Please find below specific physician order set information for IFH.
Adult Order Forms
- Adult Critical Care Order Forms
- Adult Oncology Order Forms
- Adult Ventricular Assist Device Order Forms
- Anticoagulation Order Forms
- Heart Failure Forms
- Invasive Cardiology Order Forms
- Pediatric Order Forms
- Pediatric Critical Care Order Forms
- Online Admission Request - Inova Fairfax Hospital
- Transplant Order Forms
Adult Order Forms
- AND/DNAR Orders
- AND Suspension Orders
- Active Surveillance Culture (ASC) for MRSA Colonization Protocol #86075
- Acute Confusion/Delirium Order Sheet #86645
- AMI/HF Discharge Instructions
- Adult Community Acquired Pneumonia Admission Orders, Cat #85189
- Adult Parenteral Monitoring Orders, Cat #97878
- Adult Parenteral Nutrition Orders, Cat #97251
- Adult Subcutaneous Insulin Order Set BBC Cat #85183
- Alcohol Withdrawal Syndrome (AWS) Non-ICU #86626
- Bivalarudin (Angiomax) for PCI Only Physicians Orders, Cat #86077
- Blood Transfusion Orders - Adult, Cat # 85046
- Chest Pain Observation Unit Orders
- Comfort Care Orders
- Delirium Risk Assessment #86624
- DVT/PE Screening Order Set Physicians Orders, Cat #86089
- Entereg Pre-op Order Form # 86363
- Entereg Post-op Order Form # 86364
- IFH Heart Failure Order Set, Cat# 81764
- Ischemic Stroke/TIA Admission Orders Physicians Orders, Cat #82166
- Neuroscience Discharge Instructions # 86339
- Patient/Family Education Checklist- Stroke # 86635
- Patient Discharge/Transition - # 81791FH
- Preoperative Antibiotic and Venous Thromboembolism Prophylaxis Orders # 85878
- Screening Criteria for tPA Thrombolysis, Cat #82275
- Therapeutic Low Molecular Weight Heparin Order Set for Adults, Cat #86074
- Thrombolytic Therapy for PE Order Set
- Transfused Medications, Adult-Child-Infant, Cat #84863
- Restraints Orders, Cat #81034
- WinRho, Cat #85182
Adult Critical Care Order Forms
- Airway Assessment/Intubation Cat #87769
- Alcohol Withdrawal Syndrome (AWS) Orders - Critical Care #86625
- Critical Care Admission Orders, Adult Critical Care # 84935
- ICU Orders - Inova Fairfax Hospital Trauma ICU # 96052
- ICU Orders - Severe Traumatic Brain Injury Orders
- Insulin Infusion Orders for Adult Critical Care, Cat # 85033
- Insulin Infusion for DKA and HHS, Cat # 81256
- Intracerebral Hemorrhage, Adult Critical Care # 86389
- Intravenous Electrolyte Replacement Protocol for Adult Critical Care #86787
- Ischemic Stroke/TIA Admission Orders, Adult # 82166
- Mechanical Ventilation Orders, Adult Critical Care # 84936
- Restraints Orders, Cat #81034
- Sepsis, Adult #8778510
- Subarachnioid Hemorrhage/Aneurysm, Adult Critical Care # 86390
- Therapeutic Hypothermia (Arctic Sun), Adult Critical Care # 86196
- tPA for Acute Ischemic Stroke tPA Administration Physicians orders, Cat #82276
- tPA Administration Flowsheet # 86347
- Wake Up and Breathe, Adult Critical Care # 84992
Adult Oncology Order Forms
Standards for Safe Administration of Chemotherapy
Compliance with this practice standard is ESSENTIAL to prevent chemotherapy-related medicaion errors and improve patient safety. Please read and follow the above standard when writing chemotherapy orders.
Hematologic Malignancy Order Sets
- Azacitidine (7 day regimen)
- Cytarabine + Idarubicin (7+3)
- HiDAC (less than 60 years)
- HiDAC (60 years or older)
- ME (Mitoxantrone + Etoposide)
- MEC (Mitoxantrone + Etoposide + Cytarabine)
- HyperCVAD Cycle A
- HyperCVAD Cycle B (less than 60 years)
- HyperCVAD Cycle B (60 years or older)
- Rituximab + HyperCVAD Cycle A - Burkitt Lymphoma & ALL
- Rituximab + HyperCVAD Cycle B (less than 60 years)- Burkitt Lymphoma & ALL
- Rituximab + HyperCVAD Cycle B (60 years or older) - Burkitt Lymphoma & ALL
- Rituximab + HyperCVAD Cycle A - MCL
- Rituximab + HyperCVAD Cycle B (less than 60 years) - MCL
- Rituximab + HyperCVAD Cycle B (60 years or older) - MCL
- HyperCVAD CNS Prophylaxis Cycle A or B
- Larson (CALGB 8811) Induction Regimen (less than 60 years)
- Larson (CALGB 8811) Induction Regimen (60 years or older)
- CODOX-M (Magrath)
- CODOX-M (Magrath) CNS Prophylaxis
- IVAC (Magrath)
- IVAC (Magrath) CNS Prophylaxis
- Nelarabine
- CHOP
- CHOP + Rituximab
- GEMOX
- Rituximab + GEMOX
- ICE
- Rituximab + ICE
- High-dose Methotrexate (8gm/m2)
- GI Malignancy Order Sets
- FOLFIRI
- FOLFIRI + Bevacizumab
- FOLFOX6 (Modified)
- FOLFOX6 (Modified) + Bevacizumab
- Cetuximab Single Agent Weekly Dose x 4
- Cetuximab + Irinotecan Weekly Dose X 4 Every 6 Weeks
- DCF
- Breast Cancer Order Sets
- AC Course Q 21 days
- Weekly Paclitaxel/Trastuzumab Course
- Trastuzumab Q 21 days (Following Weekly Paclitaxel/Trastuzumab)
- Dose Dense AC Course Q 14 days
- Dose Dense Paclitaxel Course Q 14 days
- TAC Q 21 days
- TC Q 21 days
- TCH Q 21 days
- Trastuzumab Q 21 days (Following TCH Course)
- GYN Oncology Order Sets
- Carboplatin + Paclitaxel Q 21 days
- Cisplatin IP (Day 2)
- Paclitaxel IP (Day 8)
- EMA-CO (Day 1 and 2)
- EMA-CO (Day 8)
- Lung Cancer Order Sets
- Cisplatin + Etoposide
- Paclitaxel 175mg/m2 + Carboplatin AUC 5
- Paclitaxel 200mg/m2 + Carboplatin AUC 6
- Paclitaxel 200mg/m2 + Carboplatin AUC 6 + Bevacizumab
- Head and Neck Cancer Order Sets
- TPF
- Miscellaneous
- Adult Medical Oncology Symptom Management Order Set
- Chemotherapy Order Form- 3 page
- Chemotherapy Order Form - 4 page
- Febrile Neutropenia Order Set and Guidelines
- Oncology Attestation Sheet
- Rasburicase(Elitek®) Order Set and Guidelines
- Adult Romiplostim (Nplate) Order Form and Guidelines
Adult Ventricular Assist Device Order Forms and Flowsheets
- Abiomed Flow Sheet
- Centrimag Orders
- Heartmate II Orders
- HeartWare Orders
- Thoratec Orders
- Ventrassist Orders
- VAD Pre-op Anti-Infective Orders
- VAD Patient/Family Education Checklist
- VAD Plan of Care/Outcome List
- Anticoagulation Order Forms NOTE: New Unfractionated Heparin (UFH) Therapy orders for IFH ONLY available on paper only
- Argatroban Orders Cat#85894
- Argatroban Administration Flowsheet #86709
- Adult Bivalirudin (Angiomax) Administration Flowsheet
- Adult Bivalirudin (Angiomax) Order Form and Guidelines
- Pradaxa Order Set #87610 with Pradaxa Review
- Warfarin #86754 (Coumadin®)
- Warfarin (Coumadin®) Reversal
- Therapeutic LMWH
Heart Failure Forms
- IFH Heart Failure Order Set, Cat# 81764
- IFH Heart Failure Patient Education Checklist, Cat # 86704
- IFH Heart Failure Pathway, Cat# 86543
- IFH Heart Failure Plan of Care/Outcomes List, Cat#86713
- AMI/HF Discharge Instructions
Invasive Cardiology Order Forms
- Adult Electrophysiology Pre Procedure Orders
- Adult Pre Cardiac Catheterization / Intervention Orders
Pediatric Order Forms
- Acute Pediatric Asthma Inpatient Orders #82684
- Blood Transfusion Orders - Child, Cat #85048
- Blood Transfusion Orders - Infant, Cat #85047
- Cystic Fibrosis Routine #84323
- Spinal Fusion With Instrumentation #84369
Pediatric Critical Care Order Forms
- ICU Orders - Inova Fairfax Hospital For Children Pediatric ICU #85529
- ICU Orders - Pediatric Severe Traumatic Brain Injury Orders #83507
Transplant Order Forms
- Pre-Op Heart Transplant #83977
- Pre-Op Lung Transplant #73106