Anesthesia

Behavioral Health

Cardiology

23006 Glycoprotein iiib-iiia Dosing Protocol-23006-QM1208 Ver4 110411 23006-QM-1208
CARD Acute MI Acute Coronary Syndrome Adult Plan 20404 QM1108 PP Rev121917 20404 PP QM1108
CARD Aquapheresis Orders 20423-QM0311 080212 NORTH ONLY 20423-QM0311
CARD Arterial Insufficiency Acute Orders 20403 QM1108-Ver5 Rev021015 20403 QM1108
CARD Atrial Fib-Flutter Plan 20402 QM1108 PP Rev021318 20402-QM1108 PP
CARD Cardiac Cath Post Procedure Plan 20401 QM1108 PP Rev092617 20401-PP-QM1108
CARD Carotid Perc Angio w Stent POST Proc-20410-QM-1108 20410-QM-1108
CARD Carotid Perc Angio w-stent Placement Pre Proc 20409 QM1108 PP Rev.021318 20409-QM1108 PP
CARD Cath Lab Pre Procedure Plan 20405 PP QM1108 Rev010918 20405 QM1108 PP
CARD EP Card Impl POST Proc Plan 20408 QM1108 PP Rev021318 20408-QM1108 PP
CARD EP Cardio Impl Pre Proc Plan 20407 QM1108 PP Rev021318 20407-QM1108 PP
CARD Heart Failure Admit Plan 20412 QM1108 PP Rev092617 20412 QM1108 PP
CARD Heart Failure Discharge Prescription Orders- 626-QM-Ver2 626-QM
CARD Implella Ventricular Assist Device 20422 QM0311 Rev041718.pdf 20422-QM0311 PP
CARD Ischemic Ulceration-Gangrene(Chronic) - 20413-QM1108-Ver7 011912 20413-QM1108
CARD PCI Post Procedure Plan 20406 QM0410 PP Rev081517 20406-QM0410 PP
CARD Post DC IABP-20417-QM-1108 20417-QM
CARD Right Heart Catheterization Plan 20425 QM0415 PP Rev021318 20425 QM0415 PP
CARD STEMI LBBB-20418-QM0908-Ver9 Rev030615 20418-QM090808
CARD Stress Perfusion Medication Plan 20420 QM0509 PP Rev021318 20420 QM0509 PP
CARD Stress Test Plan 20424 QM0509 PP Rev021318 20424 QM0509 PP
CARD TEE Post Procedure Plan 20411 QM1108 PP Rev021318 20411-QM1108 PP
PT Hydration Protocol Plan 23017 QM1214 PP Rev091115 23017 QM1214 PP
PT Amiodarone Protocol Orders 23035-QM1212-Rev042216 23035-QM1212
PT Bivalirudin (Angiomax) Cath Lab Only 23016 QM0313 Rev042517 23016-QM0313

Critical Care

Cross Condition

CC Abdominal Pain-22210-QM1008-Ver4 062111 22210-QM1008
CC Adult Procedural Sedation Plan 22254-PP-QM0214-051314 22254-PP-QM0214
CC Blood (PRBC) Transfusion-22228-QM1008 22228-QM1008
CC Chest Pain Sudden Onset Orders 22208-QM1008-(Fayette 0412)-Rev 021213 22208-QM1008
CC DIARRHEA-22207-QM1008 22207-QM1008
CC Discharge Plan 22218 QM0912 PP Rev091217 22218 QM0912 PP
CC FEVER CHILL-22220-QM1008 Ver2 051111 22220-QM1008
CC Known Seizure Disorder Observation 22252 QM0713PP Rev071718 22252 QM0713PP
CC Lumbar Puncture Plan-22217-QM1108 PP ver2 061110 22217-QM-1108 PP
CC Medical Nutrition Therapy Protocol Plan 22232 PP QM0810 Rev 071514 22232 PP QM0810
CC NAUSEA VOMIT-22201-QM1008-Ver2 071211 22201-QM1008
CC Paracentesis Plan 22227 PP QM1008 Rev111417 22227 PP QM1008
CC PICC Line Insert Protocol Orders 22204-QM0712 Rev121516 22204-QM0712
CC PRN Common Comfort Medication-22231-QM1008-Ver3 071211 22231-QM1008
CC Prophylaxis for IV Dye Allergy-22213-QM1008 22213-QM1008
CC Rheumatology-22214-QM1008 22214-QM1008
CC Routine AM Diagnostic-22215-QM-1008 22215-QM-1008
CC Routine Deceased Donor Adult Orders 22236-QM0912 PP Rev030717 22236-QM0912 PP
CC Shortness of Breath Orders 22202-QM1008-Rev 110712 22202-QM1008
CC Smoking Cessation-22219-QM1008 22219-QM1008
CC Syncope Observation Plan 22223-PP-QM0912-022713 22223-PP-QM0912
CC Thoracentesis-22212-QM1008-Ver9-102111 22212-QM1008-Ver9-102111
CC Transfuse Blood Blood Products Adult Plan 22239 QM0113 PP Rev021015 22239 QM0113 PP
CC Tunneled Drainage Catheter (Non-Dialysis) Orders-22235-QM0512-082812 22235-QM0512
CC Wound Care Admit-22006-QM-1008 22006-QM-1008
CC Wound Care Treatment Plan 22255 QM0816 PP 082316 22255 QM0816 PP
Cross 10CC Common Orders Rev042216
CROSS Adult Enteral Nutrition Plan(MD ONLY)22233-QM0711 PP Rev041817 22233-QM0711 PP
CROSS Dietitian Enteral Nutrition Adult Plan 22234 QM0711 PP Rev041817 22234-QM0711 PP
CROSS Gastroenteritis Dehydration Admit Orders 22209-QM1008-080212 22209-QM1008
CROSS Gastroenteritis Observation Plan 22238-QM1212-043013 22238-QM1212
CROSS Headache Observation Plan 22237 QM1212 PP Rev021015 22237-QM1212 PP
CROSS Hematuria Admit Plan 22211 QM1008 PP Rev062617 22211-QM1008 PP
CROSS Heparin Impella Device Non-Protocol Inf 22256 QM0217 PP 021417 22256 QM0217 PP
CROSS Hypokalemia Observation Plan-22246-QM0114 PP Rev081815 22246-QM0114 PP
CROSS Soft Tissue Infection Observation Plan 22253-PP-QM0314-040814 22253-PP-QM0314
Cross Sputum-29516-ver2-QM1008-102111 29516-ver2-QM1008-102111
CROSS TIA Observation Plan 22244 QM0614 PP Rev021616 22244 QM0614 PP
CROSS Tube Feeding Bolus Orders 22240-QM1108-Rev 021213 22240-QM1108
CROSS Tube Feeding Continuous-Int Orders 22241-QM1108-Rev 021213 22241-QM1108
CROSS-Heparin Non Protocol Infusion 22230 QM0209 Rev021417 22230-QM0209
Housewide Ped Asthma Score Protocol.12.6.11.rev 12.6.11.rev
ID Commonly Used Abx Plan 22724 QM1212 PP Rev091917 22724-PP-QM1212
Palivizumab (Synagis) Order Form- 020410 20410

CV Surg

Doctors Forms

ED

23006 Glycoprotein iiib-iiia Dosing Protocol-23006-QM1208 Ver4 110411 23006-QM-1208
Behavioral Restraint Orders- 003793 3793
ED Abd Pain Female-20505P-QM0808 Rev032117 20505-QM0808
ED Abd Pain-GI Bleeding Orders 20534P QM0313 Rev012318 20534P QM0313
ED Abdominal Pain AAA-20533-QM0808 Ver2 051111 20533-QM0808
ED Abdominal Pain Male 20506-QM0808-Rev111417 20506-QM0808
ED Admission Interim Orders 20526-QM0808 Rev012318 20526-QM0808
ED Altered Mental Status Orders-20508-QM0808-(QF0412)-Rev 031213 20508-QM0808-(QF0412)
ED Atrial Fibrillation Plan 20565 QM0615 PP 072815 20565 QM0615 PP
ED Back Pain Orders-20509-QM0808-(QF0412)-Rev081616 20509-QM0808-(QF0412)
ED Chest Pain Orders 20501-QM0808-(QF0412)-Rev 031516 20501-QM0808-(QF0412)
ED Chest Tube Thoracostomy-20524-QM0808-Ver2 071211 20524-QM0808
ED Clinical Decision Unit Status Orders 20562-QM0311 Rev012318 20562-QM0311
ED Cocaine Observation Orders-20517-QM0808 Rev012318 20517-QM0808
ED Complaint of Allergic Reaction Orders 20504-QM0808 Rev012318 20504-QM0808
ED Cough Orders 20519 QM0808 Rev012318 20519-QM0808
ED Dizziness Orders -20549-QM0808-Ver8 Rev022316 20549-QM0808
ED Eye Problems Orders-20537-QM0808 (Fayette 0412) Rev020916 20537-QM0808
ED Fever Orders-20527P-QM0313-(QM0412) Rev012318 20527P-QM0313-(QM0412)
ED Flank Pain Orders-20538P-QM0808-(QF0412)-Rev022316 20538P-QM0808-(QF0412)
ED Headache Orders 20539-QM0808-(QF0412)-Rev022316 20539-QM0808-(QF0412)
ED Hx of Drug or Alcohol Withdrawal Orders-20550-QM0808-(QF0412)-Rev052616 20550-QM0808-(QF0412)
ED Hyperglycemia Orders-20511-QM0808 Rev081616 20511-QM0808
ED Hyperkalemia per History Orders-20540-QM0912-Rev 031213 20540-QM0912
ED Hypertension PTA Orders 20541P-QM0808-(QF0412) Rev022316 20541P-QM0808-(QF0412)
ED Hypoglycemia Orders-20512-QM0808-(QF0412)-Rev022316 20512-QM0808-(QF0412)
ED Intoxication Suspected Orders-20503-QM0808 Rev.052516 20503-QM0808
ED Isch Stroke NIH Scale-20525-QM-0908 20525-QM-0908
ED IV Thrombolytics for Acute MI Orders 20557-QM0912-Rev021616 20557-QM0912
ED Low Intermediate CP (Track+3) 20553 QM0912 Rev121217 20553-QM0912
ED Lumbar Puncture Procedure-20521-QM0808 Rev012318 20521-QM0808
ED MD or RN Swallowing Screen-20531-QM0209 20531-QM0209
ED Non-STEMI Unstable Angina Orders 20530-QM0808-Ver10 Rev030615 20530-QM0808
ED Overdose Orders 20514P-QM0808-(QF0412)-Rev022316 20514-QM0808-(QF0412)
ED Pneumonia Care Track Orders 20544-QM0409 Rev012318 20544-QM0409
ED Pre Eclampsia Eclampsia Orders 20563 QM0411 Rev031318 20563-QM0411
ED Psychiatric Symptoms 20516-QM0808-(QF0412)-Rev081616 20516-QM0808-(QF0412)
ED Radiology Common Orders 20552-QM0808-(QF0412)-Rev032117 20552-QM0808-(QF0412)
ED Respiratory Support Intubation 20545-QM1108-Rev 062716 20545-QM1108
ED Sedation Procedure Orders 20522-QM0808-Rev051314 20522-QM-0808
ED Seizure Recurrent Orders 20507-QM0808 (QF0412) Rev022316 20507-QM0808-(QF0412)
ED Seizure-New Onset 20546 QM0808 Rev081616 20546-QM0808-(QF0412)
ED Severe Sepsis Bundle Plan 20568 PP QM0917 101017 20568 PP QM0917
ED Sickle Cell Pain-Pain or SOB wHx Sickle Cell Orders-20547P-QM1112-(QF0412) -Rev022316 20547P-QM1112-(QF0412)
ED Skin Redness Pain Abscess-20513-QM0808-Ver4 Rev022316 20513-QM0808-(QF0412)
ED SOB with Hx of Asthma COPD 20535 QM0808 011717 20535-QM0808
ED Sore Throat-20515- QM0808ver2 20515- QM0808
ED STAT DRUG - 20554-QM-0808 20554-QM-0808
ED STEMI-LBBB New Onset Orders 20502-QM0908- Ver13 Rev092716 20502-QM0908
ED Stroke Symptom Orders 21004P QM0908 Rev053018 21004P-QM0908
ED Syncope Orders-20518-QM0808 QF0412 Rev022316 20518-QM0808 QF0412
ED Tge Stand Strke Symp Act Res Orders 21004N QM0313 21004N QM0313
ED Trauma Orders 20510-QM0712 Rev012318 20510-QM0712
ED Vaginal Bleeding Orders 20548P-QM0313-(QF0412) Rev012318 20548-QM0808-(QF0412)
ED Vaginal or Penile Discharge Orders 20543 QM0808 Rev012318 20543 QM0808
ED Weakness Orders 20529-QM0808-QF0412-Rev.022316 20529-QM0808-QF0412
ED_SOB_Dyspnea_Orders-20536-QM0808-(QF0412)-Rev092716 20536-QM00808-(QF0412)
ID Commonly Used Abx Plan 22724 QM1212 PP Rev091917 22724-PP-QM1212
IV Thrombolytic Therapy Form 051915
LEB ED Joint Aspiration Procedure Plan 40513 PP QM0908 Rev101017 40513 PP QM0908
MED General Medicine Admit Plan 20901 PP QM1212 Rev082718 20901 PP QM1212
MED MRT Standing Orders Protocol Plan 20908 QM0816 PP Rev111716 20908 QM0816 PP
MED Sepis 6 Hour Bundle Plan 20906 QM0614 PP Rev101816 20906 QM0614 PP
MED Severe Sepsis 6 Hour Bundle Plan 20707-PP-QM0614-Rev081616 20707-PP-QM0614
PED Consent for Surgery 231410-062712 231410
PED ED REPORT OF CONSULT 24082 - 1008 24082 - 1008
PT ED Post CA Hypo Protocol-23042-QM0412-Rev041115 23042-QM0412
PT Heparin Cardiology Protocol 23019 QM0513 Rev021417w dose guide 23019 QM0513
PT Heparin VTE Protocol Orders 23018 QM0513 (QF0412) Rev021417 w dose gu... 23018 QM0513 (QF0412)
STROKE-Inclusion and Exclusion Form Rev. 032416

ED Triage Standing

Endocrinology

ENT

Gastroenterology

Hematology

ID

Med

Neuro

IV Thrombolytic Therapy Form 051915
LEB NEURO Vagus Nerve Stimulator Post Op Plan- 41005 PP-QM1008 41005 PP-QM-1008
NEURO Acute Stroke ICU Plan 21001 QM0712 PP Rev081517 21001-QM0712 PP
NEURO Acute Stroke Non-ICU Plan 21002 QM0712 PP Rev081517 21002-QM0712 PP
NEURO Adult Refractory Status Epilepticus Plan 21032 QM1017 PP 030618 21032 QM1017 PP
NEURO Adult Status Epilepticus Emergent Treatment 21033 QM1017 PP 030618 21033 QM1017 PP
NEURO Alteplase IV Acute Isch Strke CareTrack Plan 21005 QM1008 PP Rev081517 21005-QM1008 PP
NEURO Antihypertensive PRN Meds Plan 21018 QM0611 PP Rev031715 21018 QM0611 PP
NEURO Arteriogram Post Procedure Plan-21019 QM0611 PP 041817 21019 QM0611 PP
NEURO Craniotomy Post Op Plan-21007-PP-QM0611-071912 21007-PP-QM0611
NEURO Decompressive Laminectomy Post Op Plan 21009-PP-QM1008-rev 020513 21009-PP-QM1008
Neuro Factor IX (Bebulin) for Warfarin Induced ICH and Major Bleeds Plan 21025 QM0113 PP Rev011618 21025 QM0113 PP
NEURO Isch Stroke NIH Scale-20525-QM-0908 20525-QM-0908
NEURO MD or RN Swallowing Screen-20531-QM0209 20531-QM0209
NEURO Neuro Intracerebral Hemorrhage Plan 21008 QM1008 PP Rev071817 21008 QM1008 PP
NEURO Neurosurgery Admit Plan 21024-PP-QM0812-Rev110414 21024-PP-QM0812
NEURO Neurosurgery Routine Preop Admit-21013-QM1008 ver2 21013-QM1008
NEURO Pituitary Tumor Post Op Plan-21020-PP-QM0611 020712 21020-PP-QM0611
NEURO Post Carotid Endarectomy Plan 21027 QM0317 PP Rev031417 21027 QM0317 PP
NEURO Post Craniotomy-Aneurysm-830-QM0905 Ver5 111610 830-QM0905
NEURO SAH Post Op Plan-21023 QM0611 PP Rev071817 21023-PP-QM0611
NEURO Sodium Support Plan 21026 PP QM1014-110414 21026 PP QM1014
NEURO Spinal Disc Recon Surg Admit Plan-21012-PP-QM1008-Rev 040913 21012-PP-QM1008
NEURO Stroke Labs Plan 21011 PP QM1014 Rev010918 21011 PP QM1014
NEURO Ventriculostomy Plan-21010-QM0711 Rev 012114 21010-QM0711
STROKE-Inclusion and Exclusion Form Rev. 032416

OB/GYN

GYN ONC Adult Admit Plan 21414 QM081815 PP Rev081815 21414 QM081815 PP
GYN ONC Adult Post Operative Plan-21416-PP-QM0411 Rev081815 21416-PP-QM0411
GYN ONC Adult Pre Op Plan-21415-PP-QM0811-Rev082614 21415-PP-QM0811
OB Antepartum Admit-21318-PP PH1-QM-0410-101910 21318-PP PH1-QM-0410
OB Fetal Demise(Cytotec) Plan 21336 QM0215 PP Rev031318 21336 QM0215 PP
OB Intrapartum Admission-Progress Record-21322-101810 21322-101810
OB Intrapartum Plan 21319 PP QM0510 Rev100317 21319 QM0510 PP
OB Post Delivery Progress Record 21323 101810 revised 120711 21323-101810
OB Postpartum Plan 21320 QM0510 PP Rev042418 21320 QM0510 PP
OB PreEclampsia-Eclampsia Antepartum Phase-21318-PP-PH3-QM0510Ver2 122011 21318-PP PH3-QM-0510
OB Tocolysis PreTerm Labor of Antepartum Admit-21318-PP PH2 -QM-0510-101910 21318-PP PH2 -QM-0510
OB Tocolysis-Magnesium-21321-PP-QM-0510-101910 21321-PP-QM-0510
OB Triage Standing Orders Plan 21323 QM0216 PP 022316 21323 QM0216 PP
OBGYN Gynecology Surgery PostOp Plan 21307 PP QM0411 Rev081418 21307-PP-QM0411
OBGYN Gynecology Surgery PreOp Plan 21301 PP QM1008 Rev081418 21301 PP QM1008
OBGYN Minimally Invasive GYN PostOp Plan 21335-PP-QM0113-Rev 060413 21335-PP-QM0113
OBGYN Minimally Invasive GYN PreOp Plan 21334 QM0113 PP Rev081418 21334-PP-QM0113
OBGYN OB Discharges Meds-853-QM-Ver3 853-QM
OBGYN OB Outpatient Care Plan 21325 QM0216 PP 022316 21325 QM0216 PP
VTE C-Sec Surgical Prophylaxis-25013-QM-0510 Ver 2-121510 25013-QM-0510
VTE MEDICAL PROPHYLAXIS Orders-22225 QM-1008 Ver 3 121510 22225 QM-1008

Oncology

Ophthalmology

Orthopaedics

Outpatient

P & T

23006 Glycoprotein iiib-iiia Dosing Protocol-23006-QM1208 Ver4 110411 23006-QM-1208
Adult Total Parenteral Nutrition Order Form - 360-P&T-Ver2 360-P&T
Bivalirudin Dose Adjustment Guidelines Bivalirudin Dose Adjustment Guidelines
Chronic Renal Failure (PreESRD) - 1602-QM-Ver1 1602-QM
CROSS-Heparin Non Protocol Infusion 22230 QM0209 Rev021417 22230-QM0209
Heparin Flow Record- click here Heparin Flow Record
LEB Enteral Nutrition Pediatric Plan (MD Only) 43003-QM0214-PP-091614 43003-QM0214-PP
LEB Med-SURG Intranasal Medication Plan-43006-PP-QM0912 021913 43006-PP-QM0912
LEB Multivitamin Formulary Plan 43006-PP-QM0609 111412 43006-PP-QM0609
LEB Pediatric Patient Controlled Analgesia Orders- morPHINE-43003- QM 0809 43003- QM 0809
LEB RD_Enteral Nutrition Pediatric Protocol Plan 43004 QM0214 PP 091614 43004 QM0214 PP
Palivizumab (Synagis) Order Form- 020410 20410
Palivizumab (Synagis) Order Form- 020410 20410
Post CV Surgery Diltiazem Atrial Fibrillation Protocol - 103-PostCVSurgery 103-PostCVSurgery
Protein Calorie Malnutrition - 1601-QM-Ver1 1601-QM
PT Hydration Protocol Plan 23017 QM1214 PP Rev091115 23017 QM1214 PP
PT Alteplase for Peripheral Revascularization Protocol Orders 23040 QM0510 Ver2 011712 23040 -QM0510
PT Amiodarone Protocol Orders 23035-QM1212-Rev042216 23035-QM1212
PT Amphotericin B Bladder - 23003-QM-0408 23003-QM-0408
PT Angioedema Treatment Plan 23061 QM0915 PP 092215 23061 QM0915 PP
PT Antimicrobial Prophylaxis for Surgery Protocol Orders - 23001-QM1208 23001-QM1208
PT Argatroban or Bivalirudin DTI Protocol Flow Record-202-Rev 043013 202
PT Bivalirudin (Angiomax) Cath Lab Only 23016 QM0313 Rev042517 23016-QM0313
PT Delirium Tremens Treatment Protocol Orders 23049 QM0312 Rev071415 23049 QM0312
PT Dialysis IM-IV Push Antibiotics Plan 23002-PP-QM0814-082614 23002-PP-QM0814
PT Dofetilide (New Start) Protocol Orders 23060 QM1116 121516 23060 QM1116
PT DT Prophylaxis Protocol Orders-23050-QM0312 Rev010415 23050-QM0312
PT DTI Protocol Orders 23012-QM0313-Rev.030816 23012-QM0313
PT ED Post CA Hypo Protocol-23042-QM0412-Rev041115 23042-QM0412
PT Heparin Cardiology Protocol 23019 QM0513 Rev021417w dose guide 23019 QM0513
PT Heparin VTE Protocol Orders 23018 QM0513 (QF0412) Rev021417 w dose gu... 23018 QM0513 (QF0412)
PT HIT Protocol-Argatroban
PT Hypertensive Crisis Protocol Orders 23055 QM1016 102516 23055 QM1016
PT Hypoglycemia Protocol - 23015-QM1208 ver2 23015-QM1208
PT ICU Glycemic Control Protocol Orders 23026 QM0509 Rev042517 23026-QM0509
PT Insulin Sliding Scale Plans 23025 QM0715 PP Rev050818 23025 QM0715 PP
PT Intraventricular Alteplase for Intracerebral Hemorrhage Protocol-PT-23049-QM0612-080912 23049-QM0612
PT Lice Protocol-300-P T-DERM-1204-Ver3 300-P&T-DERM-1204
PT Methacholine Challenge Protocol Orders- 23041 QM0410 080911 23041 QM0410
PT Methylpred Spinal Cord Inj Protocol Orders 23007 QM0408 Rev081815 23007-QM0408
PT NMB of Mech Vent Pt Protocol 23022 QM1208 Rev050515 23022-QM1208
PT PCA- MorPHINE Protocol Plan 23027 PP QM0811 Rev122017 23027-PP-QM0811
PT PCA-HYDROmorphone Protocol Plan 23028-PP-QM0811 Rev122017 23028-PP-QM0811
PT Rasburicase ProtocolTumor Lysis 23037 QM1214 PP Rev013018 23037 QM1214 PP
PT Shivering Management for Hypothermia Orders 23053 QM0216 Rev052517 23053 QM0216
PT Thrombolytic Protocol for Cath Clearance - 063-P&T-Ver1 063-P&T

Pallative Care

PED

PED Admit/Transfer to Neuroscience Unit - 1466-QM-0805-Ver1 1466-QM-0805
PED Asthma Admit Plan 24021-PP-QM0811-Rev 121112 24021-PP-QM0811
PED Bronchiolitis Admit Plan 24020-PP-QM0811-Rev 121112 24020-PP-QM0811
PED Colonoscopy - 1362-QM-0607-Ver1 1362-QM-0607
PED Endocrine General Admit Plan 24031 PP QM0811 Rev042216 24031-PP-QM0811
PED Esophagogastroduodenoscopy - 1361-QM-0607-Ver1 1361-QM-0607
PED General Medicine Admit Plan 24028-PP-QM-0811-Rev 121112 24028-PP-QM-0811
PED GI Fecal Microbiota Transplant Plan 24045 QM0415 071415 24045 QM0415
PED Intravenous Antimicrobial Order Form - 1301-QM-0705-Ver2 1301-QM-0705
PED Monitored Sedation Care - 1321-QM-0306-Ver1 1321-QM-0306
PED Neurosurgical PICU Admission Orders - 1468-QM-0806-Ver1 1468-QM-0806
PED Newborn Nursery Admit Standing Orders Plan 24047 QM0216 PP Rev041916 24047 QM0216 PP
PED Newborn Nursery Risk for Infection Plan 24049 QM0216 PP 022316 24049 QM0216 PP
PED NICU Eye Exam Medication Orders 24038-QM1212-Rev020916 24038-QM1212
PED NICU Quick Admit Plan 24040 QM0114 PP Rev021015 24040 QM0114 PP
PED ORTHO General Post Op Plan 24022 QM0811 PP Rev051618 24022 QM0811 PP
PED Palivizumab (Synagis) Order Form - 1414-QM-0107-Ver1 1414-QM-0107
PED Pediatric Admission/Transfer Orders Status Asthmaticus - 1412-QM-0205-Ver1 1412-QM-0205
PED Pediatric Admit to Epilepsy Monitoring Unit - 1461-QM-0207-Ver3 1461-QM-0207
PED Pediatric Cardiothoracic Peritoneal Dialysis Orders - 1337-QM-0107-Ver1 1337-QM-0107
PED Pediatric Cerebral Arteriogram & Intracarotid Amytal Test (WADA Test) - 1462-QM-0207-Ver3 1462-QM-0207
PED Pediatric Ketogenic Diet - 1303-QM-0207-Ver3 1303-QM-0207
PED Pediatric MNT Protocol Plan 24005-QM0214-PP-Rev080718 24005-QM0214-PP
PED Pediatric Outpatient Video-EEG Monitoring - 1465-QM-0207-Ver3 1465-QM-0207
PED Pediatric Patient Controlled Analgesia Orders - 1481-QM-0206-Ver2 1481-QM-0206
PED Pediatric Post-Op Vagus Nerve Stimulator Placement - 1464-QM-0207-Ver3 1464-QM-0207
PED Pediatric Viral Bronchiolitis - 1411-QM-0205-Ver1 1411-QM-0205
PED Pneumonia Admit Plan 24033-PP-QM-08111-Rev 121112 24033-PP-QM-08111

PED ED

PED Ent

PED Neonatal

PED Surg

Pulmonary

Radiology

PT Alteplase for Peripheral Revascularization Protocol Orders 23040 QM0510 Ver2 011712 23040 -QM0510
RAD Arteriogram Brachial Post Proc - 21612-QM0708-Ver4 101910 21612-QM0708
RAD Arteriogram Femoral Post Procedure Plan 21611 QM0708 PP Rev041817 21611-QM0708 PP
RAD Arteriogram Pre Procedure - 21626 PP QM0309 Rev010918 21626 PP QM0309
RAD Biopsy Drain Placement Pre Proc - 21617 PP QM0309 Rev010918 21617 PP QM0309
RAD Biopsy Post Procedure - 21603-QM0908-Ver4 101910 21603-QM0908
RAD Chemoembolization Post Procedure Plan 21622-PP-QM0309-Rev 052113 21622-PP-QM0309
RAD Chemoembolization Pre Proc Plan 21628 QM0309 PP Rev090115 21628-QM0309 PP
RAD CT Guided Liver Biopsy Post Proc - 21604-QM0808-Ver4 101910 21604-QM0808
RAD CT Guided Lung Biopsy Post Proc - 21605-QM0808-Ver4 101910 21605-QM0808
RAD CT Guided Renal Core Biopsy Post Proc - 21606-QM0808-Ver4 101910 21606-QM0808
RAD Interven Rad Transjugular BX Post Proc - 21614-QM0309-Ver4 101910 21614-QM0309
RAD Kyphoplasty Pre Procedure - 21609-QM0309-PP Ver5 Rev090115 21609-QM0309 PP
RAD Liver Radiofrequency Ablation Post Proc - 21624-QM0309 Ver5 051111 21624-QM0309
RAD Liver Radiofrequency Ablation Pre Proc Plan 21623 QM0309 PP Rev021015 21623 QM0309 PP
RAD Lumbar Punct per Radiology w Injec Pre Pro Plan 21621 QM0309 PP 21621-QM0309
RAD Lumbar Puncture per Radiology w wo Inj Post Proc Plan 21610 QM0708 PP 21610-QM0708
RAD Lumbar Puncture Per Radiology wo Inj Pre Proc Plan 21630 QM0309 PP 21630-QM0309
RAD Mgmt of IV Contrast Extravasation Plan 21642 QM0315 PP 031715 21642 QM0315 PP
RAD Myelogram Post Procedure - 21608-QM0708-Ver4 101910 21608-QM0708
RAD Myelogram Pre Procedure Plan 21607 QM0309 PP Rev013018 21607-QM0309 PP
RAD Neuroform Stent Aneurysm Embolization Post Proc - 21618l-QM0309-Ver5-092410 21618l-QM0309
RAD PAC Placement Post Procedure Plan 21634-QM0812-092512 21634-QM0812
RAD PAC Placement Pre Procedure Plan 21633 QM0812 PP Rev031715 21633-QM0812 PP
RAD Peripheral Thrombolysis Post Procedure Plan-21636-QM010214-020414 21636-QM010214
RAD Peripheral Thrombolysis Pre Procedure Plan-21635-QM010214 020414 21635-QM010214
RAD Perma-Cath Pre Procedure Plan 21601 QM0309 PP Rev090115 21601-QM0309 PP
RAD Radiology CT Contrast Orders 21640-QM1214-Rev123014 21640-QM1214
RAD Radiology CT Medication Plan PP Rev032018
RAD Radiology Diagnostic Contrast Plan PP Rev032018
RAD Radiology MRI Contrast Plan 21602 QM1014 PP Rev032018 21602-PP-QM1014
RAD Radiology Nuclear Med Medication Plan PP Rev032018
RAD Radiology Specials Contrast Plan 21638 QM1014 PP Rev032018 21638-PP-QM1014
RAD Radiology Specials Medication Plan PP Rev032018
RAD Radiology Specials Medication-QM0214-03112014 QM0214
RAD Suspension of Metformin for Contrast Use - 21631-QM0508 21631-QM0508
RAD US Thoracentesis Paracen Thyroid Bx PostProc - 21625-QM0309-Ver4 101910 21625-QM0309
RAD Uterine Fibroid Embolization Post Proc 21613 PP QM1010 Rev051518 21613-PP-QM1010
RAD Uterine Fibroid Embolization Pre Proc Plan 21619 QM0309 PP Rev051018 21619 QM0309 PP
RAD Venous Angiogram Post Procedure Plan 21631 QM0309 PP Rev041817 21631-QM0309 PP
Radiology Moderate Sedation Plan PP Rev032018

Renal

Surg

CC VTE Prophylaxis-Surgical - 22226-QM-1008 ver 7 22226-QM-1008
GEN SURG Enhanced Recovery After Surgery (ERAS) Pre Op Plan 22019 QM1115 PP Rev013018 22019 QM1115 PP
GEN SURG Enhanced Recovery After Surgery (ERAS) Post Op Plan 22020 QM1115 111715 22020 QM1115
PED Consent for Surgery 231410-062712 231410
PT Antimicrobial Prophylaxis for Surgery Protocol Orders - 23001-QM1208 23001-QM1208
SDS General Pre Op Orders - MD OFFICE -42014 - QM0310_Ver2 1213 42014 -QM0310
SURG Colon Surgery Post Op Plan 22012-PP-QM0912-102312 22012-PP-QM0912
SURG Colon Surgery Pre Op Plan 22011-PP- QM0912 Rev021015 22011-PP-QM0912
SURG Gen Surgery Post OP Plan 22005 PP QM1008 Rev100317 22005 QM1008 PP
SURG General Surg Routine Admit Plan 22004 QM1008 Rev072115 22004 QM1008
SURG General Surgery - Post Op AM Admit - 1027-QM-00308 Ver 6 1027-QM-00308
SURG General Surgery SDS Admit Plan 22003 QM1008 PP Rev013018 22003-QM1008 PP
SURG Immediate Post Op/Procedure Note-22007-QM0417-Ver 3 22007-QM0417
SURG Lap Band Implantation Pre-Op - 774-QM-Ver2 774-QM
SURG Lap Band-Gastric Bypass Postop Orders 22002 QM0518 Rev052218 22002 QM0518
SURG Lap Gastric Bypass Surgery Pre-Op - 773-QM-Ver2 773-QM
SURG Laparoscopic Cholecystectomy Postop - 22006-QM1008 Ver2 071211 22006-QM1008
SURG Malignant Hyperthermia Post Acute Phase Mgmt 22030 QM1016 PP Rev030518 22030 QM1016 PP
SURG Mast w Immediate Prosthetic Recon Post Op Plan 20016 PP QM0215 021715 20016 PP QM0215
SURG Medical Clearance for Surgery - 20905-QM-1008 20905-QM-1008
SURG OUTPT ANTIMICROBIAL PROPHY - 22229-QM-1008 22229-QM-1008
SURG PACU Surgeon Common Orders Plan 22009 QM1111 PP Rev062617 22009 QM1111 PP
SURG Penile Prosthesis Pre Op Plan 22107 QM1008 PP Rev013018 22107-QM1008 PP
SURG Plastic Surgery Breast Free Flap POD 0Plan 22013 PP QM0215 Rev031015 22013 PP QM0215
SURG Plastic Surgery Breast Free Flap POD 1 plus Plan 22014 PP QM0215 Rev031015 22014 PP QM0215
SURG Plastic Surgery Breast Free Flap Reconstruction Pre Op Plan 20017 PP QM0215 021715 20017 PP QM0215
SURG Plastic Surgery Free Flap Post-Op Plan 22015 PP QM0215 021715 22015 PP QM0215
SURG Pre Op Pre Admission Work Up Plan 22018 PP QM0315 Rev092617 22018 PP QM0315
SURG Surgery Immediate Post Op Note Additional Detail - 1030-QM-0308-Ver2 1030-QM-0308
SURG TURP TURBT Preop Plan 22101 QM1008 PP Rev013018 22101-QM1008 PP
SURG Vascular Surgery AAA Endovascular Post Op Plan 22031 QM0717 PP 072517 22031 QM0717 PP
SURG Vascular Surgery AV Fistula Outpatient DC Plan 22032 QM0717 PP 072517 22032 QM0717 PP
SURG Vascular Surgery Carotid Endarectomy Post Op Plan 22035 QM0717 PP 072517 22035 QM0717 PP
SURG Vascular Surgery Cath Lab Post Procedure Plan 22033 QM0717 PP 072517 22033 QM0717 PP
SURG Vascular Surgery Pre Op or Pre Cath Lab Plan 22037 QM0717 PP Rev013018 22037 QM0717 PP
SURG Vascular Sx AAA Repair Open Post Op Plan 22034 QM0717 PP 0702517 22034 QM0717 PP
Vasc Sx Low Ext Amp or Bypass Graft Post Op 22036 QM0717 PP 072517 22036 QM0717 PP

Transplant

Liver Transplant Post-Op Transfer Plan-22410 PP-QM0411 080911 22410 PP QM0411
Parencentisis orders for Hepatology Services/Transplant Patients 1006-Ver 1- 1232-QM-1006-Ver1 1232-QM-1006
Pre-Operative Kidney Transplant Recipient PAW Orders– 1224-QM-1006-Ver 1 1224-QM-1006
Renal Transplant - Recipient Admission - 1204-QM-0907-Ver4 1204-QM-0907
Renal Transplant Post Op Plan 22406 PP-QM0411 Ver2 120611 22406 PP-QM0411
TRANS Kidney Panc-Panc Trans Re-Admit Plan 22404 QM0411 PP Rev021015 22404 QM0411 PP
TRANS Kidney-Panc Panc Transplant Post Op Plan-22402 QM0411 PP Ver4 Rev032615 22402 QM0411 PP
TRANS Liver and Kidney Transplant Post-Op Plan 22427-PP-QM1112-Rev 110414 22427-PP-QM1112
TRANS Liver OR Liver Kidney Trans Admit Plan 22408 QM0411 PP Rev101816 22408 QM0411 PP
TRANS Liver Transplant Post Op Plan 22409 QM0411 PP Rev072418 22409 PP QM0411
TRANS Liver Transplant Re-Admit Plan 22411 QM0411 PP Rev101816 22411 PP QM0411
TRANS Living Donor Hepatectomy Plan 22430 PP QM1117 111417 22430 PP QM1117
TRANS Living Donor Nephr Post Op Plan 22414 PP QM0411 Rev031015 22414 PP QM0411
TRANS Living Donor Transpl Nephr Admit Plan 22413 QM0411 PP Rev011615 22413 QM0411 PP
TRANS Renal Transplant Admit Plan 22405 QM0411 PP Rev011615 22405 QM0411 PP
TRANS Transplant Insulin Sliding Scale Protocol Plan 22425 QM0411 PP Rev050818 22425 QM0411 PP
Transpl-HBIG Insfusion- 22421-PP-QM0411 080911 22421-PP-QM0411
Transplant Home Health Orders- 1222-QM-1006-Ver 1 1222-QM-1006
Transplant Nephrectomy Admission Orders - 1207-QM-Ver2 1207-QM
Transplant Outpatient Unit S/P Transplant Admission Orders- 1231-0407-Ver 2 1231-0407
Transplant Pre Op-Intra Op Meds Plan- 22412 PP QM0411 Rev102715 22412 PP QM0411

Urology

VTE

© 2018 Methodist Le Bonheur Healthcare. All Rights Reserved.