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# At the VA, How Do I Refer for [cause]?

==== Pulmonary Transplant Evaluation ====
  * Determine if YOU think the veteran requires potential consideration
  * staff with Drs. Keller or Todd
    * in the event that neither are available, or if time constraints exist, the veteran will need to be rescheduled in a time fitting manner for this evaluation and discussion
  * for approach candidates, the patient will need to complete the TRACER evaluation
    * Mindy Conklin, APRT, has taken the role of facilitating TRACER evaluation and will need to be contacted when the veterans care dictates

# At the VA, How Do I Order [item]?


====Infusion therapies====

  * NF consult for approval
  * Clinic orders 
    * <code>Clinic Medication Quick Order > Pulmonary Service Clinic Orders Menu</code>
  * Infusion clinic consult
    * <code>Consult > Additional Services > Infusion Clinic</code>
 

====Radiology====

=== Sniff Test ===

  - Radiograph
  - abdominal radiograph
  - in comments, write <code>sniff test</code>

## Lab Tests

===Myositis Panel===

  - Misc order
  - in comments, write <code>sent out myositis panel, code 10257</code>

===Cystic Fibrosis Genetic Test===

  - Misc order
  - in Comments, write <code>send out CFTR gene, code 10458</code>

===Body Fluid Samples===
__Cytology__
  * collect sample into sample cup
  * paper lab order form

__Micro, chemistries__
  * collect samples into purple- and red-top tubes 
  * place orders
  * attach patient label to samples
  * walk to lab on 4F near MICU

## Diagnostic Tests

===Pulmonary Function Tests===

  - ''Orders''
  - ''Consult Menu''
  - ''Pulmonary, Respiratory & HOME O2''
  - ''Pulmonary Function Test Outpt - BT''

===EKG, outpatient===

  - ''Admission order''
  - ''pre op''
  - ''ekg now''
  - Personally walk the patient to EKG area
## Medications
===Ordering tPA and dornase===

  - send Teams message to [[mailto:faryal.qureshi@va.gov|Faryal Qureshi]]
  - Orders, High-alert medication

===Non-Formulary Medication===

  - ''Orders''
  - ''Meds Outpatient Quick Orders''
  - ''#12 Controlled Substances (non formulary)''
  - ''(CLICK HERE FOR CONSULT)''
  - ''Attention: Qureshi,Faryal''

===Asthma Biologics===

At Baltimore VA, Fasenra (benralizumab) is the only on-formulary biologic for severe asthma.

  * Order EpiPens x2
  * Place order for Infusion clinic
  * Place [[#Non-Formulary Medication|Non-Formulary Order]] for Fasenra

## DME
===Inhaler Adjuncts===

Includes: incentive spirometer, PEP device (Acapella), pulse oximeter

For more significant support equipment (oxygen, nebulizers, suction equipment, ventilators, etc.) see [[#Home O2 Consult|Home O2 Consult]]. 

For ordering flutter valves, spacers, peak flow meters, incentive spirometry, etc.
  - ''Orders''
  - ''Consult''
  - ''Additional Services → Prosthetics''
  - ''Prosthetics Request Non-Implant- Baltimore''

===Home O2 Consult===

Below is how to order a 6MWT (to qualify for home oxygen), qualify for nebulizers, obtain suction equipment, obtain ventilators.

  - Orders Tab
  - Consult
  - Pulmonary, Respiratory & Home O2
  - Home Oxygen Request
  - VAMHCS

To expedite home O2, contact [[mailto:richard.farr@va.gov | Richard Farr]] or Kimberley.

## Referrals

===Refer for Lung Transplant===
  * Write a VACO note
    - <code>Shared Template > Medical Care > Transplant > VACO</code>

===Refer to Subspecialty Clinics===

For lung cancer screening, lung mass clinic, pulmonary hypertension, pulmonary rehab, 6MWT, home oxygen assessment, qualify for nebulizers, suction equipment, ventilators.

  - Orders
  - Consult 
  - Pulmonary, Respiratory & Home O2 

===Sleep Disordered Breathing===

  * Refer to Sleep Clinic
    - ''Orders''
    - ''Consult''
    - ''Neurology''
    - ''Sleep''
    - ''Neurology Sleep Disorders Clinic Outpt''

  * NIPPV Equipment (CPAP, BIPAP)
    - ''Orders''
    - ''Consult''
    - ''Neurology''
    - ''Sleep''
    - ''Sleep therapy outpt''
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