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日间诊疗医嘱单

供未使用 Epic 系统的社区医疗服务提供者使用。

感谢您为患者选择 Cooley Dickinson 日间诊疗服务。发送患者医嘱时,请从下方文件夹中选择、下载、打印并传真最合适的医嘱单。

填写医嘱单时,请:

  • 请完整填写表格,包括签名并回答所有有关医疗必要性的问题。
  • 请记得开具主要药物以及任何相关的预用药或急救药物

传真医嘱单时:

  • 请将以下 所有 材料传真至 Cooley Dickinson 中央预约处,传真号码:413-582-2183:

    • 填写完整的医嘱单
    • 患者目前的病史和体格检查(H&P)记录
    • 患者当前用药及过敏情况列表
    • 治疗可能需要的任何已签署的同意书

如有任何疑问,请联系最符合您咨询需求的 Cooley Dickinson 部门:

输血

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Category


Form ID


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Blood transfusions


208-201


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Info and consent


21-12


注射和静脉输液治疗

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Category


Form ID


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Medical infusion therapy plan (to be used when specific medication therapy plan being ordered is not available)


208-200


输液(“治疗计划”)

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Category


Form ID


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Abatacept (Orencia) for rheumatology maintenance


208-204


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Access and flush


208-226


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Albumin


208-234


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Anifrolumab


208-274


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Antibiotics


208-235


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Belatacept maintenance


208-255


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Belatacept load dose


208-256


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Belimumab


208-205


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Bezlotoxumab


208-252


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Cortrosyn stimulation test


208-232


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Denosumab (Prolia)


208-273


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Dexamethasone


208-257


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Eculizumab load


208-264


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Eculizumab maintenance


208-265


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Epoetin Alfa


208-268


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Ferumoxytol


208-253


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Golimumab maintenance


208-262


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Golimumab load


208-261


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Hydrations


208-241


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Infliximab load and maintenance every 6 weeks


208-225


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Infliximab load and maintenance every 8 weeks


208-275


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Iron Sucrose Venofer (MGH)


208-244


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IVIG Allergy


208-243


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IVIG Neurology


208-240


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IVIG Neurology - schedule 2 days monthly


208-239


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Mepolizumab


208-209


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Methylprednisolone monthly


208-258


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Methylprednisolone daily


208-259


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Ocrelizumab maintenance dose


208-223


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Ocrelizumab load dose (schedule weeks 0-2)


208-224


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Omalizumab


208-208


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Pentamidine 2.18


208-245


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Prolastin


208-227


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Reclast Rheumatology


208-242


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Rituximab Dermatology (RA protocol 1000mg x 2 doses 2 weeks apart)


208-238


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Rituximab Hematology


208-246


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Rituximab Neurology 2.18


208-247


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Rituximab Rheumatology


208-213


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Romosozumab-AQQG


208-276


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Solumedrol


208-228


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Stelara 2.18


208-248


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Thymoglobulin


208-236


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Tixagevimab/Cilgavimab


208-266


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Tocilizumab Rheumatology


208-212


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Vedolizumab load (schedule weeks 0, 2, 6) and maintenance


208-229


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Vitamin B-12


208-254


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Zoledronic acid (Reclast)


208-214