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/clinical/cckm-tools/content/order-sets/inpatient/transplant/name-97919-en.cckm

201606175

page

100

UWHC,UWMF,

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

IP - Lung Transplant - Evaluation - Adult - Supplemental [4120]

IP - Lung Transplant - Evaluation - Adult - Supplemental [4120] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Lung Transplant - Evaluation - Adult - Supplemental [4120]
Intended for Adult Patients Only
Patient Care Orders
Non-Categorized Patient Care Orders [146116]
Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
Weigh with empty pockets and without shoes or coat.
Measure Height [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine, Measure
without shoes or hat.
Diagnostic Tests and Imaging
Imaging [110848]
CT SINUS W/ O IV CONTRAST [R70486B] ONCE-RAD NEXT AVAILABLE For 1 Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Lung Transplant Evaluation
Relevant recent/past history?
Is patient pregnant? No
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: Floor Determined/Entered
Pre-transplant recipient. ABN not required.
CT MAXILLOFACIAL W/ O IV CONTRAST - Note: Order
for CF Patients [R70486]
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? Lung Transplant Evaluation
Relevant recent/past history?
Is patient pregnant? No
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: Floor Determined/Entered
Pre-transplant recipient. ABN not required. Order for CF
patients in place of CT sinus.
Bone Mineral Density Axial (W Appendicular & Vertebral
Fracture Assessment (VFA) (PRN) (BMD) [R07029]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences, Routine
Perform the Appendicular exam per protocol?
Perform the VFA exam per protocol?
Current signs and symptoms? Shortness of Breath
What specific question(s) would you like answered by this
exam? Lung transplant evaluation, assess for osteoporosis
and osteopenia
Relevant recent/past history? End stage lung disease,
undergoing evaluation for lung transplant
Is patient pregnant? No
Has the patient had a PET or Nuclear Medicine procedure in
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last 48 hours or Radiology procedures with contrast (oral
and/or IV) within the last two weeks?
Is patient taking TUMS or calcium supplements or antacids?
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: Floor Determined/Entered
Pre-transplant recipient. ABN not required.
X-RAY PANOREX (ORTHOPANTOGRAM) [R70355] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Shortness of Breath
What specific question(s) would you like answered by this
exam? Lung Transplant Evaluation
Relevant recent/past history? End stage lung disease,
undergoing evaluation for lung transplant
Is patient pregnant? No
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Pre-transplant recipient. ABN not required.
CT CHEST W/ O IV CONTRAST [R71250] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Shortness of breath
What specific question(s) would you like answered by this
exam? Lung Transplant Evaluation
Relevant recent/past history? End stage lung disease,
undergoing evaluation for lung transplant
Is patient pregnant?
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: Floor Determined/Entered
Pre-transplant recipient. ABN not required. Please measure
right lung, left lung, and costal to costal diameter.
Transthoracic Resting Echocardiogram [ECH0003] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: SHORTNESS OF BREATH
Do you want Agitated Bubble Study?
Is patient mechanically ventilated? No
Is patient ICU status? No
Does patient need continuous monitoring? No
NM LUNG PERFUSION SCAN [R78580] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Relevant recent/past history? End stage lung disease,
undergoing evaluation for lung transplant
Is this a pre-surgical work-up? Y/N If yes, indentify surgery
anticipated in comments box at bottom. Yes
Current signs and symptoms? Shortness of breath
What specific question(s) would you like answered by this
Page 2 of 9
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exam? Lung Transplant Evaluation
Is patient pregnant or breastfeeding? No
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):
Transport Method: Floor Determined/Entered
Pre-transplant recipient. ABN not required.
Procedures/Requests for Procedures
Procedures/Requests for Procedures [110851]
Spirometry - Before & After Bronchodilator, Lung
Volumes, Diffusing Capacity, ABG (Room Air) [999992]
ONCE For 1 Occurrences, Routine
Reason for Exam: Lung transplant evaluation
Specify Test: Spirometry, Lung Volumes, Diffusing
Capacity,ABG on Room Air (Pulmonary Lab to draw)
Pre-transplant recipient. ABN not required.
ECG - 12 Lead [EKG0008] ONCE, Routine
Reason for exam: OTHER (COMMENT)
Pre-transplant recipient. ABN not required.
Ambulating Oximetry Test [RT0036] ONCE, Starting today For 1 Occurrences, Routine,
Ambulating oximetry tests must be done within 48 hours of
discharge due to insurance issues.
Is this order for home O2? No
Anticipated or Confirmed Discharge Date: 6/13/2016
Confirmed Discharge Time:
Pre-transplant recipient. No ABN required.
Request for Gastroenterology Procedure - Manometry
[CON0027]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): To determine if there are any
contraindications to lung transplant
Request for manometry. Pre-transplant recipient. ABN not
required.
Request for Gastroenterology Procedure - GI
Impedence [CON0027]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): To determine if there are any
contraindications to lung transplant
Request for GI Impedence. Pre-transplant recipient. ABN
not required.
Laboratory
Labs - General [110879]
ABO AND RH TYPING [ABO] NEXT AM, Starting tomorrow For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-transplant recipient.
ABO AND RH TYPING [ABO] NEXT AM, Starting 6/12/16 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Page 3 of 9
Printed by LIND, JANNA S [JSL237] at 6/10/2016 8:59:44 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

CBC WITH DIFFERENTIAL [CBC] NEXT AM, 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?
Pre-transplant recipient.
PROTHROMBIN TIME/INR [PT] NEXT AM, 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?
Pre-transplant recipient.
PTT [PTT] NEXT AM, 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?
Pre-transplant recipient.
URINALYSIS WITH MICROSCOPY [UA] NEXT AM, 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?
Pre-transplant recipient.
CREATININE, URINE [HCUCCR] NEXT AM, Starting today For 1 Occurrences, Urine-Random,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-transplant recipient.
LIPID PANEL [LIPID] NEXT AM, Starting today For 1 Occurrences, Routine, Test
includes Cholesterol, Total; HDL Cholesterol; Triglyceride;
LDL cholesterol, calculated; and non-HDL cholesterol.
Patient must fast for 10-14 hours and be heparin free for 48
hours prior to specimen collection. The patient can only have
water, black coffee or calorie free drinks during the fasting
period.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-transplant recipient. Patient must fast for 12-14 hours and
be heparin free for 48 hours prior to specimen collection.
Patient may only have water or black coffee while fasting.
GLUCOSE [GLU] NEXT AM, 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?
Pre-transplant recipient.
CALCIUM [CA] NEXT AM, 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?
Pre-transplant recipient.
ALBUMIN [ALB] NEXT AM, 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?
Pre-transplant recipient.
PROTEIN, TOTAL [TP] NEXT AM, 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?
Pre-transplant recipient.
Page 4 of 9
Printed by LIND, JANNA S [JSL237] at 6/10/2016 8:59:44 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

ELECTROLYTES [LYTE] NEXT AM, 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?
Pre-transplant recipient.
BUN [BUN] NEXT AM, 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?
Pre-transplant recipient.
CREATININE [CRET] NEXT AM, 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?
Pre-transplant recipient.
ALKALINE PHOSPHATASE [ALKP] NEXT AM, 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?
Pre-transplant recipient.
ALT/SGPT [ALT] NEXT AM, 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?
Pre-transplant recipient.
AST/SGOT [AST] NEXT AM, 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?
Pre-transplant recipient.
BILIRUBIN, TOTAL [TBIL] NEXT AM, 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?
Pre-transplant recipient.
EBV AB TO VIRAL CAPSID AG, IGG [HCEBVIGG] NEXT AM, 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?
Pre-transplant recipient.
HEPATITIS C AB [HCV] NEXT AM, 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?
Pre-transplant recipient.
CMV IGG AB [XCMVG] NEXT AM, 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?
Pre-transplant recipient.
FERRITIN [FER] NEXT AM, 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?
Pre-transplant recipient.
PREALBUMIN [XPRALB] NEXT AM, 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?
Pre-transplant recipient.
Page 5 of 9
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

TSH [TSH] NEXT AM, 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?
Pre-transplant recipient.
HIV AB/AG COMBO [HIVABAG] NEXT AM, Starting today For 1 Occurrences, Routine, I, the
ordering provider, have verified that the patient/patient's
authorized representative was:
1. Notified that the patient will be subjected to an HIV test
unless the patient/rep declines the test;
2. Given educational materials on HIV and HIV testing;
3. Notified that they may decline the test and health care
providers may not use the fact that the patient/rep declined an
HIV test as a basis for denying other services; and
4. Provided an opportunity to ask questions and to decline the
HIV test.
The ordering provider verifies:
5. The patient/patient's authorized representative
understands that an HIV test will be performed; and
6. The decision of the patient/rep regarding whether to have
an HIV test performed was not coerced or involuntary.
Pt/Pt's Rep did not opt out. Steps listed in instructions taken.
If test is declined, type ".HIVTESTDECLINE" in progress
note.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-transplant recipient
TOXOPLASMA AB, IGG/IGM [HCTOXO] NEXT AM, 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?
Pre-transplant recipient.
URIC ACID [URIC] NEXT AM, 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?
Pre-transplant recipient.
PTH [HCPTHIN] NEXT AM, 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?
Pre-transplant recipient.
VARICELLA ZOSTER AB, IGG [VZIGG] NEXT AM, 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?
Pre-transplant recipient.
HEPATITIS B SURFACE AB (IMMUNE STATUS)
[HBSABI]
NEXT AM, 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?
Pre-transplant recipient.
HEPATITIS B SURFACE AG [HBSAG] NEXT AM, 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?
Page 6 of 9
Printed by LIND, JANNA S [JSL237] at 6/10/2016 8:59:44 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

Pre-transplant recipient.
LD, TOTAL [LDH] NEXT AM, 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?
Pre-transplant recipient.
MICROALBUMIN, URINE [UMA] NEXT AM, 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?
Pre-transplant recipient.
NICOTINE (INCLUDES COTININE), URINE
[HCUNCPNL]
NEXT AM, 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?
Pre-transplant recipient.
COLD AGGLUTININS, QUAL [COLD] NEXT AM, 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?
Pre-transplant recipient.
MAGNESIUM [MAG] NEXT AM, 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?
Pre-transplant recipient.
HEMOGLOBIN A1C [HA1C] NEXT AM, 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?
Pre-transplant recipient.
QUANTIFERON-TB GOLD [GM8455] NEXT AM, 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?
Pre-transplant recipient.
C REACTIVE PROTEIN [CRPN] NEXT AM, 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?
Pre-transplant recipient.
Labs - Pre-Transplant HLA Testing
Labs - Pre-Transplant HLA Testing [110880]
HLA CLASS I AB BY LUMINEX, PRE TX [HCLUC1S] NEXT AM For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HLA CLASS II AB BY LUMINEX, PRE TX [HCLUC2S] NEXT AM For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-transplant recipient. ABN not required
HLA DR/DQ, PRE-TX [117055]
DRB1 LOCUS, PRE-TX [HCDRB1S] NEXT AM For 1 Occurrences, Routine
Indicate organ for transplant: Lung
Page 7 of 9
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If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
DRB345 LOCUS, PRE-TX [HCDRB345S] 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?
DQ LOCUS, PRE-TX [HCDQB1S] NEXT AM For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
DP LOCUS, PRE-TX [HCDPB1S] NEXT AM For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HLA CLASS I TYPING (A,B,C), PRE-TX [117059]
HLA A LOCUS, PRE-TX [HCALOCS] NEXT DRAW For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HLA B LOCUS, PRE-TX [HCBLOCS] NEXT DRAW For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HLA C LOCUS, PRE-TX [HCCLOCS] NEXT DRAW For 1 Occurrences, Routine
Indicate organ for transplant: Lung
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Consults
Consults [110881]
Consult Infection Control Practitioner (Inpatient)
[CON0036]
ONCE For 1 Occurrences, Routine
Reason for Consult: OTHER ( Are there any contraindications
to lung transplant?)
Pre-transplant recipient. ABN not required
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER (Are there any contraindications
to lung transplant?)
Pre-transplant recipient. ABN not required
Behavioral Health Consults (select below) [205803]
Health Psychology - adjustment, protocol (eg. burn, trauma, rehab, pre-amp, transplant), noncompliance, grief, pain
Addictive Disorders - alcohol or drug related problems (eg. treatment recommendations, withdrawal mgmt)
Psychiatry - safety, agitation, capacity, med mgmt, psychotropic SE
ACE - 65 and older - delirium, dementia, depression, decisional capacity, sleep (also for non-behavioral geriatric
syndromes; overall geriatric evaluation, mobility/falls, functional decline, social/caregiver issues, disposition, medication
management)
Consult Health Psychology (Inpatient) [CON0033] ONCE, Routine, Please notify consulting provider if patient
needs to be seen same day (Monday-Friday) or if special
assessment needs.
Intent for Consult: Protocol: BURN, REHAB, PRE-AMP,
TRANSPLANT EVALUATION, TRAUMA
Concern or Specific Question or Task to be Addressed
Page 8 of 9
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(Symptom, Sign, or Diagnosis): Are there any
contraindications to lung transplant?
Pre-transplant recipient. ABN not required
Consult Addictive Disorders (Inpatient) [CON0003] ONCE, Routine, This order is for ADULT patients.
Please use the Consult Adolescent/Pediatric AODA
Counselor order for adolescent/pediatric patients instead.
Intent for Consult:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Consult Psychiatry (Inpatient) [CON0064] ONCE
Intent for Consult:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Consult Nutrition (Inpatient) [CON0043] ONCE For 1 Occurrences, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
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?
Pre-transplant recipient. ABN not required
Consult Dental (Inpatient) [CON0019] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): To determine if there are any
contraindications to lung transplant.
Pre-transplant recipient. ABN not required
Consult to Otolaryngology [CON0024] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): To determine if there are any
contraindications to lung transplant
Consult Pulmonary Rehab (Inpatient) [CON0115] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Are there any contraindications to lung
transplant?
Pre-transplant recipient. ABN not required.
Page 9 of 9
Printed by LIND, JANNA S [JSL237] at 6/10/2016 8:59:44 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org