MRP Order Sets

General

W-00737 Physician’s Order Sheet Post-Parathyroidectomy Renal Health/Peritoneal Dialysis/Hemodialysis

Hemodialysis

W-00109 (SAP 295044)  Chronic Hemodialysis Physician’s Order Sheet

W-00201 Request for Hemodialysis Patient to be Placed on a LRHC Patient WAITING List

W-00598  Addendum to Manitoba Renal Program, Chronic Hemodialysis Physician’s Order Sheet for HSC

W-00606  Intravenous Iron for Chronic Kidney Disease Order Sheet – Sodium Ferric Gluconate (Ferrlecit)

W-00641  Physician’s Order Sheet – Post Hemodialysis Tunnelled Central Venous Catheter Insertion

Catheter-related Bacteremia

W-00522  Identified Central Venous Catheter Related Bacteremia Order Sheet

W-00569  Local Renal Health Centres Identified Central Venous Catheter Related Bacteremia Order Sheet

W-00582 (SAP 295070) Suspected Central Venous Catheter Related Bacteremia Order Sheet

Home Hemodialysis

W-00859 (SAP 354905) Home Hemodialysis Physician’s Order Sheet for Fresenius 5008S

W-00823 (SAP 354904) Home Hemodialysis Physician’s Order Sheet for NxStage

 Local Centres

W-00569  Local Renal Health Centres Identified Central Venous Catheter Related Bacteremia Order Sheet

W-00599  Addendum to Manitoba Renal Program, Chronic Hemodialysis Physician’s Order Sheet for Local Renal Health Centres

 Peritoneal Dialysis

W-00130  Physician’s Order Sheet for Peritoneal Dialysis (PD)

W-00813 Addendum to ‘Manitoba Renal Program, Physician’s Order Sheet for Home Peritoneal Dialysis Patients, Form # W-00130’ for Long Term Care

W-00542 (SAP354901) Physician’s Order Sheet Peritoneal Dialysis OUTPATIENTS Exit Site/Tunnel Infections and Wet Contamination (70.30.05f)

W-00617  Physician’s Order Sheet Peritoneal Dialysis Outpatients Pre-Post Peritoneal Catheter Insertion

W-00663  Physician’s Order Sheet for Oral Iron Renal Health Clinic-Peritoneal Dialysis Outpatients

Peritonitis

W-00543 (SAP354902) Physician’s Order Sheet Peritoneal Dialysis OUTPATIENTS Confirmed Pathogen Peritonitis (70.30.05e)

W-00624 (SAP354903) Physician’s Order Sheet – Peritoneal Dialysis Outpatients Empiric Treatment of Peritoneal Dialysis Related Peritonitis (70.30.05a)

W-00680 Part 3 Guideline for Empiric Antibiotic Treatment Guidelines for Rural Outpatients with Peritonitis  (70.30.05d)

Renal Health Clinics

W-00199  Chronic Kidney Disease Preprinted Orders

W-00476  Cyclophosphamide Order Sheet

W-00847 IV Cyclophosphamide Order Sheet

W-00493  HSC Renal Biopsy Order Sheet

W-00495  Intravenous Iron Preprinted Order Sheet for Chronic Renal Insufficiency

W-00663  Physician’s Order Sheet for Oral Iron Renal Health Clinic-Peritoneal Dialysis Outpatients

Transplant Referral

W-00398  Manitoba Renal Program Standing Orders for Transplant Referral

Disclaimer: The information and data in this document (“Information”) is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

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