4 h in advance
5% 500 ml/m² (= 25 g/100 kcal/m²)
float
10% 11 ml/m² (= 18 mmol/m²)
float
8,4 % 60 ml/m² (= 60 mmol/m²)
float
7,46% 15 ml/m² (= 15 mmol/m² )
float
24 h Hydration
5% 3000 ml/m² (=150 g/600 kcal/m²)
float
10% 65 ml/m² (=110 mmol/m²)
float
8,4% 180 ml/m² (=180 mmol/m²)
float
7,46% 90 ml/m² (=90 mmol/m²)
float
Methotrexate i.v.
(5000mg/m²/d)
integer
Methotrexat 30 minutes
integer
Methotrexat 23,5h
integer
Leukovorin Rescue
Methotrexate intrathecal
age
integer
methotrexate dose
integer
methotrexate i.th.
integer
Mercaptopurine
Supportive medication
Kepinol/Cotrimoxazol break
boolean
Medication 1
text
Medication Dose 1
float
administration interval 1
integer
Medication 2
text
Medication Dose 2
float
administration interval 2
integer
Medication 3
text
Medication Dose 3
float
administration interval 3
integer
Signature
Signature date 1
text
physician signature 1
text
Signature date 2
text
physician signature 2
text