Epic Smartphrases

Inpatient Admission H&P

Inpatient Progress Note

Inpatient Discharge Note

Inpatient Chronic Problems

Paxlovid Prescription

Inpatient Admission H&P

OHSU HEALTH HILLSBORO MEDICAL CENTER

INPATIENT ADMISSION HISTORY AND PHYSICAL

Patient's Name: @NAME@

Today's Date: @Td@

PCP: @PCP@

Attending Physician: @ATTPROV@

Author: @ME@

Date of Admission: @ADMITDT@

Assessment and Plan:

@NAME@ is a @AGE@ @SEX@ with ***

#Problem 1

Discussion

#Problem 2

Discussion

Admit as an inpatient/obs ***.

COVID-19 testing indicated: No.

Isolation: Standard Plus (Procedure mask+Eye protection)

- If fever, screen for COVID.

Code Status - @CODESTATUS@

DVT prophylaxis: ***

GI prophylaxis: ***

Admit to ***

Consults: ***

Diet: ***

Surrogate decision maker: ***

DISPOSITION: Home*** once medically stable.

Note routed to PCP ***

@SIGNATURE@

Department of Family Medicine

OHSU Health Hillsboro Medical Center

Orange Team Day 971-371-0176, Night 971-801-4098

Problem List:

@PROBLISTHOSP@

___________________________________________

Source of history: patient/Family*** and EPIC records

Chief Complaint :

***

HPI:

@NAME@ is a @AGE@ @SEX@ with *** who presents today with ***

ED Course:

***

ROS:

@ROS@

@PASTHISTORIESBEGIN@

PMH:

@PROBREF@

@PMH@

@PSH@

Prior Medications: Reviewed

@PTAMEDLISTFORHANDP@

Allergies: reviewed

@ALLERGYUN@

Social History

@SOCHREF@

Family History:

@FAMHX@

@PASTHISTORIESEND@

@EXAMBEGIN@

Physical Exam:

@VS@

@VITALSINPATIENT@

@PHYSEXAM@

@EXAMEND@

@DATABEGIN@

Data:

Laboratory studies:

@RESUFAST(wbc,hb,hct,plt,mcv,rdw,neutroperc,lymphperc,neutrophilco,lymphsabs,monocyteco,eosco,bandsco,basophilco,nrbc,INR)@

@RESUFAST(na,k,cl,bicarb,bun,cr,glu,ca,mg,po4,egfrnonafr)@

@RESUFAST(ast,alt,globulinlvl,ap,tp,alb,tbili,dirbili,lipase,lacticacid)@

@LABBRIEF(bnp,troponin:3,trop:3)@

@LABRCNT24hr(procalciton,esr,crp,tsh)@

@RESUFAST(osmo,osmour,urnaconc)@

@RESUFAST(a1c,chol,ldl,hdl,tri)@

@RESUFAST(ph,pco2,po2,hco3,totalco2art,o2satart,fio2,pao2fio2)@

@LASTPROC(POC90000143)@

@RESUFAST(urinecolor,urappearance,urinele,urinenitrite,urineurobili,urineprotein,urineph,urineblood,urspecgrav,urineketones,urinebili,urineglucose)@

Microbiology:

***

Imaging:

***

EKG:

@LASTPROC(ecg00002)@

***

I reviewed previous records, nurses notes and labs.

@DATAEND@

___________________________________________

I spent *** 30 / 50 / 70 minutes floor / unit time with the patient and assessment of history, physical exam, review of relevant laboratory / imaging studies, coordination of care with admitting and consulting specialties, discussion of presenting and chronic medical problems, proposed therapeutic plan with patient.

Portions of this note may have been written using voice recognition software. While I have made every attempt to proofread the final document, I may have missed errors due to the imperfections inherent to the software.

A note to patients: This note is primarily written for your care team. While you are in the hospital, there are many changes in your health status happening continuously and in real time. A note is written by your provider once per day and may not reflect the most current state of your condition. There may be areas where we are still thinking about diagnosis and treatment options. Major changes and updates in your condition may be documented in your chart up to 24 hrs later so we may focus on coordinating your care needs in real time. There are also several abbreviations used – please feel free to ask your care team for any clarifications.

Inpatient Progress Note

OHSU HEALTH HILLSBORO MEDICAL CENTER

INPATIENT PROGRESS NOTE

Patient's Name: @NAME@

Today's Date: @Td@

Attending Physician: @ATTPROV@

Author: @ME@

Date of Admission: @ADMITDT@

Hospital Day: @HOSPITAL@ @TDR@

Interval events: ***

Assessment and Plan:

@NAME@ is a @AGE@ @SEXADULT@ admitted on @ADMITDT@ with ***.

#Problem 1

Discussion

#Problem 2

Discussion

Barriers to Discharge: ***

Code Status @CODESTATUS@

DVT prophylaxis: ***

GI prophylaxis: ***

Status (obs vs inpatient): ***

Consults: ***

Diet: ***

Surrogate decision maker: ***

Expected Discharge Date: @EXPECTEDDISCHARGEDATE@

Discharge Location: Home*** once medically stable.

Discharge Milestones: ***

@SIGNATURE@

Department of Family Medicine

OHSU Health Hillsboro Medical Center

Orange Team Day 971-371-0176, Night 971-801-4098

@PROBHOSPDISCHREF@

___________________________________________

Current Symptoms: ***

ROS

@ROS@

@EXAMBEGIN@

Physical Exam:

Last Vitals: 24 hour min/max

@FLOWwithoutdates(6)@

@FLOWSTATR(6:24::1)@

@FLowwithoutdates(8)@

@FLOWSTATR(8:24::1)@

@FLowwithoutdates(9)@

@FLOWSTATR(9:24::1)@

@FLowwithoutdates(5)@

@FLOWSTATR(5:24::1)@

@FLowwithoutdates(10)@

@FLOWSTATR(10:24::1)@

@BMI@

@INTAKEANDOUTPUT@

@PHYSICALEXAM@

@EXAMEND@

@DATABEGIN@

Labs:

CBC with diff last 72 hours (or 3 results) - Refreshable

@LABRCNT1W(wbc:3,hb:3,hct:3,plt:3,mcv:3,rbc:3,rdw:3,neutroperc,lymphperc,neutrophilco,lymphsabs:monocyteco,eosco,basophilco,bandsabs,nrbc)@

@LABRCNT1W(na:3,k:3,cl:3,bicarb:3,bun:3,cr:3,ca:3,mg,egfrnonafr:3)@

@LABRCNTR(glu:5)@

@LABRCNT1W(ast:3,alt:3,globulinlvl:3,ap:3,tp:3,alb:3,tbili:3,dirbili:3,lipase)@

Imaging

***

Procedures

@DATAEND@

___________________________________________

I spent *** 15 / 25 / 35 minutes in floor / unit time caring for this patient. This included assessment of history, physical exam, review of relevant laboratory / imaging studies, coordination of care as needed, discussion with nursing staff and the patient.

Any portions of this note that were copied from prior notes were carefully reviewed and updated @TODAYDATE@.

Portions of this note may have been written using voice recognition software. While I have made every attempt to proofread the final document, I may have missed errors due to the imperfections inherent to the software.

A note to patients: This note is primarily written for your care team. While you are in the hospital, there are many changes in your health status happening continuously and in real time. A note is written by your provider once per day and may not reflect the most current state of your condition. There may be areas where we are still thinking about diagnosis and treatment options. Major changes and updates in your condition may be documented in your chart up to 24 hrs later so we may focus on coordinating your care needs in real time. There are also several abbreviations used – please feel free to ask your care team for any clarifications.

Inpatient Discharge Note

OHSU HEALTH HILLSBORO MEDICAL CENTER

INPATIENT DISCHARGE NOTE

Patient's Name: @NAME@

Today's Date: @Td@

Attending Physician: @ATTPROV@

Author: @ME@

PCP: @PCP@

Admission Date: @ADMITDT@

Discharge Date: @TODAYDATE@

Hospital Stay: @HOSPITAL@ day(s)

Reason for Admission:

***

Please see admission H&P for details.

Principal Final Diagnosis:

***

Additional Diagnoses:

***

Important Outpatient Follow-Up:

***

Procedures:

***

Consults:

***

Hospital Course:

***

Discharge Medications:

{SELECT SMARTLINK TO INSERT THE MEDICATION LIST INTO YOUR DISCHARGE SUMMARY ONLY AFTER YOU HAVE COMPLETED DISCHARGE MEDICATION RECONCILIATION:14468}

Rationale for Medication Changes:

***

Allergies:

@ALLERGY@

Code Status: {CODE STATUS:321518}

{SELECT SMARTLINK TO INSERT DISCHARGE ORDERS ONLY AFTER YOU HAVE COMPLETED THE DISCHARGE ORDERS:17904}

***

Name of physician that will be caring for this patient while at the care facility?

House MD yes

Has signout been called to this physician? {YES/NODEFAULTED:12062::"no"}

Call physician of record for:

Temp > 38.4 degrees C

SBP > 180 < 90 mmHg

HR > 120 < 50 Hct <30

Urine Output <30mL/hr x 2 hrs

SaO2 < 90 %

Discharge Physical Exam:

Last 24 hour min/max

@FLOWwithoutdates(6)@

@FLOWSTATR(6:24::1)@

@FLowwithoutdates(8)@

@FLOWSTATR(8:24::1)@

@FLowwithoutdates(9)@

@FLOWSTATR(9:24::1)@

@FLowwithoutdates(5)@

@FLOWSTATR(5:24::1)@

@FLowwithoutdates(10)@

@FLOWSTATR(10:24::1)@

@BMI@

@PHYSICALEXAM@

Discharge Labs

@RESUFAST(wbc,hb,hct,plt,mcv,rdw,neutroperc,lymphperc,neutrophilco,lymphsabs,monocyteco,eosco,bandsco,basophilco,nrbc,INR)@

@RESUFAST(na,k,cl,bicarb,bun,cr,glu,ca,mg,po4,egfrnonafr)@

@RESUFAST(ast,alt,globulinlvl,ap,tp,alb,tbili,dirbili,lipase,lacticacid)@

@LABBRIEF(bnp,troponin:3,trop:3)@

@LABRCNT24hr(procalciton,esr,crp,tsh)@

@RESUFAST(a1c,chol,ldl,hdl,tri)@

@SIGNATURE@

Department of Family Medicine

OHSU Health Hillsboro Medical Center

Orange Team Day 971-371-0176, Night 971-801-4098

I spent a total of *** <30 or >30 Minutes providing direct patient care and coordinating patient care.

Inpatient Chronic Problems

Acute Problems

Chronic Problems

#Diabetes

@LABRSLTLINER(a1c)@

@LABRSLTLINER(cr)@

@LABRSLTLINER(microalbcre,ac ratio)@

Type 2 DM, outpatient meds include: ***

Most recent sugars: *** fasting, *** daytime. Any hypoglycemia? ***

Last 24 hour insulin: *** long-acting, *** rapid-acting

Oral intake during hospitalization: *** Regular, reduced, NPO, tube feeds

Nutritionist needed? {YES/NO***:64}
Glucose checks
Stop outpatient meds
Goal glucose – < 140 fasting, < 180-200 post-prandial
Diet – diabetic (consistent carbs)
Insulin: (roughly 50/50 long acting / total short acting)
- Glargine 0.2-0.3u/kg *** SC qhs
- Lispro 0.075u/kg *** SC with meals
- SSI (no HS dosing)
Watch for hypoglycemic episodes
- Reduce insulin
Steroids?
- If prednisone, consider NPH dose with prednisone 0.3-0.6u/kg SC daily
Education ***
Discharge planning

#Hypertension

Last BMP

Proteinuria? ***

Home meds: ***

Plan:

#Chronic Kidney Disease

@LABRSLTLINER(cr, bun, EGFRCKDEPIM, EGFRCKDEPIF)@

Stage:

Avoid nephroxic medications
Meds: ACEI ***, ARB ***, diuretics ***

#Hyperlipidemia

@lastlipid@

Statin?

#CAD

History: ***

Outpatient meds: ***

Symptoms: *** asymptomatic

#Tobacco use

Tobacco use? {YES***/NO:60}

Paxlovid Prescription

Paxlovid Documentation

• Positive Covid test

• Age ***

• Risk factors {Paxlovid Risk Factors:28214}

• Symptoms c/w mild to moderate Covid - Yes

• Symptom onset within 5 days - Yes

• eGFR ***

• No known or suspected severe hepatic impairment

• https://www.covid19-druginteractions.org/ consulted - Yes

o Recommended medication changes ***

• Dosing

o eGFR >= 60: Paxlovid 300 mg nirmatrelvir (two 150 mg tablets) and 100 mg ritonavir (one 100 mg tablet) with all three tablets taken together orally twice daily for five days.

o eGFR >=30 and < 60: Paxlovid 150 mg nirmatrelvir (one 150 mg tablet) and 100 mg ritonavir (one 100 mg tablet) twice daily for five days

DELETE BELOW THIS - REFERENCE ONLY

Paxlovid Checklist

Medical History

o Positive SARS-CoV-2 test (Confirmation of a positive home rapid SARS-CoV-2 test result with additional direct SARS-CoV-2 viral testing is not required.)

o Age = 18 years OR > 12 years of age and weighing at least 40 kg

o Has one or more risk factors for progression to severe COVID-191 (Risk factors have changed over time, and additional risk factors [such as being unvaccinated or having not received a booster] could be considered. Healthcare providers should consider the benefit-risk for an individual patient.)

o Symptoms consistent with mild to moderate COVID-192

o Symptom onset within 5 days (Prescriber is encouraged to include a note to the pharmacist in the prescription stating: Please fill prescription by [insert date]. This prescription fill by date is within 5 days from symptom onset and complies with the patient eligibility criteria under the EUA.)

o Not requiring hospitalization due to severe or critical COVID-19 at treatment initiation

o No known or suspected severe renal impairment (eGFR < 30 mL/min) • Note that a dose reduction is required for patients with moderate renal impairment (eGFR =30-<60 mL/min); see the Fact Sheet for Healthcare Providers. • Prescriber may rely on patient history and access to the patient's health records to make an assessment regarding the likelihood of renal impairment. Providers may consider ordering a serum creatinine or calculating the estimated glomerular filtration rate (eGFR) for certain patients after assessment on a case-by-case basis based on history or exam.

o No known or suspected severe hepatic impairment (Child-Pugh Class C)

o No history of clinically significant hypersensitivity reactions [e.g., toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome] to the active ingredients (nirmatrelvir or ritonavir) or other components of the product

University of Liverpool Covid-19 Drug Interactions

https://www.covid19-druginteractions.org/

o In patients with moderate renal impairment (eGFR =30 to <60 mL/min), the dosage of Paxlovid is 150 mg nirmatrelvir (one 150 mg tablet) and 100 mg ritonavir (one 100 mg tablet) twice daily for five days.

o Patients with mild renal impairment (eGFR =60 to <90 mL/min) should receive the standard dose of 300 mg nirmatrelvir (two 150 mg tablets) and 100 mg ritonavir (one 100 mg tablet) with all three tablets taken together orally twice daily for five days.

o Paxlovid is not recommended at this time in patients with severe renal impairment (eGFR <30 mL/min).

Paxlovid locator tool

https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html

Risk Factors

• Cancer

• Cerebrovascular disease

• Chronic kidney disease*

• Chronic lung diseases limited to:

o Interstitial lung disease

o Pulmonary embolism

o Pulmonary hypertension

o Bronchiectasis

o COPD (chronic obstructive pulmonary disease)

• Chronic liver diseases limited to:

o Cirrhosis

o Non-alcoholic fatty liver disease

o Alcoholic liver disease

o Autoimmune hepatitis

• Cystic fibrosis

• Diabetes mellitus, type 1 and type 2*

• Disabilities

o Attention-Deficit/Hyperactivity Disorder (ADHD)

o Cerebral Palsy

o Congenital Malformations (Birth Defects)

o Limitations with self-care or activities of daily living

o Intellectual and Developmental Disabilities

o Learning Disabilities

o Spinal Cord Injuries

• Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)

• HIV (human immunodeficiency virus)

• Mental health disorders limited to:

o Mood disorders, including depression

o Schizophrenia spectrum disorders

• Neurologic conditions limited to dementia

• Obesity (BMI =30 kg/m2)*

• Primary Immunodeficiencies

• Pregnancy and recent pregnancy

• Physical inactivity

• Smoking, current and former

• Solid organ or hematopoietic cell transplantation

• Tuberculosis

• Use of corticosteroids or other immunosuppressive medications