<p> PLACE LABEL HERE POST BIOPSY ORDERS</p><p>The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked. Initial all handwritten order modifications and the bottom of each page when indicated (multipage). </p><p>1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission? 2.  Yes, admit as inpatient, proceed to # 2 No, place in observation No, outpatient, DC home 3. If admitted as inpatient, Inpatient Physician Certification: Diagnosis: ______Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference ______4.  Telemetry: If patient Medical/Surgical, must complete form # 36084 5.  Isolation:  Contact  Droplet  Airborne For: ______6. Consults: ______7. Assessments: Vital signs q 15 min x 2, then q 30 min x 4, then q hr x 3 Check for bleeding or hematoma at biopsy site at same intervals 8. Diagnostics: Chest x-ray PA & LAT, CXR (upright), reason______ now  in ______hrs Portable, PCXR reason______ now  in ______hrs PA/AP only Chest - Stretcher reason______ now  in ______hrs 9. Diet:  May resume previous diet as tolerated 10. Activity:  Bedrest, pressure at biopsy site x 30 min, then ad lib for ____ hrs with assistance  Bedrest for ______hrs</p><p>MEDICATIONS 11. IVF:  Normal saline ______ml/hr IV x ______hrs 12. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn 13. Moderate Pain:  Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered. OR  Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered. 14. Severe Pain (Begin when Epidural or PCA has been discontinued)  Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered. OR  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered. 15. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn</p><p>ADDITIONAL ORDERS: ______</p><p>______Date Time Physician Signature PID Number</p><p>*1-1352* FORM 1-1352 REV. 09/2016 WHITE: Medical Record CANARY: Pharmacy Page 1 of 1</p>