TCFHT-MD07 Uncomplicated Urinary Tract Infection
Transcript of TCFHT-MD07 Uncomplicated Urinary Tract Infection
LastUpdated16-04-2015byShazmahHussein,RN
Title: UncomplicatedUrinaryTractInfection
Number: TCFHT-MD07
ActivationDate: 18-09-2011 DateReviewed: 16-04-2015ReviewDue: 16-04-2016 Sponsoring/ContactPerson(s)(name,position,contactparticulars):
AlissiaValentinis,MD790Bay,Suite522,Toronto,Ontario416-591-1222
Orderand/orDelegatedProcedure: AppendixAttached:XNoYesTitle:
Usingthisdirective,theimplementerisabletoassess,diagnose,andtreatuncomplicatedurinarytractinfectionsduringin-personpatientencounters.RecipientPatients: AppendixAttached:NoXYes
Title:AppendixA–AuthorizerApprovalFormRecipientsmust:• BeactivepatientsofaTCFHTprimarycareproviderwhohasapprovedthisdirectivebysigning
theAuthorizerApprovalForm• Befemale• MeettheconditionsidentifiedinthisdirectiveAuthorizedImplementers:
AppendixAttached:NoXYesTitle:AppendixB–ImplementerApprovalForm
ImplementersmustbeTCFHTemployedRegulatedHealthCareProvidersorPhysicianAssistant(underthesupervisionofaphysician).ImplementersmustcompletethefollowingpreparationandsigntheImplementerApprovalForm:• Assessownknowledge,skill,andjudgmenttocompetentlyassess,diagnose,andtreat
uncomplicatedUrinaryTractInfection• Review“AcuteUncomplicatedCystitisandPyelonephritisinWomen”fromUpToDate,accessible
fromhttp://www.uptodate.com/contents/acute-uncomplicated-cystitis-and-pyelonephritis-in-
MEDICALDIRECTIVE
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women?source=search_result&search=acute+uncomplicated+cystitis&selectedTitle=1%7E80• Reviewguidelinesforcollectingamidstreamurinespecimen,accessiblefrom
http://www.nursingtimes.net/nursing-practice/clinical-zones/infection-control/specimen-collection-1-obtaining-a-midstream-specimen-of-urine/1295662.article
• Obtainmostrecenteditionof“Anti-infectiveGuidelinesforCommunity-acquiredInfections”(Anti-InfectiveReviewPanel,2013)andreviewAcuteCystitissection.Canbepurchasedfromhttp://www.mumshealth.com/guidelinestools/anti-infective
• Reviewmechanismsofactionofrecommendedantibioticsinpharmacologyreferencetextand/orCPS
• AnauthorizingPrimaryCareProvidermustsupervise3casesIndications: AppendixAttached:XNoYes
Title:• AdultFemalepatientspresentingwith1ormoreofthefollowing:dysuria,frequency,urgency,
cloudyorstrongsmellingurine,suprapubicpainorpressure,and/orlowbackpain.• Midstreamurinespecimenrevealspresenceofleukocytes(morethantraceamount)orpresence
ofnitrites(anypositive,includingtraceamount)ontestingwithchemicalreagentstrip.• Temperature<38.0CwithoutantipyreticsContraindications:• Male,pediatric,pregnant,postmenopausalpatients,orpatientswithdiabetesand/orsevereor
complexmedicalissues.• Temperature>38.0C,vomiting,orpresenceofcostovertebralangletenderness.• Patienthasahistoryofurinarycalculus.• PatienthasahistoryoffrequentUTI’s(>3inthelastyear).Forpatientspresentingwiththeabovecontraindications,theimplementerobtainshistory,performsaphysicalassessment,documentsfindings,andconsultswiththeprimarycareproviderforfurtherdirectiononpatientcareinatimelymanner.Consent: AppendixAttached:XNoYes
Title:• Patient’sconsentisimpliedforimplementertoassessandtreatuncomplicatedUTI,aspatient
haspresentedseekingtreatment,andisaFamilyHealthTeampatient,whereinterprofessionalpracticeisexpected.
• Patientinformedofpurposeoftesting,includingwhenresultswillbeavailable,andfollowuprequirediftestispositiveornegative.
• Patientabletogiveninformedconsentandiscooperativeanddoesnotneedrestraint.• Patientisinformedoftheimportanceofcontactnotificationintheeventofpositiveresults.GuidelinesforImplementingtheOrder/Procedure:
AppendixAttached:NoYesTitle:AppendixC–SampleLabRequisitionAppendixD–SamplePrescription
ForassessmentandtreatmentofpatientswhomeettheIndicationsdescribedabove:
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• Implementerperformsassessmentincluding:o History(presentingsymptoms,urinecharacteristics,confirmptisnotpregnantby
documentingLMP,pasthistoryofUTIandtreatment,allergiestoantibiotics)o Assessmentforbilateralcostovertebralangletendernesstoruleoutpyelonephritiso Temperature
• Implementerobtainsamid-streamurinesample(instructionsshouldbegiventopatienttoensureasepsisisachieved)andappliespatientlabeltospecimenbottle.Urinespecimenshouldthenbetestedwithchemicalreagentstripusingaseptictechnique.
• Assessurinecharacteristicswiththesampleprovided.• Ifmidstreamurinespecimenrevealspresenceofleukocytes(morethantraceamount)or
presenceofnitrites(anypositive,includingtraceamount),implementercommunicateswithpatientthatshelikelyhasUTI.
• ImplementerdocumentstheassessmentintheeMR,usingTCFHT-MD07stamp.• Implementerprepareslabrequisitionforurinalysisandculture&sensitivitiesusingthe
supervisingprimarycareproviderinitialsinPracticeSolutions.• LabRequisitionshouldbesignedasbelow:
o Signatureo ImplementerName/PrimaryCareProviderName(MedicalDirectiveTCFHT-MD07)
• ImplementerpreparesPrescriptionusingthesupervisingprimarycareproviderinitialsinPracticeSolutions.
• Prescriptionshouldbesignedasbelow:o Signatureo ImplementerName/PrimaryCareProviderName(MedicalDirectiveTCFHT-MD07)
• Implementerprovidespatientwitheducationofcommonsideeffectsofantibioticprescribed,whentoexpectresolutionofsymptoms,whentoseekfurthermedicalassistance,andpreventionoffutureUTIs(frequentvoiding,increasingfluidconsumption,perinealhygiene,voidingaftersexualactivity,andpotentialbenefitsofpurecranberryjuice(Jepson&Craig,2008).
• Implementertofollowupwithlabresultspromptlywhenavailableandreviewwiththepatient’sprimarycareprovider.
DocumentationandCommunication: AppendixAttached:NoXYes
Title:AppendixE–TCFHT-MD07Stamp• Documentationinthepatient’seMRneedstoinclude:nameandnumberofthedirective,name
oftheimplementer(includingcredential),andnameofthephysician/nursepractitionerauthorizerresponsibleforthedirectiveandpatient,usingthefollowingPSSStamp:TCFHT-MD07_Uncomplicated_Urinary_Tract_Infection
• Informationregardingimplementationoftheprocedureandthepatient’sresponseshouldbedocumented,inthepatient’seMR,inaccordancewithstandarddocumentationpractice(CollegeofNurses,2008).
• Standarddocumentationisrecommendedforprescriptions,requisitions,andrequestsforconsultation.
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• ImplementerwillsendamessageinPracticeSolutionstopatient’sprimarycareprovider,notifyinghim/herthatpatientwasseen,andtoreviewnoteineMRfordetails.
ReviewandQualityMonitoringGuidelines: AppendixAttached:XNoYes
Title:• Routinereviewwilloccurannuallyontheanniversaryoftheactivationdate.Reviewwillinvolve
acollaborationbetweentheauthorizingprimarycareprovidersandtheauthorizedimplementers.
• Atanysuchtimethatissuesrelatedtotheuseofthisdirectiveareidentified,TCFHTmustactupontheconcernsandimmediatelyundertakeareviewofthedirectivebytheauthorizingprimarycareprovidersandtheauthorizedimplementers.
• Thismedicaldirectivecanbeplacedonholdifroutinereviewprocessesarenotcompleted,orifindicatedforanadhocreview.Duringthehold,implementerscannotperformtheproceduresunderauthorityofthedirectiveandmustobtaindirect,patient-specificordersfortheprocedureuntilitisrenewed.
• Ifnewinformationbecomesavailablebetweenroutinereviews,suchasthepublishingofnew“Anti-infectiveGuidelinesforCommunity-aquiredInfections”,andparticularilyifthisnewinformationhasimplicationsforunexpectedoutcomes,thedirectivewillbereviewedbytheauthorizingphysician/nursepracititionerandamimimumofoneimplementer.
References:Anti-infectiveReviewPanel.(2013).Anti-infectiveGuidelineforCommunity-acquiredInfections.Toronto:MUMSGuidelineClearinghouse.CollegeofNursesofOntario.(2008).PracticeStandard:Documentation.Retrievedfromhttp://www.cno.org/Global/docs/prac/41001_documentation.pdfGuptaetal.(2011).InternationalClinicalPracticeGuidelinesfortheTreatmentofAcuteUncomplicatedCystitisandPyelonephritisinWomen:A2010UpdatebytheInfectiousDiseasesSocietyofAmericaandtheEuropeanSocietyforMicrobiologyandInfectiousDiseases.ClinicalInfectiousDisease,52,e102-120.Higgins,D.(2008).SpecimenCollection1.Obtainingamidstreamspecimenofurine.Retrievedfromhttp://www.nursingtimes.net/nursing-practice/clinical-zones/infection-control/specimen-collection-1-obtaining-a-midstream-specimen-of-urine/1295662.articleHooton,T.,&Gupta,K.(2014).AcuteUncomplicatedCystitisandPyelonephritisinWomen.Retrievedfromhttp://www.uptodate.com/contents/acute-uncomplicated-cystitis-and-pyelonephritis-in-women?source=search_result&search=uti&selectedTitle=2%7E150Jepson,RG.,&,Craig,JC.(2008).Cranberriesforpreventingurinarytractinfections.CochraneDatabaseSystematicReviews,Jan23;(1):CD001321.
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Wagenlehner,F.,Weidner,W.,&Naber,K.(2009).Anupdateonuncomplicatedurinarytractinfectionsinwomen.CurrentOpinioninUrology,2009(19),368-374.NOTE:ThismedicaldirectiveisbasedonTCFHT’spreviousmedicaldirectiveRN-1UTIentitled,“Assessment,Diagnosis,andTreatmentofUncomplicatedUrinaryTractInfections(UTI),”whichrequiredrevisioninformattingtoreflectthegrowthoftheTCFHTorganization.ThemajorityofthecontentofRN-1UTIhasremainedthesamefortherevisedTCFHT-MD07version.Therefore,allapprovedImplementersandAuthorizersformedicaldirectiveRN-1UTI“Assessment,Diagnosis,andTreatmentofUncomplicatedUrinaryTractInfections(UTI)”havegrandfatheredapprovalforTCFHT-MD07“UncomplicatedUrinaryTractInfection.”
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AppendixA:
AuthorizerApprovalForm
NameSignatureDate
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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_______________________________________________________________________________
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_______________________________________________________________________________
AppendixB:
ImplementerApprovalForm
Tobesignedwhentheimplementerhascompletedtherequiredpreparation,andfeeltheyhavethe
knowledge,skill,andjudgementtocompetentlycarryouttheactionsoutlinedinthisdirective.
NameSignatureDate
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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_______________________________________________________________________________
AppendixC:
SampleLabRequisition
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AppendixD:
SamplePrescription
Specimen Collection
x Biochemistry x Hematology x Viral Hepatitis (check one only)Glucose Random Fasting CBC Acute Hepatitis
HbA1C Prothrombin Time (INR) Chronic Hepatitis
Creatinine (eGFR) Immunology Immune Status / Previous ExposureSpecify: Hepatitis A Hepatitis B Hepatitis Cor order individual hepatitis tests in the“Other Tests” section below
Uric Acid Pregnancy Test (Urine)
Sodium Mononucleosis Screen
Potassium Rubella
Chloride Prenatal: ABO, RhD, Antibody Screen(titre and ident. if positive)CK Prostate Specifi c Antigen (PSA)
ALT Repeat Prenatal Antibodies Total PSA Free PSA
Insured – Meets OHIP eligibility criteriaUninsured – Screening: Patient responsible for payment
Alk. Phosphatase Microbiology ID & Sensitivities(if warranted)Bilirubin
Albumin CervicalLipid Assessment (includes Cholesterol, HDL-C, Triglycerides, calculated LDL-C & Chol/HDL-C ratio; individual lipid tests may be ordered in the “Other Tests” section of this form)
Vaginal Vitamin D (25-Hydroxy)Vaginal / Rectal – Group B Strep Insured - Meets OHIP eligibility criteria:
osteopenia; osteoporosis; rickets;renal disease; malabsorption syndromes;medications affecting vitamin D metabolism
Uninsured - Patient responsible for payment
Albumin / Creatinine Ratio, Urine Chlamydia (specify source):
Urinalysis (Chemical) GC (specify source):
Neonatal Bilirubin: Sputum
Child’s Age: days hours Throat Other Tests - one test per lineClinician/Practitioner’s tel. no. ( ) Wound (specify source):
Patient’s 24 hr telephone no. ( ) Urine
Therapeutic Drug Monitoring: Stool Culture
Name of Drug #1 Stool Ova & Parasites
Name of Drug #2 Other Swabs / Pus (specify source):
Time Collected #1 hr. #2 hr.
Time of Last Dose #1 hr. #2 hr.
Time of Next Dose #1 hr. #2 hr.
Fecal Occult Blood Test (FOBT) (check one) FOBT (non CCC) ColonCancerCheck FOBT (CCC) no other test can be ordered on this form
Laboratory Use Only
Time Date
Ministry of Healthand Long-Term CareLaboratory RequisitionRequisitioning Clinician / Practitioner
Laboratory Use Only
Name
Address
Clinician/Practitioner Number
Additional Clinical Information (e.g. diagnosis)
Note: Separate requisitions are required for cytology, histology / pathology and tests performed by Public Health Laboratory
Patient’s Last Name (as per OHIP Card)
Patient’s First & Middle Names (as per OHIP Card)
Patient’s Address (including Postal Code)Copy to: Clinician/PractitionerLast Name
I hereby certify the tests ordered are not for registered in or out patients of a hospital.
XClinician/Practitioner Signature
4422-84 (2012/11) © Queen’s Printer for Ontario, 2012 7530-4581
Date
Address
First Name
24 hour clock yyyy/mm/dd
OHIP/Insured Third Party / Uninsured WSIB
M F
Check (�) one: Province Other Provincial Registration Number Patient’s Telephone Contact Number
CPSO / Registration No. Health Number Version Date of Birth
Service Dateyyyy
yyyy
mm
mm
dd
ddSex
Clinician/Practitioner’s Contact Number for Urgent Results
( )
( )
Specify one below:
Rebekah Barrett, RN Medical Directive TCFHT-MD07
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AppendixE:
TCFHT-MD07_UncomplicatedUrinaryTractInfectionStamp
Donald DuckD.O.B.: Oct 11, 1930Alissia Valentinis M.D., C.C.F.P.Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 daysDonald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930Alissia Valentinis M.D., C.C.F.P.Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 daysDonald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.PCPSO #79090790 Bay Street
Suite 522, Box 58/59 Toronto, Ontario M5G 1N8
Tel: 416-591-1222 Fax: 416-591-1227
� For: Donald Duck187 Bay StreetToronto, ONN4N 5J5DOB: Oct 11, 1930 M416-555-5555 (H)
Apr 9, 2014
Macrobid100mg PO BID
Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
1 of 1Macrobid100mg PO BID
Quantity: 5 days
Alissia Valentinis M.D., C.C.F.PCPSO #79090790 Bay Street
Suite 522, Box 58/59 Toronto, Ontario M5G 1N8
Tel: 416-591-1222 Fax: 416-591-1227
� For: Donald Duck187 Bay StreetToronto, ONN4N 5J5DOB: Oct 11, 1930 M416-555-5555 (H)
Apr 9, 2014
Macrobid100mg PO BID
Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.
Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930
1 of 1Macrobid100mg PO BID
Quantity: 5 days
Donald DuckD.O.B.: Oct 11, 1930Alissia Valentinis M.D., C.C.F.P.Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 daysDonald DuckD.O.B.: Oct 11, 1930
Donald DuckD.O.B.: Oct 11, 1930Alissia Valentinis M.D., C.C.F.P.Rx Apr 9, 2014Macrobid100mg PO BID Quantity: 5 daysDonald DuckD.O.B.: Oct 11, 1930
Alissia Valentinis M.D., C.C.F.P.Professional ID:
Rebekah Barrett, RN Medical Directive TCFHT-MD07
TCFHT-MD07_UncomplicatedUrinaryTractInfection
LastUpdated16-04-2015byShazmahHussein,RN
11
S:-Hxof«dysuria,»«urinaryfrequency,»«urgency,»«suprapubicpain,»«cloudyurine,»«strong-smellingurine,»«hematuria»X•days-No«fever,»«chills,»«vomiting,»«backpain»«-Novaginalitchingorabnormaldischarge»-Not«pregnant,»«diabetic,»«post-menopausal»«-•LMP»«-Nohxofurinarycalculus»«-•UTIsinthelastyear»-«ConfirmedNKDA»«Allergiesto•noted»O:-T:•-«No»«Positive»CVAtenderness-Urinedip:•leuks,•nitrites,•protein,•blood-Urinecharacteristics:«clear,»«cloudy,»«hematuria,»«foulsmell»A:«SymptomsconsistentwithUTI»P:«UrinesenttolabforC&Sandurinalysis»«Rxfor•given»«-ReviewedmethodsofUTIprevention-properperinealcare,goodhydration,notholdingurineandvoidingimmediatelyaftersexualactivity;discussedbenefitsofcranberryjuice.»-AdvisedtoRTCifsymptomspersist/worsenorifdevelopsfever,chills,vomitingorbackpain-Advisedtocompletefullcourseofabx,evenifsymptomsimprove/resolve-Providertofollowupwithurinetestresults*actionsandinterventionsinaccordancewithMedicalDirectiveTCFHT-MD07