Requisition and Results Entry

The requisition follows the clinical ordering sequence. Searchable controls support wound coding, specimen, antimicrobial, dosing, allergies, pathogens, and MAST entry.

1Patient Information

Patient name

Patient ID / MRN

Date of birth

Sex

2Ordering Provider Information

Ordering provider

NPI

Practice / facility

Telephone

Fax

Address

3Test Ordered

TruWound PCR Only TruWound PCR with Reflex to MAST TruWound PCR with MAST

MAST workflow status

4ICD-10-CM Clinical Diagnosis

Coding guidance: Two or more diagnosis codes will commonly be needed to accurately represent the suspected wound infection. Select codes that, together, describe the infection and the wound's location, laterality, type or cause, depth or stage, and relevant underlying condition.

Primary infection indications

L08.9Local infection of skin and subcutaneous tissue, unspecified L03.90Cellulitis, unspecified L03.115Cellulitis of right lower limb L02.415Cutaneous abscess of right lower limb T81.41XASuperficial incisional surgical-site infection, active treatment

Secondary wound and underlying-condition codes

E11.621Type 2 diabetes mellitus with foot ulcer L97.512Other part of right foot ulcer with fat layer exposed

Other ICD-10-CM codes

Insufficient diagnostic coding: select at least two supported ICD-10-CM codes, including an active infection indication.

5Specimen and Laboratory Tracking

Specimen type

Accession number

Test facility

Collected

Received

Reported

6Empiric Antimicrobial Coverage

Empiric antimicrobial

Strength

Dosing instructions

7Allergies and Clinical Considerations

Antimicrobial allergies

Pregnancy

NoYesUnknown

Renal diseaseCreatinine ≥ 1.4 Liver diseaseElevated LFTs

8Pathogens Identified

PCR load is High, Moderate, or Low for every target. A separate numerical MAST load is entered only for bacteria when finalized MAST results are available.

9Alternative Antimicrobials

Final MAST results supersede PCR-only pathogen-to-antimicrobial mapping when ranking these options.

Recommendation 1

Recommendation 2

Recommendation 3

Automatically rank

10Individual Pathogen MAST Results

Each qualifying bacterial pathogen is shown only with its assigned Evolve wound antimicrobial plate from the current embedded database. Select S or R for each reported result.

11Case Data Tools

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

Live Report Preview