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REASONING for PLAN: ______(may refer to the macro buttons below)
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Lower Extremity Vascular ultrasound plan
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Lower Extremity Vascular Ultrasound plan
• • •
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Dialysis Access
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Dialysis: Ultrasound plan
• • •
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Gastrostomy tube
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Gastrostomy: Follow up eval/exchange
• • •
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OTHER clinical issue managed by MVP:
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ABI - non-invasive vascular testing
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Indication for ABI
• • •
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Should Patient Undergo Medical Management for PAD?
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Medical Management for PAD
• • •
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Prophylactic anticoagulation
• • •
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SERVICE Consult (facility patient)
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MD consultation (outpatient)
• • •
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Physical Therapy?
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PAD Impact on Therapy
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'Other' MD Consultation
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CONSERVATIVE MANAGEMENT
• • •
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After Conservative Management (please specify)
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INTERVENTION plans
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Superficial Venous treatment plan
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Time frame for Treatment Plan
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‘Other’ treatment
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Risks of Not Treating
• • •
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Arterial angiographic Treatment plan
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Bilateral LE Arterial Procedure Plan
• • •
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Bilateral, please specify
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Right LE Arterial Procedure Plan
• • •
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Right, please specify
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Left LE Arterial Procedure Plan
• • •
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Left, please specify
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Deep Venous angiographic Treatment plan
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Deep Venous Intervention
• • •
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Venous, please specify
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Would patient benefit from open surgery management?
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[other procedure] __________
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Blood work and Testing
• • •
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Request for Medical Clearance/Optimization
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Other testing/ medical clearance
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HD access plan
• • •
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Other Access Plan
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FOLLOW UP
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Discuss exam results and TREATMENT plan
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Follow up PRN
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OTHER PLAN - consult
• • •
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Follow Up
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Recommendation in INTERIM
• • •
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Communication & Consent
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Consent obtained from patient/HCP
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Refusing to Consent
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Will discuss treatment plan with...
• • •
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Name of Family/HCP with whom discussed
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Name/TITLE of CLINICAL staff with whom Plan was communicated/discussed
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Discussed with ____
• • •
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Discussed with other
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NP/PA discussed plan with MVP MD
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Interpreter Name if used
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TASK next step created, when appropriate?
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Courtesy Thank you for referral
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ICD-10 codes entered prior to locking?
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Consultation Priority (see reference ---> )
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Consultation Priority Reference
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