PROCRITline.com - Oncology Toolkit - Evaluation and Management Progress Note

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Please see full Prescribing Information, including Boxed WARNINGS, for PROCRIT^® (Epoetin alfa)

Please see full Prescribing Information, including Boxed WARNINGS, for LEUSTATIN^® (cladribine)

Reimbursement Overview

Oncology Diagnosis Codes

Nephrology Diagnosis Codes

Surgery Diagnosis Codes

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Oncology Toolkit

Evaluation & Management Progress Note

The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Centocor Ortho Biotech Inc. concerning levels of reimbursement, payment, or charge. We strongly suggest that you consult your payor organization with regard to local reimbursement policies.

EM PROGRESS NOTE/ Dictation Format (1995 EM Guidelines)
Patient Name:		Date of Service:
Vital Signs: P = T = R = BP = Weight =
Appearance:
Chief Complaint(s) today:
CC status: Stable Improving Unimproved Deteriorating
Secondary Problems:

History of Present Illness:


Past History:	Family History:	Social History:

Review of Systems (History):	Physical Exam (Physical):
Constitutional:	Constitutional:
Eyes:	Eyes:
ENT:	ENT:
CV:	CV:
Respiratory:	Respiratory:
GI:	GI:
GU:	GU:
Musculoskeletal:	Musculoskeletal:
Integumentary:	Integumentary:
Neuro:	Neuro:
Psych:	Psych:
Endocrine:	Endocrine:
Hematologic/ Lymphatic:	Hematologic/ Lymphatic:
Allergy/ Immunological:	Allergy/ Immunological:
All Others Non-Contributory:	All Others Non-Contributory:

MEDICAL DECISION-MAKING	Body Areas:
Data Reviewed Today:	Head:
	Face:
	Neck:
Tests To Order:	Chest:
	Abdomen:
	Genitalia:
	Back:
Diagnoses, Drugs and/or Procedures Considered:	Extremities:



	Counseling:
Drugs and/or Procedures Ordered:	Reason:
	Time of Counseling:
	Total Visit Time:

	Nursing Supervision:

The publications that have been created for this Centocor Ortho Biotech Inc. web site may contain examples of tools that are used by some consultants and providers. They have not been approved or sanctioned by any payor, government agency or Centocor Ortho Biotech Products, LP.

Important Safety Information for PROCRIT^® (Epoetin alfa)

WARNINGS: INCREASED MORTALITY, SERIOUS CARDIOVASCULAR EVENTS, THROMBOEMBOLIC EVENTS, STROKE and INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE

Chronic Renal Failure:

In clinical studies, patients experienced greater risks for death, serious cardiovascular events, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target hemoglobin levels of 13 g/dL and above.

Individualize dosing to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.

Cancer:

ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers (see WARNINGS: Table 1).

To decrease these risks, as well as the risk of serious cardio- and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusion.

Because of these risks, prescribers and hospitals must enroll in and comply with the ESA APPRISE Oncology Program to prescribe and/or dispense PROCRIT^® to patients with cancer. To enroll in the ESA APPRISE Oncology Program, visit www.esa-apprise.com or call 1-866-284-8089 for further assistance.

Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy.

ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure.

Discontinue following the completion of a chemotherapy course.

Perisurgery: PROCRIT^® (Epoetin alfa) increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation. Consider deep venous thrombosis prophylaxis.

(See WARNINGS: Increased Mortality, Serious Cardiovascular Events, Thromboembolic Events, and Stroke, WARNINGS: Increased Mortality and/or Increased Risk of Tumor Progression or Recurrence, INDICATIONS AND USAGE, and DOSAGE AND ADMINISTRATION.)

Please see full Prescribing Information, including Boxed WARNINGS for PROCRIT^® (Epoetin alfa)

Medication Guide for PROCRIT^®
Please read the Medication Guide for PROCRIT^® and discuss with your doctor.

Patient Instructions for Use
Instructions if you or your caregiver has been trained to give PROCRIT^® injections at home.

Boxed WARNINGS: LEUSTATIN^® (cladribine) Injection

LEUSTATIN (cladribine) Injection should be administered under the supervision of a qualified physician experienced in the use of antineoplastic therapy. Suppression of bone marrow function should be anticipated. This is usually reversible and appears to be dose dependent. Serious neurological toxicity (including irreversible paraparesis and quadraparesis) has been reported in patients who received LEUSTATIN Injection by continuous infusion at high doses (4 to 9 times the recommended dose for Hairy Cell Leukemia). Neurologic toxicity appears to demonstrate a dose relationship; however, severe neurological toxicity has been reported rarely following treatment with standard cladribine dosing regimens.

Acute nephrotoxicity has been observed with high doses of LEUSTATIN (4 to 9 times the recommended dose for Hairy Cell Leukemia), especially when given concomitantly with other nephrotoxic agents/therapies.

Please see full Prescribing Information, including Boxed WARNINGS for LEUSTATIN^® (cladribine)