suggested dose 2
mg/kg BID (Maximum Dose = 150 mg/dose) [720131]
Oral, 2 X DAILY
NOTE: Suggested dose 2 mg/kg BID (Maximum Dose = 150
mg/dose)
pantoprazole (PROTONIX) injection 1 mg/kg [800119] 1 mg/kg, Intravenous, 1 X DAILY
pantoprazole (PROTONIX) susp - NOTE: Suggested
dose 0.5 mg/kg daily (Maximum Dose = 40 mg/day)
[780113]
Oral, 1 X DAILY
NOTE: Suggested dose 0.5 mg/kg daily (Maximum Dose = 40
mg/day)
pantoprazole (PROTONIX) EC tab - NOTE: Suggested
dose 0.5 mg/kg daily (Maximum Dose = 40 mg/day)
[62661]
Oral, 1 X DAILY
NOTE: Suggested dose 0.5 mg/kg daily (Maximum Dose = 40
mg/day)
Non-categorized. [186381]
artificial tears PF ophthalmic ointment [157764] Eyes (Each), EVERY 4 HOURS
Sucrose for Oral Analgesia [110384]
sucrose (SWEET-EASE) 24% buccal soln [794009] Oral, PRN, pain, mild pain or potentially painful procedures.
See Admin Instructions
Laboratory
Draw Now (if not done in ER) [186400]
BLOOD GASES AND O2 SATURATION [HCBGASOS] STAT - RN COLLECT For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] STAT - RN COLLECT 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] STAT - RN COLLECT 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] STAT - RN COLLECT 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] STAT - RN COLLECT 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] STAT - RN COLLECT 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 © 2015 University of Wisconsin Hospitals and Clinics Authority


MAGNESIUM [MAG] STAT - RN COLLECT 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] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL [CBC] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
Studies [186402]
X-RAY CHEST AP VIEW - STAT [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
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
Consults
Consults [186418]
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult:
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?
Consults (Peds Pulmonary/Allergy) [187433]
Consult Pediatric Allergy (Inpatient) [CON0088] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Pediatric Pulmonary (Inpatient) [CON0098] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
BestPractice
No Hospital Problems Have Yet Been Identified. [186403]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on signing.
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority