Physician’s Orders

BASELINE ROUTINE SARS WORK-UP

Patient name: _______________________________

Date (YY/MM/DD): _______________     Time: ____________

 
  1. Chest X-ray
  1. Vital signs and O2Sat
  1. CBC and differential
  1. b-HCG, if child bearing age
  1. Electrolytes, Creatinine
  1. AST, ALT, ALP, bilirubin
  1. LDH, CPK, troponin
  1. PTT / INR
  1. Calcium, Magnesium, Albumin
  1. Amylase, lipase
  1. Urine C&S, urinalysis
  1. Urine for Legionella antigen
  1. Blood Cultures x 2 sets
  1. Sputum for C&S (if producing sputum)
  1. Throat swab for C&S (if sore throat)

Fill out Sunnybrook SARS Coronavirus PCR Requisition for following tests and send samples to Microbiology
  1. NP swab for viral isolation and SARS Coronavirus PCR– please use viral transport kit provided by Microbiology laboratory labeled (Note: viral panel for respiratory viruses is also done on this sample)
  1. Urine for SARS Coronavirus PCR
  1. Stool for SARS Coronavirus PCR - fresh or in viral transport media (NO preservative!)
  1. Sputum for SARS Coronavirus PCR – if producing sputum

       Fill out PHL Requisition for following serologic tests and 

       send samples to Microbiology with Requisition

20.  SARS Coronavirus serology

21. Mycoplasma, chlamydia and legionella serology

 

Please ensure that the above samples are sent to the respective SWCHSC Laboratories

 

Other orders:

 

 

 

MD Signature:       _______________________

Draw line through order if not wanted

 

Prepared by Dr. Mona Loutfy and Dr. Anita Rachlis