Transcription of PROTOCOL CODE: GIAVPG DOCTOR’S ORDERS ... - …
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PROTOCOL CODE: GIAVPG DOCTOR’S ORDERS ... - …
Information on this form is a guide only. User will be solely responsible for verifying its currency and accuracy with the corresponding BC Cancer treatment protocols located at of-use and according to acceptable standards of care. PROTOCOL CODE: GIAVPG Page 1 of 1 BC Cancer Provincial Preprinted Order GIAVPG Created: 18 Sept 2009 Revised: 1 May 2023 DOCTOR S ORDERS Ht_____cm Wt_____kg BSA_____m2 REMINDER: Please ensure drug allergies and previous bleomycin are documented on the Allergy & Alert Form DATE: To be given: Cycle #: Date of Previous Cycle: Delay treatment _____ week(s) CBC & Diff, Platelets day of treatment May proceed with doses as written if within 24 hours ANC greater than or equal to x 109/L, Platelets greater than or equal to 100 x 109/L, Creatinine Clearance greater than or equal to 60 mL/min (if using CISplatin) Dose modification for: Hematology Other Toxicity: _____ Proceed with
Information on this form is a guide only. User will be solely responsible . for verifying its currency and accuracy with the corresponding BCCA
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