AAFP: CVT Outpatient Screening Criteria

Inclusion Criteria
Beskrivning

Inclusion Criteria

Acute, symptomatic, proximal or distal DVT documented by venogram/Doppler U/S
Beskrivning

Inclusion Criteria

Datatyp

boolean

Patient agrees to outpatient therapy
Beskrivning

Inclusion Criteria

Datatyp

boolean

Exclusion Criteria
Beskrivning

Exclusion Criteria

Current, active bleeding, active peptic or ulcer disease, congenital or acquired bleeding disorder or disease process in which, in the judgement of the physician, there may be an increased risk of bleeding (e.g. hepatic or renal insufficiency, recent surgery or stroke)
Beskrivning

Exclusion Criteria

Datatyp

boolean

Concurrent symptomatic pulmonary emboli
Beskrivning

Exclusion Criteria

Datatyp

boolean

Expected hospitalization greater than five days due to co-existing conditions
Beskrivning

Exclusion Criteria

Datatyp

boolean

Known hypercoagulability: familiar or acquired
Beskrivning

Exclusion Criteria

Datatyp

boolean

Pregnant or breast-feeding
Beskrivning

Exclusion Criteria

Datatyp

boolean

Uncontrolled hypertension
Beskrivning

Exclusion Criteria

Datatyp

boolean

Extensive iliofemoral DVT
Beskrivning

Exclusion Criteria

Datatyp

boolean

Likelihood of non-compliance due to cognitive limitations, alcohol/drug abuse, dementia, psychiatric disorders, etc.
Beskrivning

Exclusion Criteria

Datatyp

boolean

if yes, please describe
Beskrivning

Exclusion Criteria - Likelihoof of non-compliance

Datatyp

text

Decision
Beskrivning

Decision

Patient meets criteria for outpatient Lovenox therapy. Begin patient education.
Beskrivning

Decision

Datatyp

boolean

Lovenox self-administration and anticoagulation precautions.
Beskrivning

Decision

Datatyp

boolean

Patient does not qualify for outpatient Lovenox therapy.
Beskrivning

Decision

Datatyp

boolean

Signature
Beskrivning

Signature

Datatyp

text

Print Name
Beskrivning

Print Name

Datatyp

text

Date and Time
Beskrivning

Date and Time

Datatyp

datetime

Similar models

AAFP: CVT Outpatient Screening Criteria

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Inclusion Criteria
Inclusion Criteria
Item
Acute, symptomatic, proximal or distal DVT documented by venogram/Doppler U/S
boolean
Inclusion Criteria
Item
Patient agrees to outpatient therapy
boolean
Item Group
Exclusion Criteria
Exclusion Criteria
Item
Current, active bleeding, active peptic or ulcer disease, congenital or acquired bleeding disorder or disease process in which, in the judgement of the physician, there may be an increased risk of bleeding (e.g. hepatic or renal insufficiency, recent surgery or stroke)
boolean
Exclusion Criteria
Item
Concurrent symptomatic pulmonary emboli
boolean
Exclusion Criteria
Item
Expected hospitalization greater than five days due to co-existing conditions
boolean
Exclusion Criteria
Item
Known hypercoagulability: familiar or acquired
boolean
Exclusion Criteria
Item
Pregnant or breast-feeding
boolean
Exclusion Criteria
Item
Uncontrolled hypertension
boolean
Exclusion Criteria
Item
Extensive iliofemoral DVT
boolean
Exclusion Criteria
Item
Likelihood of non-compliance due to cognitive limitations, alcohol/drug abuse, dementia, psychiatric disorders, etc.
boolean
Exclusion Criteria - Likelihoof of non-compliance
Item
if yes, please describe
text
Item Group
Decision
Decision
Item
Patient meets criteria for outpatient Lovenox therapy. Begin patient education.
boolean
Decision
Item
Lovenox self-administration and anticoagulation precautions.
boolean
Decision
Item
Patient does not qualify for outpatient Lovenox therapy.
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime