SAGE PSI CAP Guideline Encoding

This encoding reflect IHC's pneumonia evaluation care process model.

meta_data:
Guideline_Metadata ()
- identifier: SAGE PSI-based Community Acquired Pneumonia Orderset Guideline
- title: SAGE PSI-based Community Acquired Pneumonia Orderset Guideline
- version: 0.1
- category: Care of clinical condition
- developer: SAGE Project
enrollment_criteria:
( NOT
)
absence of Problem Human immunodeficiency virus infection (disorder) [SNOMED CT]
( NOT
)
presence of Problem Community acquired pneumonia (disorder) [SNOMED CT]
recommendation set:

Recommendation Set (Activity Graph): Outpatient CAP therapy AG

1. Context: Outpatient therapy required

precondition: ( OR
- most_recent CAP risk classification [SAGE] Observation Encounter start to NOW equals Class I CAP risk [SAGE]
- most_recent CAP risk classification [SAGE] Observation Encounter start to NOW equals Class II CAP risk [SAGE]
- most_recent CAP risk classification [SAGE] Observation Encounter start to NOW equals Class III CAP risk [SAGE]
)
new_session: true

3. Decision: Aspiration suspected, nursing home, or viral with bacterial super-infection?

decision_model:

5. Action: CAP therapy for comorbid w/ no recent Abx

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

7. Decision: No comorbidities, determine therapy based on recent antibiotic use

decision_model:

9. Action: CAP therapy for healthy w/ No Abx in last 3 months

action_spec:
Recommend_OrderSet ( Recommend stnd CAP multi-drug therapy order set )
- label: Recommend stnd CAP multi-drug therapy order set
- description: Standard CAP multi-drug therapy order set with XOR
- order_set: Mod outpatient incomplete

11. Decision: Current comorbidities, determine therapy based on recent antibiotic use

decision_model:

13. Decision: Does patient have existing comorbidities?

decision_model:

15. Action: IDSA-based outpatient therapy for CAP with suspected aspiration

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

17. Action: CAP therapy for comorbid w/ recent non-fluro Abx

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

19. Action: IDSA-based therapy delivered in NH for CAP in nursing home patient

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

21. Decision: Does patient need short stay before outpatient therapy?

decision_model:

23. Action: Vomiting or unreliable, needs short stay

description: Patients that are unable to keep down fluids or can not reliably take medications should recieve short non-admit stay
action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

25. Action: IDSA-based outpatient therapy for CAP with influenza complicated by bacterial super infection

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

27. Action: CAP therapy for healthy w/ recent fluro Abx

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

29. Action: CAP therapy for healthy w/ recent non-fluro Abx

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

31. Action: CAP therapy for comorbid w/ recent fluro Abx

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

33. Context: Outpatient Therapy for demo

new_session: true

)

Recommendation Set (Activity Graph): Inpatient AG

Inpatient order set determined strictly based on PSI class. No orders for Nursing Home therapy created.

1. Context: Inpatient Orderset needed

triggering_events:
Administrative_Event ( Store PSI Score )
- SAGE_event_type: Data confirmation event
- HL7_type: User_Request_Based
- label: Store PSI Score
- object: Flowcharting and recording data entry tools
precondition: ( OR
- presence of ObservationObservation where 'True (qualifier value) [SNOMED CT]' code = 'Class IV CAP risk [SAGE]' Encounter start to NOW
- presence of ObservationObservation where 'True (qualifier value) [SNOMED CT]' code = 'Class V CAP risk [SAGE]' Encounter start to NOW
- presence of ObservationObservation where 'CAP risk classification [SAGE]' code = 'Class IV CAP risk [SAGE]' Encounter start to NOW
)
description: WHen the PSI score is determined and stored, the guideline will determine which orderset is appropriate. This one is for patients class IV or V (should be an inpatient.)
new_session: true

3. Action: Record JCAHO-specific measures

description: Collect information needed for JCAHO but not expected to already be a part of normal data set.
action_spec:
Inquire ( JCAHO inquire )
- label: JCAHO inquire
- data_entries:
  - Pneumococcal vaccination up-to-date CEM
  - Influenza vaccination is up-to-date CEM
  - At risk for Pseudomonas infection CEM
  - Transfered from outside ED CEM
  - Previous antibiotics for current CAP prior to arrival CEM
  - Blood cultures obtained prior to arrival CEM
  - Comfort measures only CEM
- communication_mode: Workstation session messaging
- addressee: Session_Owner

5. Action: Recommend non-ICU Inpatient order sets

description: the set of order sets that are used for uncomplicated inpatient admission
action_spec:
Recommend_OrderSet ( Recommend main CAP orderset )
- label: Recommend main CAP orderset
- description: Tell the CIS to provide the CAP orderset, modified based on preferred conditions in the "enclosed" components
- If true
- order_set: Main CAP orderset

7. Decision: Determine if PSI class IV patient

decision_model:

9. Action: ICU admission needed. Recommend CAP ICU order set

action_spec:
Recommend_OrderSet ( Placeholder for Recommend orderset )
- label: Placeholder for Recommend orderset
- description: This is an empty orderset as a placeholder
- order_set: Placeholder orderset

)

Recommendation Set (Activity Graph): CAP Disposition Using PSI Score

Determine CAP therpy disposition based on PSI score.

1. Action: Get PSI Inquires

action_spec:
Inquire ( PSI inquire CEMs )
- label: PSI inquire CEMs
- data_entries:
  - Nursing home resident Obs CEM
  - Neoplastic disease Obs CEM
  - Chronic Liver Disese Obs CEM
  - CHF disease Obs CEM
  - Cerebrovascular disease Obs CEM
  - Chronic Renal Disease Obs CEM
  - Altered mental status during encounter as CAP risk factor
  - Respiratory rate >= 30.0 breaths/min Obs CEM
  - Systolic BP < 90.0 mm Hg Obs CEM
  - Pulse >= 125.0 beats/min Obs CEM
  - Temperature <35.0C or >=40.0C Obs CEM
  - Arterial pH < 7.35 Obs CEM
  - BUN >= 30.0mg/dL Obs CEM
  - Sodium < 130.0 Obs CEM
  - Glucose >= 250.0 mg/dL Obs CEM
  - Hematocrit < 30.0% Obs CEM
  - PaO2 < 60.0 mmHg or O2 Sat < 90.0% Obs CEM
  - Bilateral Pleural Effusion Obs CEM
- communication_mode: Workstation session messaging
- addressee: Session_Owner

3. Context: CAP guideline desposition needed

triggering_events:
precondition: presence of Problem Community acquired pneumonia (disorder) [SNOMED CT]
description: The physician has made the diagnosis of CAP and done something that should elicit
new_session: true
clinical_context:
Clinical_Context ()
- clinical_setting:
  - Outpatient clinical setting
  - Emergency department

5. Decision: What disposition is appropriate for this patient?

description: Evaluate PSI score and classify patient
decision_model:

7. Action: Do Outpatient therapy subguideline

subguideline:
Subguideline ( Outpatient therapy SG )
- subrecommendations: Outpatient CAP therapy AG
- execution_type: SYNCHR

9. Action: Do Outpatient therapy subguidline

subguideline:
Subguideline ( Outpatient therapy SG )
- subrecommendations: Outpatient CAP therapy AG
- execution_type: SYNCHR

11. Action: Do Outpatient therapy subguidline

subguideline:
Subguideline ( Outpatient therapy SG )
- subrecommendations: Outpatient CAP therapy AG
- execution_type: SYNCHR

13. Action: Class IV Do therapy subguidline

subguideline:
Subguideline ( Inpatient CAP Therapy SG )
- description: Subguideline to provide inpatient odersets
- subrecommendations: Inpatient AG
- execution_type: SYNCHR

15. Action: Class V Do therapy subguidline

action_spec:
Conclude ()
- assertion: Observation of 'CAP risk classification [SAGE] 'Class V CAP risk [SAGE]'
subguideline:
Subguideline ( Inpatient CAP Therapy SG )
- description: Subguideline to provide inpatient odersets
- subrecommendations: Inpatient AG
- execution_type: SYNCHR

17. Context: Storage of PSI score

triggering_events:
Administrative_Event ( Store PSI Score )
- SAGE_event_type: Data confirmation event
- HL7_type: User_Request_Based
- label: Store PSI Score
- object: Flowcharting and recording data entry tools
new_session: true

19. Action: Conclude class IV

action_spec:
Conclude ()
- assertion: Observation of 'CAP risk classification [SAGE] 'Class IV CAP risk [SAGE]'

21. Context: Admit PSI=125

triggering_events:
Clinical_Event ( class IV conclusion )
- label: class IV conclusion
new_session: true

23. Action: Conclude Class V

action_spec:
Conclude ()
- assertion: Observation of 'CAP risk classification [SAGE] 'Class V CAP risk [SAGE]'

25. Action: Conclude Class I

action_spec:

27. Action: Conclude Class II

action_spec:
Conclude ()
- assertion: Observation of 'CAP risk classification [SAGE] 'Class II CAP risk [SAGE]'

29. Action: Conclude Class III

action_spec:
Conclude ()
- assertion: Observation of 'CAP risk classification [SAGE] 'Class III CAP risk [SAGE]'

31. Action: Display PSI Score

action_spec:
Display ( Display PSI score disposition )
- display_data: PSI score is ?ObsPSI. where
  - ?ObsPSI is Observed PSI Value
- addressee: Session_Owner

33. Action: PSI Conclusion

action_spec:
Conclude ()
- assertion: Observation of 'PSI score [SAGE] 'PSI Score var'

)

Recommendation Set (Activity Graph): CAP critical actions timing monitor

Monitor actions to make sure critical tests and terheapy are performed in timely manner

1. Context: Patient to be admitted for CAP

triggering_events:
precondition: presence of Problem Community acquired pneumonia (disorder) [SNOMED CT]
description: Patient is admitted. Monitor to make sure critical actions for CAP are completed (Blood culture and antibiotics).
new_session: true
clinical_context:
Clinical_Context ()
- clinical_setting: Hospital medicine floor
- clinical_role: Patient

3. Decision: Determine if Bld Cultures have been drawn

decision_model:

5. Decision: Cultures not drawn, Determine order status

description: Cultures are not drawn, alternatives differentiate between need for an order and need for draw
decision_model:

7. Decision: Determine if Antibiotics have been given

decision_model:

9. Decision: Abx not given, Determine order status

decision_model:

11. Action: Bld Cltr not ordered, Alert team

action_spec:
Notify ( Page physician; alert that no blood culture ordered )
- label: Page physician; alert that no blood culture ordered
- communication_mode: Paging system
- addressee: Physician
- parameterized_string: (?PatientName)|' has not had a blood culture ordered.' where
  - ?PatientName is Patient Name var

13. Action: Abx not ordered, alert team

action_spec:
Notify ( MD Page: Notify that Abx not ordered )
- label: MD Page: Notify that Abx not ordered
- communication_mode: Paging system
- addressee: Inpatient attending physician
- parameterized_string: (?PatientName)|' has not had antibiotics ordered' where
  - ?PatientName is Patient Name var

15. Action: Cultures ordered, not drawn, alert team

action_spec:
Notify ( Notify lab that blood cultures ordered, not drawn )
- label: Notify lab that blood cultures ordered, not drawn
- communication_mode: Workstation session messaging
- parameterized_string: (?PatientName)|' has blood cultures ordered and need to be drawn stat.' where
  - ?PatientName is Patient Name var

17. Action: Abx ordered but not given, Alert team

action_spec:
Notify ( Nurse alert: Abx ordered but not given )
- label: Nurse alert: Abx ordered but not given
- communication_mode: Workstation session messaging
- addressee: Inpatient primary care nurse
- parameterized_string: (?PatientName)|' has antibiotic orders but they have not been given. Abx need to given in the first 6 hours for best outcome. ' where
  - ?PatientName is Patient Name var

19. Action: Generate CAP monitoring Event

description: This generates an event that indicates critical activities in CAP therapy have not been completed. This event is a trigger for the Critical actions timing monitor AG.
action_spec:
Generate_Event ()
- time_to_activate: within 0.25 Minute (qualifier value) [SNOMED CT] after NOW

21. Context: Patient's Blood culture was drawn

new_session: true

23. Context: Antibiotics given to patient

new_session: true

25. Decision: Determine if ABG or O2Sat has been performed

decision_model:

27. Decision: ABG or O2Sat not done, determine status

decision_model:

29. Context: ABG or O2 Sat done

new_session: true

31. Action: ABG or O2 Sat not ordered, alert team

action_spec:
Notify ( MD Page: Patient has not had an ABG or O2 sat ordered )
- label: MD Page: Patient has not had an ABG or O2 sat ordered
- communication_mode: Paging system
- addressee: Inpatient attending physician
- parameterized_string: (?PatientName)|' has not had an ABG or O2 sat ordered' where
  - ?PatientName is Patient Name var

33. Action: ABG or O2 sat ordered but not done, alert team

action_spec:
Notify ( Nurse alert: ABG/O2 sat ordered but not done )
- label: Nurse alert: ABG/O2 sat ordered but not done
- communication_mode: Workstation session messaging
- addressee: Inpatient primary care nurse
- parameterized_string: 'An order exists but '|(?PatientName)|' has not had an ABG or O2 sat result yet. Please review.' where
  - ?PatientName is Patient Name var

35. Context: timing test

triggering_events:
Clinical_Event ( timingtest )
- label: timingtest
new_session: true

)

Recommendation Set (Activity Graph): Determine if patient could be discharged

This AG looks at parameters to suggest if patient could be discharged. Generates an event to re-check every 12hrs. Once alert occurs noting potential for d/c, no more alerts will occur.

1. Context: CAP inpatient care

triggering_events:
precondition: presence of Observation Bronchopneumonia, organism unspecified [485] [ICD-9-CM] Encounter start to NOW
description: Patient admitted with CAP diagnosis or potential CAP discharge event seen starts this AG
new_session: true

3. Decision: Evaluate potential discharge parameters

decision_model:

5. Action: Patient not ready for discharge

description: Patient does not satisfy D/C criteria, generate an event to cause a re-check in 12 hours
action_spec:
Generate_Event ()
- time_to_activate: within 5.0 Minute (qualifier value) [SNOMED CT] after NOW

7. Action: Patient may be ready for d/c, notify team

description: Patient satisfys initial criteria for discharge
action_spec:

)

Evidence Statements

Condition	is	to	source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, JNC VI ) label: Micromedex, NDF-RT, JNC VI role: source
presence of Problem Angiotensin-converting-enzyme inhibitor allergy (disorder) [SNOMED CT]	Absolute_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hyperkalemia (disorder) [SNOMED CT]	Relative_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Angioedema (disorder) [SNOMED CT]	Absolute_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Aortic valve stenosis (disorder) [SNOMED CT]	Relative_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal artery stenosis (disorder) [SNOMED CT]	Relative_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Aldosterone antagonists allergy (disorder) [SNOMED CT]	Absolute_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Type 2 diabetes mellitus with persistent microalbuminuria (disorder) [SNOMED CT]	Absolute_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hyperkalemia (disorder) [SNOMED CT]	Absolute_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Acidosis (disorder) [SNOMED CT]	Relative_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Alpha-adrenoceptor blocking drug allergy (disorder) [SNOMED CT]	Absolute_contraindication	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Disorder of liver (disorder) [SNOMED CT]	Relative_contraindication	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute cerebrovascular insufficiency (disorder) [SNOMED CT]	Relative_contraindication	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Angioedema (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Aortic valve stenosis (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Mitral valve stenosis (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal artery stenosis (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem First degree atrioventricular block (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Chronic obstructive lung disease (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Cardiogenic shock (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Non-cardioselective beta-blocker allergy (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Incomplete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Complete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Severe sinus bradycardia (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acebutolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Acebutolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Incomplete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Complete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Severe sinus bradycardia (disorder) [SNOMED CT]	Absolute_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Cardiogenic shock (disorder) [SNOMED CT]	Absolute_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Asthma (disorder) [SNOMED CT]	Absolute_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Chronic obstructive lung disease (disorder) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Cardiogenic shock (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Incomplete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Complete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Severe sinus bradycardia (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Sick sinus syndrome (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Sick sinus syndrome (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Severe sinus bradycardia (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cardiogenic shock (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Asthma (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Incomplete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Complete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Diltiazem allergy (disorder) [SNOMED CT]	Absolute_contraindication	Diltiazem (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cardiogenic shock (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Sick sinus syndrome (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Wolff-Parkinson-White pattern (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem First degree atrioventricular block (disorder) [SNOMED CT]	Relative_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Relative_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Relative_contraindication	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Clonidine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cerebrovascular disease (disorder) [SNOMED CT]	Relative_contraindication	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hemolytic anemia (disorder) [SNOMED CT]	Relative_contraindication	Methyldopa (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Disorder of liver (disorder) [SNOMED CT]	Absolute_contraindication	Guanfacine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Guanfacine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Methyldopa allergy (disorder) [SNOMED CT]	Absolute_contraindication	Methyldopa (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Ulcerative colitis (disorder) [SNOMED CT]	Absolute_contraindication	Reserpine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Thiazide diuretic allergy (disorder) [SNOMED CT]	Absolute_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to sulfonamides (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Anuria (finding) [SNOMED CT]	Absolute_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Chlorthalidone allergy (disorder) [SNOMED CT]	Absolute_contraindication	Chlorthalidone (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Gout (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hyponatremia (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypomagnesemia (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypercalcemia (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hydrochlorothiazide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Hydrochlorothiazide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hyperuricemia (disorder) [SNOMED CT]	Relative_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Polythiazide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Polythiazide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Indapamide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Indapamide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic coma (disorder) [SNOMED CT]	Absolute_contraindication	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Loop diuretic allergy (disorder) [SNOMED CT]	Absolute_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Bumetanide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Bumetanide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Anuria (finding) [SNOMED CT]	Absolute_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic coma (disorder) [SNOMED CT]	Absolute_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF ) label: NDF
presence of Problem Hyperuricemia (disorder) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypomagnesemia (disorder) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Gout (disorder) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Triamterene allergy (disorder) [SNOMED CT]	Absolute_contraindication	Triamterene (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hyperkalemia (disorder) [SNOMED CT]	Absolute_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acidosis (disorder) [SNOMED CT]	Relative_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Absolute_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Anuria (finding) [SNOMED CT]	Absolute_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Disorder of liver (disorder) [SNOMED CT]	Relative_contraindication	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Dissection of aorta (disorder) [SNOMED CT]	Absolute_contraindication	Hydralazine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Minoxidil allergy (disorder) [SNOMED CT]	Absolute_contraindication	Minoxidil (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Mitral valve disorder (disorder) [SNOMED CT]	Relative_contraindication	Hydralazine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Coronary arteriosclerosis (disorder) [SNOMED CT]	Relative_contraindication	Direct Vasodilator Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Pheochromocytoma (disorder) [SNOMED CT]	Absolute_contraindication	Minoxidil (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Pericardial effusion (disorder) [SNOMED CT]	Relative_contraindication	Direct Vasodilator Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Metolazone allergy (disorder) [SNOMED CT]	Absolute_contraindication	Metolazone (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hydralazine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Hydralazine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Systemic lupus erythematosus (disorder) [SNOMED CT]	Absolute_contraindication	Hydralazine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Direct Vasodilator Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Relative_contraindication	Direct Vasodilator Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal failure syndrome (disorder) [SNOMED CT]	Relative_contraindication	Direct Vasodilator Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertrichosis (disorder) [SNOMED CT]	Relative_contraindication	Minoxidil (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Orthostatic hypotension (disorder) [SNOMED CT]	Relative_contraindication	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem H/O: angiotensin II receptor antagonist allergy (context-dependent category) [SNOMED CT]	Absolute_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Myasthenia gravis (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Peripheral vascular disease (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Timolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Timolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Propranolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Propranolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Sick sinus syndrome (disorder) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Pulmonary edema [SAGE SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Diabetes mellitus (disorder) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Peripheral vascular disease (disorder) [SNOMED CT]	Relative_contraindication	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Penbutolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Penbutolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Pindolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Pindolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Atenolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Atenolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cardioselective beta-blocker allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Bisoprolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Bisoprolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Metoprolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Metoprolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Nadolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Nadolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Asthma (disorder) [SNOMED CT]	Relative_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Diabetes mellitus (disorder) [SNOMED CT]	Relative_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Peripheral vascular disease (disorder) [SNOMED CT]	Relative_contraindication	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Carvedilol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Carvedilol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Orthostatic hypotension (disorder) [SNOMED CT]	Relative_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Peripheral vascular disease (disorder) [SNOMED CT]	Relative_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Labetalol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Labetalol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Wide QRS ventricular tachycardia (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Incomplete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Complete atrioventricular block (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Verapamil allergy (disorder) [SNOMED CT]	Absolute_contraindication	Verapamil (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Amlodipine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Amlodipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Preinfarction syndrome (disorder) [SNOMED CT]	Absolute_contraindication	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Aortic valve stenosis (disorder) [SNOMED CT]	Relative_contraindication	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Peripheral edema (disorder) [SNOMED CT]	Relative_contraindication	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Felodipine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Felodipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Isradipine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Isradipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Nicardipine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Nicardipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Nifedipine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Nifedipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Peptic ulcer (disorder) [SNOMED CT]	Absolute_contraindication	Reserpine (product) [SNOMED CT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Depressive disorder (disorder) [SNOMED CT]	Absolute_contraindication	Reserpine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Rauwolfia antihypertensive allergy (disorder) [SNOMED CT]	Absolute_contraindication	Reserpine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Amiloride allergy (disorder) [SNOMED CT]	Absolute_contraindication	Amiloride (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hyperglycemia (disorder) [SNOMED CT]	Relative_contraindication	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Frusemide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Furosemide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Torasemide allergy (disorder) [SNOMED CT]	Absolute_contraindication	Torasemide (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypertrophic cardiomyopathy (disorder) [SNOMED CT]	Relative_contraindication	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Indications	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Diabetic renal disease (disorder) [SNOMED CT]	Indications	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Primary hyperaldosteronism (disorder) [SNOMED CT]	Indications	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic ascites (disorder) [SNOMED CT]	Indications	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hirsutism (disorder) [SNOMED CT]	Indications	Aldosterone Receptor Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Hyperplasia of prostate (disorder) [SNOMED CT]	Indications	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Open-angle glaucoma (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Ocular hypertension (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Pheochromocytoma (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Tachyarrhythmia (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Migraine (disorder) [SNOMED CT]	Indications	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Indications	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Tachyarrhythmia (disorder) [SNOMED CT]	Indications	Beta-blockers with Intrinsic Sympathomimetic Activity Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Open-angle glaucoma (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Ocular hypertension (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Pheochromocytoma (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Tachyarrhythmia (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Migraine (disorder) [SNOMED CT]	Indications	Cardioselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Pheochromocytoma (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Tachyarrhythmia (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Migraine (disorder) [SNOMED CT]	Indications	Combined Alpha- and Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Atrial flutter (disorder) [SNOMED CT]	Indications	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Atrial fibrillation (disorder) [SNOMED CT]	Indications	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Angina pectoris (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Atrial flutter (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Raynaud's syndrome (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Raynaud's phenomenon (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Raynaud's disease (disorder) [SNOMED CT]	Indications	Calcium Channel Blocker-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Gilles de la Tourette's syndrome (disorder) [SNOMED CT]	Indications	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hollow visceral neuropathy (disorder) [SNOMED CT]	Indications	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Psychoactive substance-induced organic withdrawal (disorder) [SNOMED CT]	Indications	Clonidine (product) [SNOMED CT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Guanfacine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Methyldopa (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Reserpine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Edema (finding) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypercalciuria (disorder) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Observation Edema (finding) [SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Nephrotic syndrome (disorder) [SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Renal impairment (disorder) [SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Indications	Potassium-sparing Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Cystic fibrosis (disorder) [SNOMED CT]	Indications	Amiloride (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Atrial tachycardia (disorder) [SNOMED CT]	May_have_favorable_effects	Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Supraventricular tachycardia (disorder) [SNOMED CT]	May_have_favorable_effects	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Atrial fibrillation (disorder) [SNOMED CT]	May_have_favorable_effects	Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Atrial fibrillation (disorder) [SNOMED CT]	May_have_favorable_effects	Calcium Channel blocker Non-Dihydropyridine Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Essential tremor (finding) [SNOMED CT]	May_have_favorable_effects	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Hyperthyroidism (disorder) [SNOMED CT]	May_have_favorable_effects	Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Migraine (disorder) [SNOMED CT]	May_have_favorable_effects	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Osteoporosis (disorder) [SNOMED CT]	May_have_favorable_effects	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Prostatism (disorder) [SNOMED CT]	May_have_favorable_effects	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Benign prostatic hyperplasia (disorder) [SNOMED CT]	May_have_favorable_effects	Alpha 1 Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Raynaud's syndrome (disorder) [SNOMED CT]	May_have_favorable_effects	Calcium Channel Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Type 1 diabetes mellitus with persistent microalbuminuria (disorder) [SNOMED CT]	May_have_favorable_effects	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Type 2 diabetes mellitus with persistent microalbuminuria (disorder) [SNOMED CT]	May_have_favorable_effects	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Type 2 diabetes mellitus with persistent microalbuminuria (disorder) [SNOMED CT]	May_have_favorable_effects	Angiotensin II Antagonist Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( JNC 7 ) label: JNC 7 role: source
presence of Problem Postmenopausal flushing (disorder) [SNOMED CT]	Indications	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Postmenopausal flushing (disorder) [SNOMED CT]	Indications	Methyldopa (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Osteoporosis (disorder) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Osteopenia (disorder) [SNOMED CT]	Indications	Thiazide Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Congestive heart failure (disorder) [SNOMED CT]	Indications	Triamterene (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Hypertensive disorder, systemic arterial (disorder) [SNOMED CT]	Indications	Triamterene (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Pulmonary edema [SAGE SNOMED CT]	Indications	Loop Diuretic Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Betaxolol allergy (disorder) [SNOMED CT]	Absolute_contraindication	Betaxolol (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Absolute_contraindication	Clonidine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Guanfacine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Cerebrovascular disease (disorder) [SNOMED CT]	Relative_contraindication	Guanfacine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Disorder of liver (disorder) [SNOMED CT]	Absolute_contraindication	Methyldopa (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Disorder of liver (disorder) [SNOMED CT]	Absolute_contraindication	Reserpine (product) [SNOMED CT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem ACE inhibitor-aggravated angioedema (disorder) [SNOMED CT]	Absolute_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Anuria (finding) [SNOMED CT]	Absolute_contraindication	ACE Inhibitor Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Heart failure (disorder) [SNOMED CT]	Relative_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Asthma (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Calcium-channel blocker allergy (disorder) [SNOMED CT]	Absolute_contraindication	Nisoldipine (product) [SNOMED CT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Sick sinus syndrome (disorder) [SNOMED CT]	Absolute_contraindication	Nonselective Beta-Blocker Oral Preparation for Hypertension [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Tetracyclines group allergy (disorder) [SNOMED CT]	Absolute_contraindication	Doxycycline Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Doxycycline allergy (disorder) [SNOMED CT]	Absolute_contraindication	Doxycycline Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	Doxycycline Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Doxycycline Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Clindamycin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Lincomycin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Antibiotic enterocolitis (disorder) [SNOMED CT]	Absolute_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Atopy (disorder) [SNOMED CT]	Relative_contraindication	Clindamycin Oral Preparation [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Clindamycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Crohn's disease (disorder) [SNOMED CT]	Absolute_contraindication	Clindamycin Parenteral Preparation [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Ulcerative colitis (disorder) [SNOMED CT]	Absolute_contraindication	Clindamycin Parenteral Preparation [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Allergy to erythromycin (disorder) [SNOMED CT]	Absolute_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Myasthenia gravis (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hypomagnesemia (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Bradycardia (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Acute coronary syndrome (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cardiomyopathy (disorder) [SNOMED CT]	Relative_contraindication	Erythromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Azithromycin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Azithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to macrolide antibiotic (disorder) [SNOMED CT]	Absolute_contraindication	Azithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Azithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem End stage renal disease (disorder) [SNOMED CT]	Relative_contraindication	Azithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Azithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Clarithromycin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to erythromycin (disorder) [SNOMED CT]	Absolute_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Allergy to macrolide antibiotic (disorder) [SNOMED CT]	Absolute_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Acute intermittent porphyria (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT ) label: Micromedex, NDF-RT role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hypomagnesemia (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Bradycardia (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Acute coronary syndrome (disorder) [SNOMED CT]	Relative_contraindication	Clarithromycin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem 4-quinolones allergy (disorder) [SNOMED CT]	Absolute_contraindication	Moxifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	Moxifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Moxifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Moxifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Moxifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem 4-quinolones allergy (disorder) [SNOMED CT]	Absolute_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute coronary syndrome (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Cerebral arteriosclerosis (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Diabetes mellitus (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Renal failure syndrome (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem End stage renal failure on dialysis (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Dyslipidemia (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Gatifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem 4-quinolones allergy (disorder) [SNOMED CT]	Absolute_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Absolute_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Renal failure syndrome (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem End stage renal failure on dialysis (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Dyslipidemia (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Diabetes mellitus (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Levofloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem 4-quinolones allergy (disorder) [SNOMED CT]	Absolute_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Prolonged QT interval (finding) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Hypokalemia (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Hypomagnesemia (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Bradycardia (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute myocardial infarction (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Acute coronary syndrome (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Observation Patient currently pregnant (finding) [SNOMED CT]	Relative_contraindication	Gemifloxacin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Absolute_contraindication	Amoxicillin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Relative_contraindication	Amoxicillin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Classical phenylketonuria (disorder) [SNOMED CT]	Relative_contraindication	Amoxicillin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Amoxicillin Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Hepatic failure (disorder) [SNOMED CT]	Relative_contraindication	Amoxicillin-Clavulanate Oral Preparation [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Obstruction of bile duct (disorder) [SNOMED CT]	Relative_contraindication	Amoxicillin-Clavulanate Oral Preparation [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cefpodoxime allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Relative_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Cefpodoxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Relative_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Classical phenylketonuria (disorder) [SNOMED CT]	Relative_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Cefprozil Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cefuroxime allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Relative_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Cefuroxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Ampicillin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Ampicillin-Sulbactam Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Absolute_contraindication	Ampicillin-Sulbactam Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Relative_contraindication	Ampicillin-Sulbactam Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Infectious mononucleosis (disorder) [SNOMED CT]	Relative_contraindication	Ampicillin-Sulbactam Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Ampicillin-Sulbactam Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Carbapenem allergy (disorder) [SNOMED CT]	Absolute_contraindication	Ertapenem Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Lignocaine allergy (disorder) [SNOMED CT]	Absolute_contraindication	Ertapenem Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Ertapenem Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, Epocrates ) label: Micromedex, Epocrates
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Ertapenem Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Cefotaxime allergy (disorder) [SNOMED CT]	Absolute_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Relative_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Cefotaxime Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Cephalosporin allergy (disorder) [SNOMED CT]	Absolute_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Ceftriaxone allergy (disorder) [SNOMED CT]	Absolute_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Neonatal hyperbilirubinemia (disorder) [SNOMED CT]	Absolute_contraindication	Ceftriaxone Parenteral Preparation [SAGE NDF-RT]	Supplemental_Material ( Micromedex, NDF-RT, Epocrates ) label: Micromedex, NDF-RT, Epocrates role: source
presence of Problem Allergy to penicillin (disorder) [SNOMED CT]	Relative_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Pseudomembranous enterocolitis (disorder) [SNOMED CT]	Relative_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Micromedex ) label: Micromedex
presence of Problem Disorder of gallbladder (disorder) [SNOMED CT]	Relative_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( NDF-RT ) label: NDF-RT
presence of Problem Epilepsy (disorder) [SNOMED CT]	Relative_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source
presence of Problem Renal impairment (disorder) [SNOMED CT]	Relative_contraindication	Ceftriaxone Preparation for CAP [SAGE NDF-RT]	Supplemental_Material ( Epocrates ) label: Epocrates role: source

Order Set: Mod outpatient incomplete

title: Mod outpatient incomplete

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Moderate CAP outpatient multi-drug therapy

If false

group_body:

Order_Item ()

orderItem: Medication Order where code is subsumed by Erythromycin [NDF-RT]

identifier: Mod outpatient incomplete

Order Set: Vital Signs

title: Vital Signs

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Vital Signs

If true

group_body:

Order_Item ()

fullTextOrder: VS per Protocal
If true
orderItem: VMR Order where code is subsumed by Assess Vital Signs [SNOMED CT]

Order_Item ()

fullTextOrder: Obtain weight daily
If true
orderItem: VMR Order where code is subsumed by Body weight (observable entity) [SNOMED CT]

Order_Item ()

fullTextOrder: I&O per shift
If true
orderItem: VMR Order where code is subsumed by Record patient intake & output [SAGE]

Order_Item ()

fullTextOrder: Calculate PSI score
If true
orderItem: VMR Order where code is subsumed by PSI score [SAGE]

Order_Item ()

fullTextOrder: Pulse Oximetry
If true
orderItem: VMR Order where code is subsumed by Pulse oximetry (procedure) [SNOMED CT]

identifier: BOC_9

Order Set: Treatments

title: Treatments

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Treatments

If true

group_body:

Order_Item ()

fullTextOrder: Turn, cough and deep breathe per protocol
If true
orderItem: VMR Order where code is subsumed by Turn, cough and deep breathe per protocol [SAGE]

identifier: BOC_23

Order Set: Admission, Discharge, Transfer

title: Admission, Discharge, Transfer

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Admission, Discharge, Transfer

If true

group_body:

Order_Item ()

fullTextOrder: Admit to Hospital
If true
orderItem: VMR Order where code is subsumed by Admission to general medical department (procedure) [SNOMED CT]

Order_Item ()

fullTextOrder: Diagnosis: Community Acquired Pneumonia
If true
orderItem: VMR Order where code is subsumed by Community acquired pneumonia (disorder) [SNOMED CT]

Order_Item ()

fullTextOrder: Add Pneumonia to Problem List
If true
orderItem: VMR Order where code is subsumed by Community acquired pneumonia (disorder) [SNOMED CT]

Order_Item ()

fullTextOrder: Admit to Ward
If true
orderItem: VMR Order where code is subsumed by Admission to ward (procedure) [SNOMED CT]

Order_Item ()

fullTextOrder: Attending is
If true
orderItem: VMR Order where code is subsumed by Attending physician (occupation) [SNOMED CT]

identifier: BOC_1

Order Set: Diet

title: Diet

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Diet

If true

group_body:

Order_Item ()

fullTextOrder: Encourage fluids
If true
orderItem: VMR Order where code is subsumed by Fluid intake encouragement (regime/therapy) [SNOMED CT]

Order_Item ()

fullTextOrder: Regular Diet
If true
orderItem: VMR Order where code is subsumed by Normal diet (finding) [SNOMED CT]

identifier: BOC_10

Order Set:

boolean_connective: AND

metadata:

OrderSet_Metadata ()

title: Serum electrolytes panel order

If false

group_body:

Order_Item ()

orderItem: VMR Order where code is subsumed by Actual bicarbonate measurement (procedure) [SNOMED CT]

Order_Item ()

orderItem: VMR Order where code is subsumed by Serum chloride measurement (procedure) [SNOMED CT]

Order_Item ()

orderItem: VMR Order where code is subsumed by Serum potassium measurement (procedure) [SNOMED CT]

Order_Item ()

orderItem: VMR Order where code is subsumed by Sodium measurement, serum (procedure) [SNOMED CT]

identifier: not used lab orders

Order Set: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set

title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set

boolean_connective: AND

metadata:

OrderSet_Metadata ()

title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set
references:
Supplemental_Material ( IDSA CAP 2003 Update )
- label: IDSA CAP 2003 Update
- role: evidence

If ( OR

presence of SubstanceAdministration [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
presence of MedicationOrder [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
presence of SubstanceAdministration CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
presence of MedicationOrder CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW

)

orderAlertingOrExplanationText:

ConditionalString ()

If ( OR
- presence of SubstanceAdministration [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of SubstanceAdministration CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
)
if-string: Patients with CAP and recent exposure to a Macrolid or beta-lactam shouldbe treated with a respiratory fluroquinalone.

ConditionalString ()

If presence of ObservationObservation where 'Recieved antibiotics for CAP prior to arrival [SAGE]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW
if-string: Patient appears to received abx prior to arrival, please confirm

group_body:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by MOXIFLOXACIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

identifier: BOC_36

Order Set: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset

title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset

boolean_connective: AND

metadata:

OrderSet_Metadata ()

title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset
problemCode: Community acquired pneumonia (disorder) [SNOMED CT]
references:

If ( OR

presence of SubstanceAdministration CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
presence of MedicationOrder CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW

)

orderAlertingOrExplanationText:

ConditionalString ()

If ( OR
- presence of SubstanceAdministration CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
)
if-string: Use Macrolid & B-lactam in patient with recent exposure to resp. fluroqinalone.

ConditionalString ()

If presence of ObservationObservation where 'Recieved antibiotics for CAP prior to arrival [SAGE]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW
if-string: Patient appears to received abx prior to arrival, please confirm

group_body:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by AZITHROMYCIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by AMPICILLIN NA/SULBACTAM NA 3GM/VIL INJ [NDF-RT]

identifier: BOC_37

Order Set: Default CAP inpatient meds, no recent Abx

title: Default CAP inpatient meds, no recent Abx

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Default meds for inpatient CAP, no recent abx

If ( AND

presence of SubstanceAdministration Antibacterial drugs (product) [SNOMED CT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
presence of MedicationOrder Antibacterial drugs (product) [SNOMED CT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW

)

orderAlertingOrExplanationText:

ConditionalString ()

If ( OR
- presence of SubstanceAdministration Antibacterial drugs (product) [SNOMED CT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder Antibacterial drugs (product) [SNOMED CT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
)
if-string: Avoid use of Macrolid & B-lactam in patient with recent exposure to same drug class(es).
then-string: There was no evidence of recent Abx therapy, please confirm.

ConditionalString ()

If presence of ObservationObservation where 'Recieved antibiotics for CAP prior to arrival [SAGE]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW
if-string: Patient appears to received abx prior to arrival, please confirm

group_body:

Default Macrolid and B-lactam for inpatient CAP

Order_Item ()

If false
orderItem: Medication Order where code is subsumed by MOXIFLOXACIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

identifier: BOC_35

Order Set: Main CAP orderset

title: Main CAP orderset

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Top level Main CAP Orderset

If true

group_body:

Order Set: Consults

title: Consults
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Consults
If true
group_body:
Order_Item ()
- fullTextOrder: Referral to smoking cessation training.
- If ( AND
  - presence of Problem Smoker (finding) [SNOMED CT] Now
  - absence of VMROrder Referral to smoking cessation advisor (procedure) [SNOMED CT] Encounter start to NOW
  )
- orderItem: VMR Order where code is subsumed by Referral to smoking cessation advisor (procedure) [SNOMED CT]
- effectiveTime: Now
- orderAlertingOrExplanationText:
  ConditionalString ()
  - If presence of Problem Smoker (finding) [SNOMED CT] Now
  - if-string: Pt is smoker. where
identifier: BOC_7

Order Set: Labs

title: Labs
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Labs
If true
group_body:
identifier: BOC_19

Order Set: Medications

title: Medications
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Medications
If true
group_body:
- title: Default CAP inpatient meds, no recent Abx
- boolean_connective: OR
- metadata:
  OrderSet_Metadata ()
  - title: Default meds for inpatient CAP, no recent abx
- If ( AND
  )
- orderAlertingOrExplanationText:
- group_body:
  - Default Macrolid and B-lactam for inpatient CAP
- identifier: BOC_35
- title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set
- boolean_connective: AND
- metadata:
  OrderSet_Metadata ()
  - title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set
  - references:
    Supplemental_Material ( IDSA CAP 2003 Update )
    - label: IDSA CAP 2003 Update
    - role: evidence
- If ( OR
  - presence of SubstanceAdministration [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  - presence of MedicationOrder [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  - presence of SubstanceAdministration CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  - presence of MedicationOrder CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  )
- orderAlertingOrExplanationText:
- group_body:
  Order_Item ()
  - If true
  - orderItem: Medication Order where code is subsumed by MOXIFLOXACIN PREPARATION [NDF-RT]
  - orderAlertingOrExplanationText:
- identifier: BOC_36
- title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset
- boolean_connective: AND
- metadata:
  OrderSet_Metadata ()
  - title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset
  - problemCode: Community acquired pneumonia (disorder) [SNOMED CT]
  - references:
- If ( OR
  - presence of SubstanceAdministration CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  - presence of MedicationOrder CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
  )
- orderAlertingOrExplanationText:
- group_body:
- identifier: BOC_37
identifier: BOC_34

Order Set: Treatments

title: Treatments
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Treatments
If true
group_body:
Order_Item ()
- fullTextOrder: Turn, cough and deep breathe per protocol
- If true
- orderItem: VMR Order where code is subsumed by Turn, cough and deep breathe per protocol [SAGE]
identifier: BOC_23

Order Set: Diet

title: Diet
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Diet
If true
group_body:
identifier: BOC_10

Order Set: Vital Signs

title: Vital Signs
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Vital Signs
If true
group_body:
identifier: BOC_9

Order Set: Admission, Discharge, Transfer

title: Admission, Discharge, Transfer
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Admission, Discharge, Transfer
If true
group_body:
identifier: BOC_1

identifier: OScp0001

Order Set: Placeholder orderset

title: Placeholder orderset

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Placeholder Fake orderset

If false

group_body:

Order_Item ()

If false
orderItem: VMR Order where code is subsumed by [AM000] ANTIMICROBIALS [NDF-RT]

identifier: placeholder fake id1

Order Set: Consults

title: Consults

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Consults

If true

group_body:

Order_Item ()

fullTextOrder: Referral to smoking cessation training.
If ( AND
- presence of Problem Smoker (finding) [SNOMED CT] Now
- absence of VMROrder Referral to smoking cessation advisor (procedure) [SNOMED CT] Encounter start to NOW
)
orderItem: VMR Order where code is subsumed by Referral to smoking cessation advisor (procedure) [SNOMED CT]
effectiveTime: Now
orderAlertingOrExplanationText:
ConditionalString ()
- If presence of Problem Smoker (finding) [SNOMED CT] Now
- if-string: Pt is smoker. where

identifier: BOC_7

Order Set: Labs

title: Labs

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Labs

If true

group_body:

Order_Item ()

If true
orderItem: VMR Order where code is subsumed by Analysis of arterial blood gases and pH (procedure) [SNOMED CT]
orderAlertingOrExplanationText: JCAHO Requirement. where

Order_Item ()

If true
orderItem: VMR Order where code is subsumed by Blood culture (procedure) [SNOMED CT]
repeatNumber: [2,2]
effectiveTime: Now
orderAlertingOrExplanationText:

Order_Item ()

fullTextOrder: Comprehensive Metabolic Panel
If true
orderItem: VMR Order where code is subsumed by Comprehensive Metabolic Panel [SAGE]

identifier: BOC_19

Order Set: Medications

title: Medications

boolean_connective: OR

metadata:

OrderSet_Metadata ()

title: Medications

If true

group_body:

Order Set: Default CAP inpatient meds, no recent Abx

title: Default CAP inpatient meds, no recent Abx
boolean_connective: OR
metadata:
OrderSet_Metadata ()
- title: Default meds for inpatient CAP, no recent abx
If ( AND
)
orderAlertingOrExplanationText:
group_body:
- Default Macrolid and B-lactam for inpatient CAP
identifier: BOC_35

Order Set: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set

title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set
boolean_connective: AND
metadata:
OrderSet_Metadata ()
- title: Inpatient CAP therapy, recent macrolid or B-lactam Abx therapy order set
- references:
  Supplemental_Material ( IDSA CAP 2003 Update )
  - label: IDSA CAP 2003 Update
  - role: evidence
If ( OR
- presence of SubstanceAdministration [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder [AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of SubstanceAdministration CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder CAP-focused B-lactam [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
)
orderAlertingOrExplanationText:
group_body:
Order_Item ()
- If true
- orderItem: Medication Order where code is subsumed by MOXIFLOXACIN PREPARATION [NDF-RT]
- orderAlertingOrExplanationText:
identifier: BOC_36

Order Set: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset

title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset
boolean_connective: AND
metadata:
OrderSet_Metadata ()
- title: Inpatient CAP therapy, recent resp. fluroquin. Abx orderset
- problemCode: Community acquired pneumonia (disorder) [SNOMED CT]
- references:
If ( OR
- presence of SubstanceAdministration CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
- presence of MedicationOrder CAP-focused respiratory fluroquinalone [SAGE NDF-RT] within 3.0 Month (qualifier value) [SNOMED CT] before NOW
)
orderAlertingOrExplanationText:
group_body:
identifier: BOC_37

identifier: BOC_34

Order Collection: Potential macrolid and beta-lactam prep orders for CAP

identifier: ee

title: Potential macrolid and beta-lactam prep orders for CAP

boolean_connective: AND

group_body:

dd Macrolid choice order group XOR true AZITHROMYCIN PREPARATION [NDF-RT] presence of AdverseReaction: '[AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT]' to ' ' Now Patient is allergic to Macrolid Antibiotics. Absolute contraindication to macrolids Patient has an absolute contraindication to Macrolid Antibiotics Relative contraindication to macrolids Patient has a relative contraindication to a macrolid drug presence of MedicationOrder WARFARIN SODIUM PREPARATION [NDF-RT] Now Pt is on Warfarin, monitor levels if using Azithromycin CLARITHROMYCIN PREPARATION [NDF-RT] Patient has an absolute contraindication to Macrolid Antibiotics Patient is allergic to Macrolid Antibiotics.
aa CAP inpatient Beta-Lactam choice order group XOR false AMOXICILLIN PREPARATION [NDF-RT] Intravenous (qualifier value) [SNOMED CT] 1.0 gram (qualifier value) [SNOMED CT] AMOXICILLIN 1000MG/CLAVULANATE K 62.5MG TAB,SA [NDF-RT] presence of AdverseReaction: 'CAP-focused B-lactam [SAGE NDF-RT]' to ' ' Now Alert: Patient is allergic to B-lactam antibiotics. Absolute Contraindication to Cap B-lactam Patient has an absolute contraindication to B-lactams Relative contraindication to CAP B-lactam Patient has a relative contraindication to a B-lactam drug

Order Collection: Macrolid choice order group

identifier: dd

title: Macrolid choice order group

boolean_connective: XOR

group_body:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by AZITHROMYCIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

Order_Item ()

orderItem: Medication Order where code is subsumed by CLARITHROMYCIN PREPARATION [NDF-RT]

orderAlertingOrExplanationText:

Patient has an absolute contraindication to Macrolid Antibiotics Patient is allergic to Macrolid Antibiotics.

Order Collection: CAP inpatient Beta-Lactam choice order group

identifier: aa

title: CAP inpatient Beta-Lactam choice order group

boolean_connective: XOR

group_body:

Order_Item ()

If false
orderItem: Medication Order where code is subsumed by AMOXICILLIN PREPARATION [NDF-RT]
routeCode: Intravenous (qualifier value) [SNOMED CT]
doseQuantity: 1.0 gram (qualifier value) [SNOMED CT]

Order_Item ()

orderItem: Medication Order where code is subsumed by AMOXICILLIN 1000MG/CLAVULANATE K 62.5MG TAB,SA [NDF-RT]

orderAlertingOrExplanationText:

ConditionalString ()

If presence of AdverseReaction: 'CAP-focused B-lactam [SAGE NDF-RT]' to ' ' Now
if-string: Alert: Patient is allergic to B-lactam antibiotics.

ConditionalString ()

If Absolute Contraindication to Cap B-lactam
if-string: Patient has an absolute contraindication to B-lactams

ConditionalString ()

If Relative contraindication to CAP B-lactam
if-string: Patient has a relative contraindication to a B-lactam drug

Order Collection: Fluroquinalone prep orders

identifier: cc

title: Fluroquinalone prep orders

boolean_connective: XOR

group_body:

Order_Item ()

If false
orderItem: Medication Order where code is subsumed by LEVOFLOXACIN PREPARATION [NDF-RT]

Order_Item ()

If false
orderItem: Medication Order where code is subsumed by MOXIFLOXACIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

Order_Item ()

If false
orderItem: Medication Order where code is subsumed by GATIFLOXACIN PREPARATION [NDF-RT]

orderAlertingOrExplanationText:

ConditionalString ()

If Absolute contraindication to Moxifloxacin
if-string: Patient has absolute contraindication to fluroquinalones.

ConditionalString ()

If presence of AdverseReaction: 'Allergic drug reaction (disorder) [SNOMED CT]' to 'CAP-focused respiratory fluroquinalone [SAGE NDF-RT]' Now
if-string: Patient has an allergy to fluroquinalones

ConditionalString ()

If Relative contraindication to Moxifloxacin
if-string: Patient has a relative contraindication to a fluroquinalone drug

Order Collection: CAP non-ICU inpatient abx therapy, no abx tx in past 3 months

identifier: bb

title: CAP non-ICU inpatient abx therapy, no abx tx in past 3 months

boolean_connective: XOR

group_body:

ee Potential macrolid and beta-lactam prep orders for CAP AND dd Macrolid choice order group XOR true AZITHROMYCIN PREPARATION [NDF-RT] presence of AdverseReaction: '[AM200] ERYTHROMYCINS/MACROLIDES [NDF-RT]' to ' ' Now Patient is allergic to Macrolid Antibiotics. Absolute contraindication to macrolids Patient has an absolute contraindication to Macrolid Antibiotics Relative contraindication to macrolids Patient has a relative contraindication to a macrolid drug presence of MedicationOrder WARFARIN SODIUM PREPARATION [NDF-RT] Now Pt is on Warfarin, monitor levels if using Azithromycin CLARITHROMYCIN PREPARATION [NDF-RT] Patient has an absolute contraindication to Macrolid Antibiotics Patient is allergic to Macrolid Antibiotics. aa CAP inpatient Beta-Lactam choice order group XOR false AMOXICILLIN PREPARATION [NDF-RT] Intravenous (qualifier value) [SNOMED CT] 1.0 gram (qualifier value) [SNOMED CT] AMOXICILLIN 1000MG/CLAVULANATE K 62.5MG TAB,SA [NDF-RT] presence of AdverseReaction: 'CAP-focused B-lactam [SAGE NDF-RT]' to ' ' Now Alert: Patient is allergic to B-lactam antibiotics. Absolute Contraindication to Cap B-lactam Patient has an absolute contraindication to B-lactams Relative contraindication to CAP B-lactam Patient has a relative contraindication to a B-lactam drug
cc Fluroquinalone prep orders XOR false LEVOFLOXACIN PREPARATION [NDF-RT] false MOXIFLOXACIN PREPARATION [NDF-RT] Absolute contraindication to Moxifloxacin Patient has absolute contraindication to fluroquinalones. presence of MedicationOrder Class Ia antiarrhythmics [SAGE NDF-RT] Now (?PatientName)|' is on a class Ia antiarrhythmic which can lead to fatal arrhythmias when taken with this drug. Please review.' Patient Name var ?PatientName EntityNamePart Patient Name Query most_recent value Observation of 'Patient name (observable entity) [SNOMED CT] ' ' presence of AdverseReaction: 'Allergic drug reaction (disorder) [SNOMED CT]' to 'CAP-focused respiratory fluroquinalone [SAGE NDF-RT]' Now Patient has an allergy to fluroquinalones Relative contraindication to Moxifloxacin Patient has a relative contraindication to a fluroquinalone drug false GATIFLOXACIN PREPARATION [NDF-RT] Absolute contraindication to Moxifloxacin Patient has absolute contraindication to fluroquinalones. presence of AdverseReaction: 'Allergic drug reaction (disorder) [SNOMED CT]' to 'CAP-focused respiratory fluroquinalone [SAGE NDF-RT]' Now Patient has an allergy to fluroquinalones Relative contraindication to Moxifloxacin Patient has a relative contraindication to a fluroquinalone drug

Order Collection: Default Macrolid and B-lactam for inpatient CAP

identifier: BOC_41

title: Default Macrolid and B-lactam for inpatient CAP

If true

boolean_connective: AND

group_body:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by AMPICILLIN NA/SULBACTAM NA 3GM/VIL INJ [NDF-RT]
orderAlertingOrExplanationText:

Order_Item ()

If true
orderItem: Medication Order where code is subsumed by AZITHROMYCIN PREPARATION [NDF-RT]
orderAlertingOrExplanationText:

Variable: DAY

label: DAY

referenced_as: ?DAY

datatype: CodedValue

derivation_expression: day (qualifier value) [SNOMED CT]

Variable: Date of birth

label: Date of birth

referenced_as: ?DOB

datatype: PointInTime

derivation_expression: select most_recent value from Observation of 'Date of birth (observable entity) [SNOMED CT] ' '

Variable: Patient weight variable

label: Patient weight variable

referenced_as: ?Weight

datatype: Observation

derivation_expression: select most_recent value from Observation of 'Body weight only ' '

Variable: Patient height variable

label: Patient height variable

referenced_as: ?Height

datatype: Observation

derivation_expression: select value from Observation of 'standing height (observable entity) [SNOMED CT] ' '

Variable: Age

label: Age

referenced_as: ?Age

update_expression: update Observation set code=<Age> value=?Age valid_time=?NOW

datatype: PhysicalQuantity

derivation_expression: age formula ()

Variable: Today (mid-night to midnight)

label: Today (mid-night to midnight)

referenced_as: ?Today

datatype: TimeInterval

derivation_expression: Today (midnight to midnight)

Variable: NOW

label: NOW

referenced_as: ?NOW

datatype: PointInTime

derivation_expression: Now ()

Variable: Inital CAP Risk Factors Variable

label: Inital CAP Risk Factors Variable

referenced_as: ?CAPInitRiskFactors

datatype: IntegerNumber

derivation_expression: CAP PSI risk factor GELLO expression modified ()

Variable: Smoking status Variable

label: Smoking status Variable

referenced_as: ?Smoker

datatype: CodedValue

derivation_expression: select value from

Problem ()

code is subsumed by Smoker (finding) [SNOMED CT]

Variable: Asplenia problem Variable

label: Asplenia problem Variable

referenced_as: ?AspleniaProblem

datatype: CodedValue

derivation_expression: select value from

Problem ()

code is subsumed by Functional asplenia (disorder) [SNOMED CT]

Variable: Asplenia observation Variable

label: Asplenia observation Variable

referenced_as: ?AspleniaObservation

datatype: CodedValue

derivation_expression: select value from Observation of 'Finding (finding) [SNOMED CT] 'Functional asplenia (disorder) [SNOMED CT]'

Variable: Diabetes problem Variable

label: Diabetes problem Variable

referenced_as: ?DiabetesProblem

datatype: CodedValue

derivation_expression: select value from

Problem ()

code is subsumed by Diabetes mellitus (disorder) [SNOMED CT]

Variable: Cavitation of lung present variable

label: Cavitation of lung present variable

referenced_as: ?CavitationPresent

datatype: Boolean

derivation_expression: presence of ObservationObservation where 'Cavitation of lung (finding) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW

Variable: Asplenia variable

label: Asplenia variable

referenced_as: ?Asplenia

datatype: Boolean

derivation_expression: ( OR

presence of Procedure Splenectomy (procedure) [SNOMED CT]
presence of Problem Concepts indicating absent spleen [SAGE SNOMED CT] Now
presence of ObservationObservation where 'Spleen absent (finding) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW

)

Variable: CAP age risk factor variable

label: CAP age risk factor variable

referenced_as: ?CAPAgeRiskFactor

datatype: Boolean

derivation_expression: ( OR

Age >= 65.0 year (qualifier value) [SNOMED CT] )
( AND
- Age >= 40.0 year (qualifier value) [SNOMED CT] )
- presence of Problem Smoker (finding) [SNOMED CT] Now
)

)

Variable: Aspiration risk variable

label: Aspiration risk variable

referenced_as: ?AsprirationRisk

datatype: Boolean

derivation_expression: ( OR

presence of Problem At risk for aspiration (finding) [SNOMED CT] Now
presence of ObservationObservation where 'At risk for aspiration (finding) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW

)

Variable: From start of Encounter to Now

label: From start of Encounter to Now

referenced_as: ?EncounterStartToNow

datatype: TimeInterval

derivation_expression: Encounter start to NOW

Variable: Time Interval of most recent check-in event

label: Time Interval of most recent check-in event

referenced_as: ?MostRecentCheckInTime

datatype: TimeInterval

derivation_expression: select most_recent effectiveTime from Encounter where

Variable: Start of most recent encounter variable

label: Start of most recent encounter variable

referenced_as: ?TimeOfLastEncounter

datatype: PointInTime

derivation_expression: Start of most recent encounter function ()

Variable: Observed PSI Value

label: Observed PSI Value

referenced_as: ?ObsPSI

datatype: Observation

derivation_expression: select from Observation of 'PSI score [SAGE] ' '

Variable: Observed Sodium

label: Observed Sodium

referenced_as: ?ObsNA

datatype: Observation

derivation_expression: select from Observation of 'SODIUM:SCNC:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] ' ' Encounter start to NOW

Variable: Observed GLU

label: Observed GLU

referenced_as: ?ObsGLU

datatype: Observation

derivation_expression: select from Observation of 'GLUCOSE:MCNC:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] ' ' Encounter start to NOW

Variable: Observed PaO2

label: Observed PaO2

referenced_as: ?ObsPAO2

datatype: Observation

derivation_expression: select from Observation of 'OXYGEN CONTENT:SCNC:PT:BLDA:QN: [LOINC [Logical Observation Identifiers Names and Codes]] ' ' Encounter start to NOW

Variable: Observed O2 Sat

label: Observed O2 Sat

referenced_as: ?ObsO2SAT

datatype: Observation

derivation_expression: select from Observation of 'OXYGEN SATURATION:SFR:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] ' ' Encounter start to NOW

Variable: Observed HCT

label: Observed HCT

referenced_as: ?ObsHCT

datatype: Observation

derivation_expression: select from Observation of 'HEMATOCRIT:VFR:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] ' '

Variable: Observed Neoplastic Disease

label: Observed Neoplastic Disease

referenced_as: ?ObsNEODS

datatype: Boolean

derivation_expression: presence of Problem Neoplastic disease that affect pnumonia risk [SAGE SNOMED CT] Now

Variable: NHome Status Observation

label: NHome Status Observation

referenced_as: ?ObsNH

datatype: Boolean

derivation_expression: ( OR

presence of Problem Lives in a nursing home (finding) [SNOMED CT] Now
presence of ObservationObservation where 'Lives in a nursing home (finding) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Now

)

Variable: Test PaO2

label: Test PaO2

datatype: CharacterString

Variable: CHF disease as CAP risk var

label: CHF disease as CAP risk var

referenced_as: ?CHF

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent CHF disease affecting CAP risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation CHF disease affecting CAP risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem CHF disease affecting CAP risk [SAGE SNOMED CT] Now
)

)

Variable: BUN >= 30.0 mg/dL as CAP risk var

label: BUN >= 30.0 mg/dL as CAP risk var

referenced_as: ?BUN

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent BUN elevated affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation BUN elevated affecting CAP risk [SAGE] Encounter start to NOW
- most_recent UREA NITROGEN:MCNC:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW >= 30.0 mg/dL (qualifier value) [SNOMED CT]
)

)

Variable: Glucose >= 250.0 mg/dL as CAP risk var

label: Glucose >= 250.0 mg/dL as CAP risk var

referenced_as: ?Glucose

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Glucose >= 250.0 mg/dL affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Glucose >= 250.0 mg/dL affecting CAP risk [SAGE] Encounter start to NOW
- most_recent GLUCOSE:MCNC:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW >= 250.0 mg/dL (qualifier value) [SNOMED CT]
)

)

Variable: Sodium < 130.0 mEq/L as CAP risk var

label: Sodium < 130.0 mEq/L as CAP risk var

referenced_as: ?Sodium

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Sodium < 130 mEq/L affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Sodium < 130 mEq/L affecting CAP risk [SAGE] Encounter start to NOW
- most_recent SODIUM:SCNC:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW < 130.0 mEq/L (qualifier value) [SNOMED CT]
)

)

Variable: Systolic blood pressure < 90.0 mm Hg as CAP risk var

label: Systolic blood pressure < 90.0 mm Hg as CAP risk var

referenced_as: ?SBP

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Systolic blood pressure < 90 mm Hg affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Systolic blood pressure < 90 mm Hg affecting CAP risk [SAGE] Encounter start to NOW
- most_recent Systolic blood pressure (observable entity) [SNOMED CT] Observation Encounter start to NOW < 90.0 mmHg (qualifier value) [SNOMED CT]
)

)

Variable: Hematocrit < 30.0% as CAP risk var

label: Hematocrit < 30.0% as CAP risk var

referenced_as: ?Hematocrit

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Hematocrit < 30.0% affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Hematocrit < 30.0% affecting CAP risk [SAGE] Encounter start to NOW
- most_recent HEMATOCRIT:VFR:PT:BLD:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW < 30.0 Percent (property) (qualifier value) [SNOMED CT]
)

)

Variable: Arterial pH < 7.35 as CAP risk var

label: Arterial pH < 7.35 as CAP risk var

referenced_as: ?ArtPH

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Arterial pH < 7.35 affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Arterial pH < 7.35 affecting CAP risk [SAGE] Encounter start to NOW
- most_recent PH:SCNC:PT:BLDA:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW < 7.35
)

)

Variable: Respiratory rate >= 30.0 breaths/min as CAP risk var

label: Respiratory rate >= 30.0 breaths/min as CAP risk var

referenced_as: ?RR

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- presence of Observation Respiratory rate (observable entity) [SNOMED CT]
)
( OR
- presence of Observation Respiratory rate >= 30.0 breaths/min affecting CAP risk [SAGE] Encounter start to NOW
- most_recent BREATHS:NRAT:PT:RESPIRATORY SYSTEM:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW > 30.0 breaths/min (qualifier value) [SNOMED CT]
)

)

Variable: Altered mental status as CAP risk var

label: Altered mental status as CAP risk var

referenced_as: ?ALTMental

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Altered mental status affecting CAP risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Altered mental status affecting CAP risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem Altered mental status affecting CAP risk [SAGE SNOMED CT] Now
)

)

Variable: Pulse >= 125.0 beats/min as CAP risk var

label: Pulse >= 125.0 beats/min as CAP risk var

referenced_as: ?Pulse

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Pulse >= 125.0 beats/min affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Pulse >= 125.0 beats/min affecting CAP risk [SAGE] Encounter start to NOW
- most_recent HEART BEAT:NRAT:PT:XXX:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW >= 125.0 Beats/min (qualifier value) [SNOMED CT]
)

)

Variable: Temperature <35.0C or >=40.0C as CAP risk var

label: Temperature <35.0C or >=40.0C as CAP risk var

referenced_as: ?Temp

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Temperature <35.0 C or >= 40.0 C affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Temperature <35.0 C or >= 40.0 C affecting CAP risk [SAGE] Encounter start to NOW
- ( OR
  - most_recent BODY TEMPERATURE:TEMP:PT:^PATIENT:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Body temperature model Encounter start to NOW < 35.0 Degrees C (qualifier value) [SNOMED CT]
  - most_recent BODY TEMPERATURE:TEMP:PT:^PATIENT:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Body temperature model Encounter start to NOW >= 40.0 Degrees C (qualifier value) [SNOMED CT]
  )
)

)

Variable: PaO2 < 60.0 mmHg OR O2 Sat < 90.0% as CAP risk var

label: PaO2 < 60.0 mmHg OR O2 Sat < 90.0% as CAP risk var

referenced_as: ?O2Sat

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- presence of Oxygen saturation CEM Oxygen saturation measurement (procedure) [SNOMED CT] Encounter start to NOW
)
( OR
- presence of Observation PaO2 < 60.0 mmHg or O2 Sat < 90.0% affecting CAP risk [SAGE] Encounter start to NOW
- ( OR
  - most_recent OXYGEN CONTENT:SCNC:PT:BLDA:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW < 60.0 mmHg (qualifier value) [SNOMED CT]
  - most_recent OXYGEN SATURATION:SFR:PT:BLDA:QN: [LOINC [Logical Observation Identifiers Names and Codes]] Observation Encounter start to NOW < 90.0 Degree of saturation of (qualifier value) [SNOMED CT]
  )
)

)

Variable: Bilateral pleural effusions as CAP risk var

label: Bilateral pleural effusions as CAP risk var

referenced_as: ?BilPleuE

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Bilateral pleural effusions affecting CAP risk [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Bilateral pleural effusions affecting CAP risk [SAGE] Encounter start to NOW
- presence of ObservationObservation where 'Pleural effusion (disorder) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Encounter start to NOW
)

)

Variable: PSI Score var

label: PSI Score var

referenced_as: ?PSIScore

datatype: IntegerNumber

derivation_expression: CAP PSI risk factor GELLO expression modified ()

Variable: PSI disposition string var

label: PSI disposition string var

referenced_as: ?PSIDisposition

datatype: CharacterString

derivation_expression: PSI dispo GELLO string generator ()

Variable: Patient Name var

label: Patient Name var

referenced_as: ?PatientName

datatype: EntityNamePart

derivation_expression: select most_recent value from Observation of 'Patient name (observable entity) [SNOMED CT] ' '

Variable: Acute critical illness Obs var

label: Acute critical illness Obs var

referenced_as: ?CritiallyIll

datatype: Boolean

derivation_expression: presence of ObservationObservation where 'Acute severe general illness [SAGE]' code = 'true' Encounter start to NOW

Variable: NHome resident status var

label: NHome resident status var

referenced_as: ?NHomeStatus

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Nursing home resident risk factor [SAGE] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Nursing home resident risk factor [SAGE] Encounter start to NOW
- ( OR
  - presence of Problem Lives in a nursing home (finding) [SNOMED CT] Now
  - presence of ObservationObservation where 'Lives in a nursing home (finding) [SNOMED CT]' code = 'True (qualifier value) [SNOMED CT]' Now
  )
)

)

Variable: Neoplastic disease status var

label: Neoplastic disease status var

referenced_as: ?NeoplasticDis

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Neoplastic disease that affect pnumonia risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Neoplastic disease that affect pnumonia risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem Neoplastic disease that affect pnumonia risk [SAGE SNOMED CT] Now
)

)

Variable: Cerebrovascular Disease var

label: Cerebrovascular Disease var

referenced_as: ?CVDisease

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Cerebrovascular disease affecting CAP risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Cerebrovascular disease affecting CAP risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem Cerebrovascular accident
)

)

Variable: Patient is female var

label: Patient is female var

referenced_as: ?Female

datatype: Boolean

derivation_expression: presence of ObservationObservation where 'Gender finding (finding) [SNOMED CT]' code = 'Female (finding) [SNOMED CT]'

Variable: Chronic Liver Disease as CAP risk var

label: Chronic Liver Disease as CAP risk var

referenced_as: ?CLDisease

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Chronic liver disease affecting CAP risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Chronic liver disease affecting CAP risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem Chronic liver disease affecting CAP risk [SAGE SNOMED CT] Now
)

)

Variable: Chronic Renal Disease var

label: Chronic Renal Disease var

referenced_as: ?CRDisease

datatype: Boolean

derivation_expression: ( AND

( OR
- ( NOT
  )
- most_recent Chronic renal failure with effect on CAP risk [SAGE SNOMED CT] Observation Encounter start to NOW equals True (qualifier value) [SNOMED CT]
)
( OR
- presence of Observation Chronic renal failure with effect on CAP risk [SAGE SNOMED CT] Encounter start to NOW
- presence of Problem Chronic renal failure with effect on CAP risk [SAGE SNOMED CT] Now
)

)

Variable: Observed RR

label: Observed RR

referenced_as: ?ObsRR

datatype: Observation

derivation_expression: select from Observation of 'Respiratory rate (observable entity) [SNOMED CT] ' ' Encounter start to NOW

Variable: Observed SBP

label: Observed SBP

referenced_as: ?ObsSBP

datatype: Observation

derivation_expression: select from Observation of 'Systolic blood pressure (observable entity) [SNOMED CT] ' '

Variable: Observed HR

label: Observed HR

referenced_as: ?ObsHR

datatype: Observation

derivation_expression: select from Observation of 'Pulse rate (observable entity) [SNOMED CT] ' ' Encounter start to NOW

Variable: Observed BUN

label: Observed BUN

referenced_as: ?ObsBUN

datatype: Observation

derivation_expression: select from Observation of 'BUN [SNOMED CT] ' ' Encounter start to NOW

Variable: Observed Temp for PSI

label: Observed Temp for PSI

referenced_as: ?ObsTempC

datatype: Observation

derivation_expression: select from Observation of 'Body temperature (observable entity) [SNOMED CT] ' ' Encounter start to NOW

Variable: Observed Arterial pH

label: Observed Arterial pH

referenced_as: ?ObsApH

datatype: Observation

derivation_expression: select from Observation of 'Arterial pH in LOINC ' ' Encounter start to NOW

Variable: Body Weight Variable

label: Body Weight Variable

referenced_as: ?BWeight

datatype: Observation

derivation_expression: select from Observation of 'Body weight (observable entity) [SNOMED CT] ' '

SAGE PSI CAP Guideline Encoding

Guideline_Metadata ()

Recommendation Set (Activity Graph): Outpatient CAP therapy AG

1. Context: Outpatient therapy required

3. Decision: Aspiration suspected, nursing home, or viral with bacterial super-infection?

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

5. Action: CAP therapy for comorbid w/ no recent Abx

Recommend_OrderSet ( Placeholder for Recommend orderset )

7. Decision: No comorbidities, determine therapy based on recent antibiotic use

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

9. Action: CAP therapy for healthy w/ No Abx in last 3 months

Recommend_OrderSet ( Recommend stnd CAP multi-drug therapy order set )

11. Decision: Current comorbidities, determine therapy based on recent antibiotic use

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

13. Decision: Does patient have existing comorbidities?

Alternative_Choice ()

Alternative_Choice ()

15. Action: IDSA-based outpatient therapy for CAP with suspected aspiration

Recommend_OrderSet ( Placeholder for Recommend orderset )

17. Action: CAP therapy for comorbid w/ recent non-fluro Abx

Recommend_OrderSet ( Placeholder for Recommend orderset )

19. Action: IDSA-based therapy delivered in NH for CAP in nursing home patient

Recommend_OrderSet ( Placeholder for Recommend orderset )

21. Decision: Does patient need short stay before outpatient therapy?

Alternative_Choice ()

Alternative_Choice ()

23. Action: Vomiting or unreliable, needs short stay

Recommend_OrderSet ( Placeholder for Recommend orderset )

25. Action: IDSA-based outpatient therapy for CAP with influenza complicated by bacterial super infection

Recommend_OrderSet ( Placeholder for Recommend orderset )

27. Action: CAP therapy for healthy w/ recent fluro Abx

Recommend_OrderSet ( Placeholder for Recommend orderset )

29. Action: CAP therapy for healthy w/ recent non-fluro Abx

Recommend_OrderSet ( Placeholder for Recommend orderset )

31. Action: CAP therapy for comorbid w/ recent fluro Abx

Recommend_OrderSet ( Placeholder for Recommend orderset )

33. Context: Outpatient Therapy for demo

Recommendation Set (Activity Graph): Inpatient AG

1. Context: Inpatient Orderset needed

Administrative_Event ( Store PSI Score )

3. Action: Record JCAHO-specific measures

Inquire ( JCAHO inquire )

5. Action: Recommend non-ICU Inpatient order sets

Recommend_OrderSet ( Recommend main CAP orderset )

7. Decision: Determine if PSI class IV patient

Alternative_Choice ()

Alternative_Choice ()

9. Action: ICU admission needed. Recommend CAP ICU order set

Recommend_OrderSet ( Placeholder for Recommend orderset )

Recommendation Set (Activity Graph): CAP Disposition Using PSI Score

1. Action: Get PSI Inquires

Inquire ( PSI inquire CEMs )

3. Context: CAP guideline desposition needed

Clinical_Event ( Select CAP protocol )

Administrative_Event ( Patient is enrolled in a care support guideline )

Clinical_Context ()

5. Decision: What disposition is appropriate for this patient?

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

Alternative_Choice ()

7. Action: Do Outpatient therapy subguideline

Subguideline ( Outpatient therapy SG )

9. Action: Do Outpatient therapy subguidline

Subguideline ( Outpatient therapy SG )

11. Action: Do Outpatient therapy subguidline

Subguideline ( Outpatient therapy SG )

13. Action: Class IV Do therapy subguidline

Subguideline ( Inpatient CAP Therapy SG )

15. Action: Class V Do therapy subguidline

Conclude ()