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