ID

16038

Description

AAFP: DVT Discharge, Standardizes Admission Orders, Author: Robert M. Wiprud, MD The primary purpose of these Ordersets is to decrease unnecessary variability and to improve quality through standardized Admission Orders. Developed by the Scott & White Clinic at College Station, Texas. Copyright © 2006 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. Wiprud RM. Providing consistent care with standardized admission orders. Fam Pract Manag. September 2006: 49-52 See http://www.aafp.org/fpm/2006/0900/p49.html This ODM Form includes the twelfth section ("DVT Discharge").

Link

http://www.aafp.org/fpm/2006/0900/p49.html

Keywords

Versions (2)
  1. 6/27/16 6/27/16 -
  2. 8/14/16 8/14/16 -
Uploaded on

June 27, 2016

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License

Creative Commons BY-NC 3.0
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AAFP: DVT Discharge

English

AAFP: DVT Discharge

1 forms  
  1. StudyEvent: ODM
    1. AAFP: DVT Discharge
Default Itemgroup
Description

Default Itemgroup

Name
Description

Name

Data type

text

Age
Description

Age

Data type

integer

Date of Birth
Description

Date of Birth

Data type

date

Medical record
Description

Medical record

Data type

integer

Status
Description

Status

Discharge home
Description

Status

Data type

boolean

If discharge home, please specify date
Description

Status

Data type

date

Attending
Description

Attending

Name of attending physician
Description

Attending

Data type

text

Phone number of attending physician
Description

Attending

Data type

integer

Discharge Diagnosis
Description

Discharge Diagnosis

DVT___lower extremity
Description

Discharge Diagnosis

Data type

boolean

If DVT ___ lower extremity please specify
Description

Discharge Diagnosis

Data type

text

Other
Description

Discharge Diagnosis

Data type

boolean

If Other, please specify
Description

Discharge Diagnosis

Data type

text

Status
Description

Status

Status
Description

Status

Data type

text

Allergies
Description

Allergies

Allergies
Description

Allergies

Data type

text

Diet
Description

Diet

Diet
Description

Diet

Data type

text

Activity
Description

Activity

As tolerated
Description

Activity

Data type

boolean

Elevate affected leg as much as possible
Description

Activity

Data type

boolean

No driving or prolonged standing
Description

Activity

Data type

boolean

Medications
Description

Medications

Lovenox___mg subcutaneously BID for ___days
Description

Provide patient with prescription for Lovenox or call the pharmacy. Lovenox is dispensed in prefilled syringes in the following doses: 30 mg, 40 mg, 60 mg, 80 mg, 100 mg. There are no pre-authorization requirements.

Data type

boolean

If Lovenox, please specify amount
Description

Lovenox specification

Data type

integer

Measurement units
  • mg
mg
If Lovenox, please specify duration in days
Description

Lovenox specification

Data type

integer

Coumadin__mg by mouth every day
Description

Medications

Data type

boolean

If Coumadin, please specify amount
Description

Medications

Data type

integer

Additional medications
Description

Medications

Data type

boolean

If additional medications, please specify
Description

Medications

Data type

text

Patient Education
Description

Patient Education

Lovenox self-injection
Description

Patient Education

Data type

boolean

Dietician counseling for food-drug interactions
Description

Patient Education

Data type

boolean

Signs and symptoms of abnormal bleeding that need to be reported
Description

Patient Education

Data type

boolean

Avoidance of NSAID medications (aspirin, ibuprofen, Aleve, etc.)
Description

Patient Education

Data type

boolean

Follow-up
Description

Follow-up

Date and Time of Appointment already set
Description

Follow-up

Data type

boolean

If Appointment set, please specify date and time
Description

Follow-up

Data type

datetime

Call for an appointment in the next 3 days
Description

Follow-up

Data type

boolean

Call for an appointment with Dr.____in the next ___days
Description

Follow-up

Data type

boolean

Please specify name of doctor
Description

Follow-up

Data type

text

Please specify amount of days
Description

Follow-up

Data type

integer

Other
Description

Other

Please fax the attached Coumadin Clinic Referral
Description

Other

Data type

boolean

Please fax the attached Discharge Summary
Description

Other

Data type

boolean

Signature
Description

Signature

Data type

text

Signature
Description

Signature

Data type

text

Date and Time
Description

Date and Time

Data type

datetime

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Similar models

AAFP: DVT Discharge

1 forms
  1. StudyEvent: ODM
    1. AAFP: DVT Discharge
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Name
Item
Name
text
Age
Item
Age
integer
Date of Birth
Item
Date of Birth
date
Medical record
Item
Medical record
integer
Item Group
Status
Status
Item
Discharge home
boolean
Status
Item
If discharge home, please specify date
date
Item Group
Attending
Attending
Item
Name of attending physician
text
Attending
Item
Phone number of attending physician
integer
Item Group
Discharge Diagnosis
Discharge Diagnosis
Item
DVT___lower extremity
boolean
Discharge Diagnosis
Item
If DVT ___ lower extremity please specify
text
Discharge Diagnosis
Item
Other
boolean
Discharge Diagnosis
Item
If Other, please specify
text
Item Group
Status
Item
Status
text
Status
Code List
Status
CL Item
Stable (1)
CL Item
Fair (2)
CL Item
Serious (3)
CL Item
Critical (4)
Item Group
Allergies
Allergies
Item
Allergies
text
Item Group
Diet
Diet
Item
Diet
text
Item Group
Activity
Activity
Item
As tolerated
boolean
Activity
Item
Elevate affected leg as much as possible
boolean
Activity
Item
No driving or prolonged standing
boolean
Item Group
Medications
Medications
Item
Lovenox___mg subcutaneously BID for ___days
boolean
Lovenox specification
Item
If Lovenox, please specify amount
integer
Lovenox specification
Item
If Lovenox, please specify duration in days
integer
Medications
Item
Coumadin__mg by mouth every day
boolean
Medications
Item
If Coumadin, please specify amount
integer
Medications
Item
Additional medications
boolean
Medications
Item
If additional medications, please specify
text
Item Group
Patient Education
Patient Education
Item
Lovenox self-injection
boolean
Patient Education
Item
Dietician counseling for food-drug interactions
boolean
Patient Education
Item
Signs and symptoms of abnormal bleeding that need to be reported
boolean
Patient Education
Item
Avoidance of NSAID medications (aspirin, ibuprofen, Aleve, etc.)
boolean
Item Group
Follow-up
Follow-up
Item
Date and Time of Appointment already set
boolean
Follow-up
Item
If Appointment set, please specify date and time
datetime
Follow-up
Item
Call for an appointment in the next 3 days
boolean
Follow-up
Item
Call for an appointment with Dr.____in the next ___days
boolean
Follow-up
Item
Please specify name of doctor
text
Follow-up
Item
Please specify amount of days
integer
Item Group
Other
Other
Item
Please fax the attached Coumadin Clinic Referral
boolean
Other
Item
Please fax the attached Discharge Summary
boolean
Signature
Item
Signature
text
Signature
Item
Signature
text
Date and Time
Item
Date and Time
datetime
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