Requisition and Patient Information Entry

Enter data directly or use the Tom Select search fields. The PCR-only report preview updates automatically.

1Patient Information

Patient name

Patient ID / MRN

Date of birth

Sex

2Requisition and Specimen

Ordering provider

Specimen type

Accession number

Test facility

Test ordered

Collected date

Received date

Reported date

Collected time

Received time

Reported time

3ICD-10-CM Indications

0 selected

Select only diagnoses and symptoms documented in the medical record. Green items are primary active respiratory indications. Yellow items are supporting risk, exposure, or associated conditions and may be payer-dependent.

Green — primary indicationYellow — supporting / payer-dependent

INADEQUATE CODING: No primary respiratory indication is selected. Verify the documented reason for testing and select an appropriate green diagnosis if supported by the medical record. Yellow supporting codes alone may be insufficient. Coverage is payer- and policy-dependent.

4PCR Pathogens Detected

0 entries

HIGH automatically reports Clinical Significance = Yes; LOW reports No. Add as many pathogens as needed; the report creates portrait continuation pages after the first three.

5Empiric Therapy and Clinical Information

Empiric antimicrobial / antiviral

Strength

Dosing instructions

Antimicrobial allergies

Pregnancy status

Kidney diseaseCreatinine ≥ 1.4 Liver diseaseElevated LFTs

Entry note: Strength and dosing-instruction choices are data-entry presets. Confirm all entries against the provider order and current clinical requirements.

6Alternative Recommendations

Recommendations may be entered or ranked automatically from the detected-pathogen mappings.

Recommendation 1

Recommendation 2

Recommendation 3

Automatically load recommendations

Recommendations use every clinically significant detected pathogen. The empiric medication, recognized allergy conflicts, and duplicates are excluded.

7Case Data Tools

Sample system: This generator remains SAMPLE - NOT FOR CLINICAL USE pending formal laboratory validation and approval. Panel membership and recommendation order remain governed by the packaged TruPath data libraries.

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