The most current assessment of this problem can be found in the Apex note dated

Transcription

1 Him andpcos Smartphrase:.REFENDOPCOS NOTE: patients with suspected PCOS are welcomed to endocrine clinic. There is also a PCOS clinic is available in the Ob/Gyn Department. I am y/o woman to Endocrinology for additional evaluation and treatment of possible PCOS. The patient has hirsutism and oligo/amenorrhea. The following results are available in Apex: Fasting blood glucose, lipids, estradiol, FSH/LH, TSH, free T4, prolactin, ESP,FTEST,FTST,DHT)@

2 {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N1]: smartlist

3 Adrenal Insufficiency Smartphrase:.REFENDOADRENALINSUFFICIENCY Endocrinology for additional evaluation and treatment of possible adrenal insufficiency The following results are available in Apex: AM ACTH, AM cortisol, ACTH Stim test (Give Cosyntropin 0.25mg IM, draw cortisol levels at 0 min and min) {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N2]: smartlist

4 Adrenal Mass Smartphrase:.REFENDOADRENALMASS Endocrinology for additional evaluation and treatment of an adrenal mass. The following results are available in Apex: - 24h urine catecholamines and metanephrines (with urine Cr) - If hypertensive, 8 AM plasma aldosterone, plasma renin activity, K, Creatinine - If Cushingoid, 24h urine cortisol collection (with urine Cr). {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N3]: smartlist

5 Oligo / amenorrhea Smartphrase:.REFENDOAMENORRHEA I am y/o woman to Endocrinology for additional evaluation and treatment of oligo / amenorrhea The following results are available in Apex: Pregnancy test Estradiol, FSH/LH, TSH/free T4, prolactin (Add testosterone if @BRIEFLAB(TT4,FT4,FT4DIAL)@ TEST,FTST,DHT)@ {CHOOSE ONE: xxxxx}

6 -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N4]: smartlist

7 Diabetes Smartphrase:.REFENDODIABETES Endocrinology for additional evaluation and treatment of a diabetes. The following studies are available in Apex or were recently ordered: HbA1c, fasting glucose, lipids, LFTs, Na, @BRIEFLAB(CHOL,LDL,TLDL,HDL,THDL,TG,TRID,CHOLRATI LWB,GGT,ANA5)@ {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person

8 -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate)

9 Hirsutism Smartphrase:.REFENDOHIRSUTISM I am y/o woman to Endocrinology for additional evaluation and treatment of hirsutism. At least one of the of the following is present, unusual course of hirsutism (rapid onset, progressive) Testosterone level increase > 2 x The following results are available in Apex: Testosterone (DHEA-S, 17OH progesterone can be TEST,FTST,DHT)@ {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N5]: smartlist

10 Hyperaldosteronism Smartphrase:.REFENDOHYPERALDO Short Description: econsult to Endocrine: Hyperaldosteronism Endocrinology for evaluation and treatment of suspected or confirmed primary hyperaldosteronism. At least one of the following is present Resistant hypertension (requiring 3 antihypertensives) Spontaneous hypokalemia Adrenal mass and hypertension The following results are available in Apex: 8 AM plasma aldosterone 8 AM plasma renin activity Potassium Comment [N6]: Smartlist use same list as the external econsult smartphrase "select all that apply" (If on Spironolactone or Eplerenone, switch to alternate antihypertensive for 6 weeks prior to drawing lab values unless contraindicated. Antihypertensives including alpha blockers, CCB and Hydralazine appear to interfere least with diagnostic testing for hyperaldosteronism. Lab values are most sensitive when drawn after patients have been sitting for 5-15

11 {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N7]: smartlist

12 Hypercalcemia Smartphrase:.REFENDOHYPERCALCEMIA Endocrinology for evaluation and treatment of hypercalcemia. At least one of the following Is present Persistent hypercalcemia (any thiazide diuretics held for at least 2 weeks) Hyperparathyroidism The following results are available in Apex: Calcium, albumin, phosphorus, 25 OH-vit D, {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N8]: smartlist

13 Hyperparathyroid Smartphrase:.refendohyperpara Endocrinology for evaluation and treatment of hyperparathyroidism. At least one of the following Is present Hypercalcemia Severe vitamin D deficiency < 10 Kidney stones Urine calcium > 250mg/24 hours if available Normal vitamin D status an unusual course: The following results are available in Apex: Calcium, albumin, phosphorus, alkaline phosphatase, 25 OH-vit D, PTH, Creatinine (If 25OH vitamin D is normal, please order 24 hour

14 {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N9]: smartlist

15 Hyperprolactinemia Smartphrase:.refendohyperprolactin Endocrinology for additional evaluation and treatment of hyperprolactinemia. I have confirmed at least two prolactin values above the upper limit of normal. (Drugs known to increase prolactin values, including risperidone, haloperidol, and metoclopramide, should be discontinued when possible prior to documenting elevated prolactin levels.) The patient has the following symptoms Galactorrhea Oligo/amenorrhea Headaches Visual field changes None of the above Comment [N10]: Smartlist use same list as the external econsult smartphrase select all that apply The following results are available in Apex: Prolactin, TSH, free T4, urine NTSH)@

16 {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N11]: smartlist

17 Hyperthyroid Smartphrase:.refendohyperthyroid Endocrinology for additional evaluation and treatment of hyperthyroid. The following results are available in Apex: TSH, free T4, free NOTE: please start a beta blocker if symptomatic without contraindications. {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N12]: smartlsit

18 Hypoglycemia Smartphrase:.REFENDOHYPOGLYCEMIA Endocrinology for evaluation and treatment of hypoglycemia. has documented blood glucose <60 (fasting or random) and is not a diabetic patient. The following results are available in Apex: Documented blood {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N13]: Smartlist.

19 Hypothyroid Smartphrase:.refendohypothyroid Endocrinology for evaluation and treatment of hypothyroidism. At least one of the following Is present. Pregnant Plans to become pregnant Suspect central hypothyroidism (low TSH, low free T4) Severe hypothyroid Difficulty with dose titration Other unusual situation: The following results are available in Apex: TSH and free {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and

20 determined to be appropriate) Comment [N14]: smartlist

21 Low testosterone Smartphrase:.REFENDOHYPOGONADISM I am y/o man, to Endocrinology for additional evaluation and treatment of hypogonadism. His low testosterone level was confirmed on occasion. The following results are available in Apex: Early AM (7-9AM) total testosterone, LH/FSH. Also: - If borderline total testosterone, check free testosterone - If low testosterone and normal or low LH/FSH, add iron studies, prolactin, TSH, and Free T4 for central hypogonadism TEST,FTST,DHT)@ {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N15]: smartlist

22 Osteoporosis Smartphrase:.refendoosteoporosis Endocrinology for evaluation and treatment of osteoporosis. At least one of the following Is present intolerance or contraindications to oral bisphosphonate GFR<35 fracture on oral bisphosphonate severe osteoporosis (T score < -3) history or organ transplant other unusual course: The following results are available in Apex: DEXA in the past year, Ca, albumin, phos, 25-OH vit D, PTH, Creatinine {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N16]: smartlist

23 Pituitary Mass Smartphrase:.REFENDOPITUITARYMASS Endocrinology for additional evaluation and treatment of a pituitary tumor. The following results are available in Apex: Prolactin, TSH, free T4, IGF1 (insulin like growth factor), AM ACTH and @BRIEFLAB(CORTISOL,CORTFREE,CRTSLPL,FCRT,LABCOR T,PVCORTISOL)@ {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N17]: smartlist

24 Thyroid nodule Smartphrase:.refendothyroidnodule Endocrinology for evaluation and treatment of thyroid nodule or goiter. The following results are available in Apex: TSH, free {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N18]: smartlist

25 Thyroid cancer Smartphrase:.refendothyroidcancer Endocrinology for evaluation and treatment of thyroid cancer The following results are available in Apex: TSH, free {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N19]: smartlist

26 Endocrine Unspecified Smartphrase:.REFENDOunspecified Endocrinology for additional evaluation. None of the current endocrine smartphrases apply (adrenal insufficiency adrenal mass, amenorrhea, diabetes, hirsutism, hypercalcemia, hyperpara, hyperprolactinemia, hyperthyroid, hypoglycemia, hypothyroid, low testosterone, osteoporosis, PCOS, pituitary tumor, thyroid cancer, thyroid nodule or goiter, Vit D deficiency) {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N20]: smartlist

27 AsVitamin D Deficiency Smartphrase:.REFENDOVITAMIND Endocrinology for evaluation and treatment of vitamin D deficiency. At least one of the following Is present Severe vitamin D deficiency < 10 Recurrent kidney stones Hypercalcemia Sarcoidosis or other granulomatous disease The following results are available in Apex: Calcium, albumin, phosphorus, 25 OH vit D, {CHOOSE ONE: xxxxx} -Please evaluate this patient in-person -OK to convert to econsult (if reviewed by the specialist and determined to be appropriate) Comment [N21]: smartlist

28 Abdominal Pain Smartphrase:.REFGIABDPAIN Gastroenterology for evaluation of abdominal pain The following results are available in Apex: CBC, Chem 7, Ca, Lipase, Liver Function Tests, TSH H. pylori IgG, Anti-tissue transglutaminase, @BRIEFLAB(CALCIUM,CA)@ @BRIEFLAB(FERR)@ (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Imaging report available in Apex Imagine report available in Apex Scanned Documents

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30 GI Anemia Smartphrase:.REFGIAnemia GI: ANEMIA Gastroenterology for evaluation of anemia. Note: consider direct referral for EGD and/or colonscopy as first step, using those Smartphrases, if clinically appropriate, The following recommended studies are available in Apex: CBC, iron studies, BUN, Creatinine, H. pylori IgG, (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents

31 GI Diarrhea Smartphrase:.REFGIDiarrhea GI: DIARRHEA Gastroenterology for evaluation of diarrhea. Note: pending the clinical scenario, consider the following studies: CBC, Chem 7, TSH, Anti-tissue transglutaminase, stool culture, stool O&P, and c (please mark any that apply) Microbiology report available in Apex Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Relevant radiology report available in Apex Relevant radiology report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents

32 Direct Referral COLONOSCOPY Smartphrase:.REFGICOLONOSCOPY Gastroenterology for direct scheduling for colonoscopy Indication: (choose one) Screening (no prior colonoscopy or normal prior study): Surveillance (history of POLYPS) Surveillance (history of CANCER) Other diagnostic indication (please explain): (IF the patient has a history of anemia, coagulopathy, or renal failure, please ensure that recent relevant labs are available in Apex -- e.g. CBC, @BRIEFLAB(INR,POCTINR)@ My assessment that this patient is safe for an endoscopic procedure with sedation. (please select any that apply) This patient, has had a recent MI OR STROKE requires HOME OXYGEN is on ANTICOAGULATION therapy has a clinically significant CARDIAC ARRHYTHMIA has a history of CHRONIC OPIATE use SUBSTANCE ABUSE or ALCOHOLISM

33 has a history of a PSYCHIATRIC disorder, such as schizophrenia or PTSD, to consider when planning sedation. has severe OSA Other co-morbidity that should be considered in consultation prior to colonoscopy If the patient has one of the above will be scheduled in the GI clinic for an evaluation prior to the procedure. (please select any that apply) Prior endoscopy report available in Apex Prior endoscopy report from outside facility available in Apex Scanned Documents Import Drug NOTE: UCSF Hepatologists perform endoscopy (screening and diagnostic) on patients established in their practice This patient is established in the Hepatology Practice

34 GI Direct EGD Smartphrase:.REFGIEGD GI: Direct Schedule EGD Gastroenterology for direct scheduling for upper endoscopy. Indication: (choose one) Symptoms of dyspepsia/acid reflux despite trial of PPI Symptoms of dyspepsia/acid reflux and patient age is >50 Iron Deficiency Anemia (consider also Colonoscopy) Surveillance (history of BARRETT S) Surveillance (history of CANCER) Other diagnostic indication (please explain): My assessment that this patient is safe for an endoscopic procedure with sedation. (please select any that apply) This patient, has had a recent MI OR STROKE requires HOME OXYGEN is on ANTICOAGULATION therapy has a clinically significant CARDIAC ARRHYTHMIA has a history of CHRONIC OPIATE use SUBSTANCE ABUSE or ALCOHOLISM has a history of a PSYCHIATRIC disorder, such as schizophrenia or PTSD, to consider when planning sedation. has severe OSA Other co-morbidity that should be considered in consultation prior to colonoscopy If the patient has one of the above will be scheduled in the GI clinic for an evaluation prior to the procedure.

35 (IF the patient has a history of coagulopathy or renal failure, please ensure that recent relevant labs are available in Apex -- e.g. (please select any that apply) Prior endoscopy report available in Apex Prior endoscopy report from outside facility available in Apex Scanned Documents Import Drug NOTE: UCSF Hepatologists perform endoscopy (screening and diagnostic) on patients established in their practice This patient is established in the Hepatology Practice

36 GI Dysphagia Smartphrase:.REFGIDysphagia GI: Dysphagia Gastroenterology for evaluation of dysphagia. (NOTE: if oropharyngeal mechansm likely, consider modified barium swallow prior to referral to GI) (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents Imaging available in Apex Imaging available in Apex Scanned Documents

37 GI GERD Smartphrase:.REFGIGERD GI: GERD Gastroenterology for evaluation of Esophageal Reflux Disease. Please select. NOTE: # 1, 2, and 3 will be SCHEDULED FOR EGD FIRST, with follow-up in clinic if indicated, per GI, based upon result 1. Reflux with alarm symptoms (e.g. dysphagia, bleeding, anemia, weight loss, or recurrent vomiting) 2. Symptomatic in spite of BID PPI therapy for at least 8 weeks 3. Man, over age 50, with reflux symptoms for > 5 years, and additional risk factors (nocturnal reflux symptoms, hiatal hernia, tobacco use, and central adiposity) 4. Schedule GI clinic visit only. Do NOT schedule EGD first (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents COMPLETE BELOW IF PROCEEDING TO EGD

38 My assessment that this patient is safe for an endoscopic procedure with sedation. (please select any that apply) This patient, has had a recent MI OR STROKE requires HOME OXYGEN is on ANTICOAGULATION therapy has a clinically significant CARDIAC ARRHYTHMIA has a history of CHRONIC OPIATE use SUBSTANCE ABUSE or ALCOHOLISM has a history of a PSYCHIATRIC disorder, such as schizophrenia or PTSD, to consider when planning sedation. has severe OSA Other co-morbidity that should be considered in consultation prior to colonoscopy If the patient has one of the above will be scheduled in the GI clinic for an evaluation prior to the procedure. NOTE: UCSF Hepatologists perform endoscopy (screening and diagnostic) on patients established in their practice This patient is established in the Hepatology Practice

39 GI IBD Smartphrase:.REFGIIBD GI: Known IBD Gastroenterology for evaluation of Inflammatory Bowel Disease (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents Imaging available in Apex Imaging available in Apex Scanned Documents GI clinical notes from outside facility available in Apex Scanned Documents

40 Irritable Bowel Syndrome Smartphrase:.REFGIIBS Gastroenterology for evaluation and treatment of possible irritable bowel syndrome The following results are available in Apex: CBC, Chem 7, Lipase, Liver Function Tests, TSH H. pylori IgG, Anti-tissue transglutaminase, ferritin, stool cultures (if (Please mark any that apply (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents Imaging available in Apex Imaging available in Apex Scanned Documents

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42 GI Nausea/Vomiting Smartphrase:.REFGINauseaVomiting GI: NAUSEA & VOMITING Gastroenterology for evaluation of nausea. The following recommended studies are available in Apex: CBC, Chem 7, Ca, Lipase, Liver Function Tests, H. pylori IgG, Anti-tissue @BRIEFLAB(CALCIUM,CA)@ LWB,GGT,ANA5)@ (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents Imaging available in Apex Imaging available in Apex Scanned Documents

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44 GI Pancreatitis Smartphrase:.REFGIPancreatitis GI: PANCREATITIS Gastroenterology for evaluation and treatment of chronic or recurrent pancreatitis. (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Radiology report available in Apex Radiology report available in Apex Scanned Documents

45 GI Unspecified Smartphrase:.REFGIunspecified Gastroenterology for evaluation. The available GI referral phrases do not apply (abdominal pain, IBS, IBD, anemia, diarrhea, dysphagia, GERD, Nausea/vomiting, pancreatitis) (please mark any that apply) Endoscopy report available in Apex Endoscopy report available in Apex Scanned Documents Pathology report available in Apex Pathology report available in Apex Scanned Documents Imaging available in Apex Imaging available in Apex Scanned Documents