Unique Plan Description: FHCC Diagnostics
Plan Selection Display: FHCC Diagnostics
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2018-09-26 10:23:44
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:33:21
Available at all facilities: No

FHCC Diagnostics
IV Solutions
	DOBUTamine 500 mg/250mL IV (In Office)
		250 mL, IV, NOW
		500 mg, EVERY BAG, 10 mcg/kg/min
	Sodium Chloride 0.9% IV (In Office)
		500 mL, IV, NOW, 20 ml/hr
		250 mL, IV, NOW, 20 ml/hr
Medications
	adenosine (In Office)
		6 mg, Injection, IV Push, Once, NOW
	nitroglycerin (Nitrostat) sublingual tablet (In Office)
		0.4 mg, Tab, SUBLINGUAL, Once, NOW
	regadenoson (Lexiscan) (In Office)
		0.4 mg, Syringe, IV Push, Once, NOW
	sodium chloride bacteriostatic 0.9% injectable soln (In Office)
		30 mL, Injection, IV Push, Once, NOW
	sulfur hexafluoride (Lumason) (In Office)
		2 mL, Injection, IV Push, Once, NOW
		3 mL, Injection, IV Push, Once, NOW
		4 mL, Injection, IV Push, Once, NOW
		5 mL, Injection, IV Push, Once, NOW
Charges/Supplies
	93224 HOLTER MONITOR 24/48 HRS
		
	******ECHO/STRESS******
		
	93017 CARDIAC STRESS TEST; TRACING ONLY, NO INTERP/REPORT
		
	93015 CARDIAC STRESS TEST COMPLETE
		
	93325 DOPPLER ECHO COLOR FLOW
		
	93320 DOPPLER ECHO EXAM HEART
		
	93306 ECHO W DOPPLER RESTING
		
	93351 STRESS ECHO COMPLETE
		
	93350 STRESS ECHO LIMITED
		
	93308 TTE FOLLOW-UP OR LIMITED
		
	93307 TTE W/O DOPPLER COMP
		
	93924 US FULL SEGMENT EXRCS, COMPLETE BIL
		
	******NUC MED******
		
	78452 MYOCARDIAL SPECT, MULTIPLE R/S
		
	******ISOTOPES******
		
	A9502 Tc99m Myoview
		QTY 1
		QTY 2
	A9505 Tl 201 per mCi
		QTY 1
		QTY 4
	******ECG******
		
	93271 ECG/MONITORING AND ANALYSIS
		
	93226 ECG MONIT/REPRT UP TO 48 HRS
		
	93005 ECG TRACING ONLY, NO INTERP/REPORT

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase