Requisition and Patient Information Entry

Searchable Tom Select controls are provided for pathogens, qualitative loads, antimicrobials, strengths, dosing instructions, and allergies.

1Patient Information

Patient name

Patient ID / MRN

Date of birth

Sex

2Physician Information

Ordering provider

Provider NPI

Practice / facility

Office phone

Office fax

3Study Requested

TruWomen’s Health Plus Panel

5Specimen and Accession

Specimen type

Test facility

Accession number

Collected date

Received date

Reported date

6Pathogens Detected

0 entries

7Resistance Genes Detected

8Empiric Therapy and Clinical Information

Empiric antimicrobial

Strength

Dosing instructions

Antimicrobial allergies

Pregnancy status

Kidney diseaseCreatinine ≥ 1.4Liver diseaseElevated LFTs

9Alternative Recommendations

Recommendation 1

Recommendation 2

Recommendation 3

Automatically load mapped alternatives

Alternatives are ranked from the master pathogen–antimicrobial mapping, then filtered for detected resistance genes, allergies, pregnancy, and renal/hepatic precautions.

10Case Data Tools

Sample system: SAMPLE - NOT FOR CLINICAL USE pending formal laboratory validation and approval.

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