5994569	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994570	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994879	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:5489	{n/a}	1
5994880	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:5489	{n/a}	1
5994571	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994572	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 rapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994573	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994574	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994575	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994576	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994577	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994578	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994579	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994580	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994881	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:5489	{n/a}	1
5994581	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994582	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 poor metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994583	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 poor metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994584	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994585	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994586	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994587	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994588	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994589	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994590	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994591	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994592	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994593	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994594	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994595	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994596	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994597	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994598	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994599	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994600	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994601	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994882	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:5489	{n/a}	1
5994602	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994603	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994604	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 poor metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994605	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 normal metabolizer. There is no reason to selectively adjust the dose of this medication based on the CYP2C19 result. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994606	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994607	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994608	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994609	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994610	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994611	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994625	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
5994612	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994613	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994614	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994615	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994616	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994617	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994618	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994619	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994620	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994621	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994622	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
5994623	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
5994624	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
5994651	adults	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:121243	{"CYP2C19 genotype may be important for voriconazole dosing and use. A CYP2C19 genotype does not appear to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994626	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
5994627	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, this patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994628	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 intermediate metabolizer. There is no reason to selectively adjust the dose of this medication based on the CYP2C19 result. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994629	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994630	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994631	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994632	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994633	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994634	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994635	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994636	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994685	aspirin <1g	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1191	{n/a}	1
5994686	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1191	{n/a}	1
5994637	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994638	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994639	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994640	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994641	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994642	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994643	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994644	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994645	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
5994646	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994647	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994648	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994649	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994650	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 intermediate metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
5994652	adults	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer, and the probability of attainment of therapeutic concentrations is small. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
5994653	adults	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer, and the probability of attainment of therapeutic concentrations is modest. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
5994654	adults	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
5994655	adults	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
5994656	adults	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
5994657	adults	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
5994658	adults	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
5994659	adults	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
5994660	pediatrics	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:121243	{"CYP2C19 genotype may be important for voriconazole dosing and use. A CYP2C19 genotype does not appear to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994661	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer, and the probability of attainment of therapeutic concentrations is small. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
5994662	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer, and the probability of attainment of therapeutic concentrations is variable. Initiate therapy with recommended standard of care dosing. Meticulous therapeutic drug monitoring to titrate dose to therapeutic trough concentrations is critical due to large variability in trough concentrations in rapid metabolizers. Please consult a clinical pharmacist for more information."}	1
5994663	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
5994664	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
5994665	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
5994687	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1191	{n/a}	1
5994688	aspirin <1g	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1191	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994666	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely with normal starting dosages and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
5994667	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely with normal starting dosages and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
5994668	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
5994669	general	Pre-test	{HLA-B}	{}	{}	{"HLA-B": "No *57:01 result on file"}	{"HLA-B": "No *57:01 result on file"}	RxNorm:190521	{"A HLA-B*57:01 genotype test is recommended before prescribing abacavir per the FDA's black box warning regarding the risk of serious hypersensitivity reactions in patients that carry this allele. A HLA-B*57:01 genotype test does not appear to have been ordered for this patient. Please do the following to order the HLA-B*57:01 genotype test (insert dialogue boxes here to order clinical HLA-B test)."}	1
5994670	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*57:01 negative"}	{"HLA-B": "*57:01 negative"}	RxNorm:190521	{n/a}	1
5994671	general	Post-test	{HLA-B}	{}	{}	{"HLA-B": "*57:01 positive"}	{"HLA-B": "*57:01 positive"}	RxNorm:190521	{"The HLA-B*57:01 allele has been detected in this patient. This allele is associated with high risk of severe hypersensitivity to abacavir. DO NOT prescribe abacavir per the FDA's black box warning. Please choose an alternate antiretroviral. For more information, please consult a clinical pharmacist."}	1
5994672	general	Pre-test	{HLA-B}	{}	{}	{"HLA-B": "No *58:01 result on file"}	{"HLA-B": "No *58:01 result on file"}	RxNorm:519	{"An HLA-B*58:01 genotype test does not appear to have been ordered for this patient. Patients who carry this allele are at increased risk of serious dermatologic reactions with the use of allopurinol, including Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Please consult a clinical pharmacist for more information."}	1
5994673	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*58:01 negative"}	{"HLA-B": "*58:01 negative"}	RxNorm:519	{n/a}	1
5994674	general	Post-test	{HLA-B}	{}	{}	{"HLA-B": "*58:01 positive"}	{"HLA-B": "*58:01 positive"}	RxNorm:519	{"The patient carries the HLA-B*58:01 allele, which indicates that the patient is at risk of developing a serious dermatologic reaction, including Toxic Epidermal Necrolysis or Stevens-Johnson Syndrome. Allopurinol is contraindicated. Please consult a clinical pharmacist for more information."}	1
5994675	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5994676	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{n/a}	1
5994677	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{n/a}	1
5994678	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:641	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994679	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7833	{n/a}	1
5994680	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7833	{n/a}	1
5994681	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7833	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994682	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7833	{n/a}	1
5994683	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7833	{n/a}	1
5994684	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7833	{n/a}	1
5994691	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994692	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994693	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994694	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994695	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 Intermediate metabolizer and may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994696	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994697	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994698	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994699	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994883	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:5489	{n/a}	1
5994700	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994701	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994702	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994703	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994704	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994705	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994706	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994707	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994719	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994708	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994709	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994710	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
5994711	adults	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
5994712	adults	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:38400	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994713	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994714	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994715	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994716	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
5994717	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994718	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994720	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994721	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994722	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994723	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994724	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994725	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994726	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994727	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994728	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994729	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994807	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994730	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994731	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994732	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994733	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
5994734	pediatrics	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
5994735	pediatrics	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:38400	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994736	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994737	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994738	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
5994739	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994740	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994741	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity."}	1
5994742	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994743	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994744	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994745	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994746	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day, (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994747	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994808	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994884	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:5489	{n/a}	1
5994748	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994749	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day, (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994750	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994751	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994752	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994753	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994754	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994885	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:5489	{n/a}	1
5994755	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994756	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994757	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994758	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994759	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994760	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994761	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994762	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994763	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{n/a}	1
5994764	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994765	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994766	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994767	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994768	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994769	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994770	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994809	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994771	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
5994772	general	Pre-test	{DPYD}	{}	{"DPYD": "No Result"}	{}	{"DPYD": "No Result"}	RxNorm:194000	{"DPYD genotype may be useful for capecitabine dosing and use. A DPYD genotype does not appear to have been ordered for this patient. Use of an alternative dose or agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994773	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:194000	{n/a}	1
5994774	general	Post-test	{DPYD}	{}	{"DPYD": "1.5"}	{}	{"DPYD": "1.5"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1.5) and has an increased risk of severe toxicity when treated with capecitabine. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
5994775	general	Post-test	{DPYD}	{}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1) and has an increased risk of severe toxicity when treated with capecitabine. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
5994776	general	Post-test	{DPYD}	{}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0.5) and has an increased risk of severe toxicity when treated with capecitabine. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, capecitabine should be administered at a strongly reduced dose with early therapeutic drug monitoring in order to immediately discontinue therapy if the drug level is too high. If available, a phenotyping test should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on capecitabine clearance. Please consult a clinical pharmacist for more information."}	1
5994777	general	Post-test	{DPYD}	{}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0) and has an increased risk of severe toxicity when treated with capecitabine. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. Please consult a clinical pharmacist for more information."}	1
5994778	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:140587	{"CYP2C9 genotype may be important for celecoxib dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994779	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:140587	{n/a}	1
5994780	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:140587	{n/a}	1
5994781	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
5994782	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 8 days for celecoxib). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994810	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994783	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 8 days for celecoxib). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994784	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:140587	{n/a}	1
5994785	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2348	{n/a}	1
5994786	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2348	{n/a}	1
5994787	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2348	{n/a}	1
5994788	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2348	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994789	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2348	{n/a}	1
5994790	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2348	{n/a}	1
5994791	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2393	{n/a}	1
5994792	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2393	{n/a}	1
5994793	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2393	{n/a}	1
5994794	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2393	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994795	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2393	{n/a}	1
5994796	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2393	{n/a}	1
5994797	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2551	{n/a}	1
5994798	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2551	{n/a}	1
5994799	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2551	{n/a}	1
5994800	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2551	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994801	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2551	{n/a}	1
5994802	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2551	{n/a}	1
5994803	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994804	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:2670	{"CYP2D6 genotype is important for codeine and tramadol dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than tramadol) may be recommended. Please consult a clinical pharmacist for more information."}	1
5994805	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994806	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994886	Hydrocodone	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:5489	{"CYP2D6 genotype may be important for hydrocodone dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than codeine and tramadol) may be recommended. Please consult a clinical pharmacist for more information."}	1
5994814	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994815	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:2670	{n/a}	1
5994816	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:2670	{n/a}	1
5994817	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:2670	{n/a}	1
5994818	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:2670	{n/a}	1
5994819	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:2670	{n/a}	1
5994820	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994821	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994822	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994823	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994824	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 poor metabolizer and is at risk of having no analgesic response to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994825	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:2670	{n/a}	1
5994826	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3108	{"G6PD status may be predictive of hemolytic anemia with dapsone. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5994827	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3108	{n/a}	1
5994828	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3108	{"This patient has a result consistent with G6PD deficiency. Dapsone is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Stronlgy consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient very closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5994829	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3108	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Dapsone is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5994830	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3108	{"You are attempting to place an order for dapsone on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and dapsone is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5994831	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3108	{"You are attempting to place an order for dapsone on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and dapsone is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5994832	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{n/a}	1
5994833	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:3328	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994834	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5994835	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{n/a}	1
5994836	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3445	{n/a}	1
5994837	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3445	{n/a}	1
5994838	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3445	{n/a}	1
5994839	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3445	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994840	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3445	{n/a}	1
5994841	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3445	{n/a}	1
5994842	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3639	{n/a}	1
5994843	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3639	{n/a}	1
5994844	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3639	{n/a}	1
5994845	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3639	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994846	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3639	{n/a}	1
5994847	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3639	{n/a}	1
5994848	general	Pre-test	{DPYD}	{}	{"DPYD": "No Result"}	{}	{"DPYD": "No Result"}	RxNorm:4492	{"DPYD genotype may be useful for 5-fluorouracil dosing and use. A DPYD genotype does not appear to have been ordered for this patient. Use of an alternative dose or agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994849	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:4492	{n/a}	1
5994850	general	Post-test	{DPYD}	{}	{"DPYD": "1.5"}	{}	{"DPYD": "1.5"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1.5) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
5994851	general	Post-test	{DPYD}	{}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
5994852	general	Post-test	{DPYD}	{}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0.5) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, 5-fluorouracil should be administered at a strongly reduced dose with early therapeutic drug monitoring in order to immediately discontinue therapy if the drug level is too high. If available, a phenotyping test should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on 5-fluorouracil clearance. Please consult a clinical pharmacist for more information."}	1
5994853	general	Post-test	{DPYD}	{}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. Please consult a clinical pharmacist for more information."}	1
5994854	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:4502	{"CYP2C9 genotype may be important for flurbiprofen dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994855	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:4502	{n/a}	1
5994857	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
5994858	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for flurbiprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994859	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for flurbiprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994860	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:4502	{n/a}	1
5994861	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4601	{n/a}	1
5994862	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4601	{n/a}	1
5994863	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4601	{n/a}	1
5994864	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:4601	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994865	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4601	{n/a}	1
5994866	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4601	{n/a}	1
5994867	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	ATC:D06AX07	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994868	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5994869	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{n/a}	1
5994870	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{n/a}	1
5994871	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4815	{n/a}	1
5994872	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4815	{n/a}	1
5994873	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4815	{n/a}	1
5994874	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:4815	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994875	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4815	{n/a}	1
5994876	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4815	{n/a}	1
5994877	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:5489	{n/a}	1
5994894	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994895	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994896	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994897	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994898	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 poor metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
5994899	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:5489	{n/a}	1
5994900	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:5521	{n/a}	1
5994901	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:5521	{n/a}	1
5994902	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:5521	{n/a}	1
5994903	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:5521	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994904	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:5521	{n/a}	1
5994905	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:5521	{n/a}	1
5994906	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:5640	{"CYP2C9 genotype may be important for ibuprofen dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994907	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:5640	{n/a}	1
5994908	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:5640	{n/a}	1
5994909	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
5994910	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for ibuprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994977	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:6878	{"You are attempting to place an order for methylene blue on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and methylene blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5994911	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for ibuprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994912	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:5640	{n/a}	1
5994913	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:6099	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5994914	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5994915	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{n/a}	1
5994916	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{n/a}	1
5994917	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:20890	{"CYP2C9 genotype may be important for lornoxicam dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
5994918	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:20890	{n/a}	1
5994919	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:20890	{n/a}	1
5994920	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
5994921	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for lornoxicam). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994922	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for lornoxicam). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
5994923	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:20890	{n/a}	1
5994924	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6572	{n/a}	1
5994925	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6572	{n/a}	1
5994926	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6572	{n/a}	1
5994927	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:6572	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5994933	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Initiate therapy with 50% of the lowest recommended starting dose. Titrate dose to clinical effect or 50% of the maximum recommended dose with caution. In accordance with the meloxicam prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 7 days). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider alternative therapy. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, celecoxib, fluriprofen, lornoxicam, and ibuprofen). Please consult a clinical pharmacist for more information."}	1
5994934	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, flurbiprofen, lornoxicam, or ibuprofen). Please consult a clinical pharmacist for more information."}	1
5994935	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, flurbiprofen, lornoxicam, or ibuprofen). Please consult a clinical pharmacist for more information."}	1
5994936	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:41493	{n/a}	1
5994937	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994938	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994939	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994940	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994978	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:6878	{"You are attempting to place an order for methylene blue on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and methylene blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5994941	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity."}	1
5994942	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. Initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994943	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994944	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994945	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994946	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994947	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994948	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. Initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994949	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5994950	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994951	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994952	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994953	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already <75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5995045	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8120	{n/a}	1
5995046	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8120	{n/a}	1
5994954	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994955	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994956	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994957	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994958	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994959	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already <75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994979	general	Pre-test	{CYP2D6}	{"CYP2D6": "No Result"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:6918	{"CYP2D6 genotype may be important for metoprolol dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
5994980	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": ">2.25"}	{}	{"CYP2D6": ">2.25"}	RxNorm:6918	{n/a}	1
5994981	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:6918	{n/a}	1
5994960	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994961	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994962	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994963	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994964	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994965	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{n/a}	1
5994966	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
5994967	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5994982	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:6918	{n/a}	1
5994983	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:6918	{n/a}	1
5994968	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5994969	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994970	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994971	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week, (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994972	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5994973	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6878	{"G6PD status may be predictive of hemolytic anemia with methylene blue. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5994974	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6878	{n/a}	1
5994975	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6878	{"This patient has a result consistent with G6PD deficiency. Methylene blue is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5994976	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:6878	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Methylene blue is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5994984	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:6918	{n/a}	1
5995001	general	Post-test	{CYP2D6}	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:6918	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at risk of greater heart rate and blood pressure reductions with metoprolol. Initiate therapy with lowest recommended starting dose. Carefully titrate dose upward to clinical effect or guideline-recommended dose; closely monitor for bradycardia. Alternatively, consider selecting another beta-blocker. Please consult a clinical pharmacist for more information."}	1
5995002	general	No CDS	{CYP2D6}	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:6918	{n/a}	1
5995003	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7240	{n/a}	1
5995004	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7240	{n/a}	1
5995005	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7240	{n/a}	1
5995006	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7240	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995007	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7240	{n/a}	1
5995008	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7240	{n/a}	1
5995009	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{n/a}	1
5995010	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7299	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995011	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995012	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{n/a}	1
5995013	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995014	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{n/a}	1
5995015	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{n/a}	1
5995016	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7337	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995017	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7454	{"This patient has a result consistent with G6PD deficiency. Use nitrofurantoin with caution and monitor the patient for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5995018	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7454	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Nitrofurantoin may cause hemolytic anemia and worsen any existing anemia and should be avoided. Consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995019	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7454	{"G6PD status may be predictive of hemolytic anemia with nitrofurantoin. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Increased monitoring for signs of hemolysis may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5995020	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7454	{n/a}	1
5995021	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7454	{"You are attempting to place an order for nitrofurantoin on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and nitrofurantoin is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995047	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8120	{n/a}	1
5995022	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7454	{"You are attempting to place an order for nitrofurantoin on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and nitrofurantoin is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995023	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7517	{n/a}	1
5995024	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7517	{n/a}	1
5995025	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7517	{n/a}	1
5995026	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7517	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995027	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7517	{n/a}	1
5995028	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7517	{n/a}	1
5995029	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7623	{n/a}	1
5995030	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7623	{n/a}	1
5995031	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7623	{n/a}	1
5995032	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7623	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995033	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7623	{n/a}	1
5995034	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7623	{n/a}	1
5995035	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7934	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995036	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995037	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{n/a}	1
5995038	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{n/a}	1
5995039	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1011650	{"G6PD status may be predictive of hemolytic anemia with pegloticase. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5995040	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1011650	{n/a}	1
5995041	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1011650	{"This patient has a result consistent with G6PD deficiency. Pegloticase is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5995042	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1011650	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Pegloticase is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Stronlgy consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995043	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1011650	{"You are attempting to place an order for pegloticase on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and pegloticase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995044	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1011650	{"You are attempting to place an order for pegloticase on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and pegloticase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995048	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:8120	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995049	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8120	{n/a}	1
5995050	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:8120	{n/a}	1
5995051	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:2049549	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995052	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995053	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{n/a}	1
5995054	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{n/a}	1
5995055	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8687	{"G6PD status may be predictive of hemolytic anemia with primaquine, depending on the primaquine dosage regimen. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Increased monitoring for signs of hemolysis or alternative agent may be recommended if the patient is G6PD deficient, depending on dosage. Please consult a clinical pharmacist for more information."}	1
5995056	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8687	{n/a}	1
5995057	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8687	{"This patient has a result consistent with G6PD deficiency. Avoid primaquine, except in the following cases where established expert consensus guidelines for the treatment of malaria should be followed: (1) Treating Plasmodium falciparum malaria by using primaquine as a gametocytocide: 0.25 mg/kg x1 dose (WHO)--without need for monitoring for hemolysis; and (2) treating Plasmodium vivax or Plasmodium ovale malaria for radical cure of liver-stage infections: 0.75 mg/kg once weekly x8 weeks (WHO) or 45 mg once weekly x8 weeks (CDC)---with close monitoring for hemolysis. Please consult a clinical pharmacist for more information."}	1
5995058	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:8687	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Primaquine is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995059	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8687	{"You are attempting to place an order for primaquine on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and primaquine is prescribed, depending on the dose. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995060	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:8687	{"You are attempting to place an order for primaquine on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and primaquine is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995061	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9071	{n/a}	1
5995062	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9071	{n/a}	1
5995063	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9071	{n/a}	1
5995064	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:9071	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995065	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9071	{n/a}	1
5995066	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9071	{n/a}	1
5995067	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:283821	{"G6PD status may be predictive of hemolytic anemia with rasburicase. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5995068	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:283821	{n/a}	1
5995069	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:283821	{"This patient has a result consistent with G6PD deficiency. Rasburicase is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5995070	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:283821	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Rasburicase is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995071	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:283821	{"You are attempting to place an order for rasburicase on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and rasburicase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995072	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:283821	{"You are attempting to place an order for rasburicase on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and rasburicase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995073	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{n/a}	1
5995074	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:NA	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995075	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995076	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{n/a}	1
5995077	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:10109	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995078	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995079	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{n/a}	1
5995080	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{n/a}	1
5995081	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10171	{n/a}	1
5995082	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10171	{n/a}	1
5995083	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10171	{n/a}	1
5995084	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10171	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995085	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10171	{n/a}	1
5995086	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10171	{n/a}	1
5995087	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10178	{n/a}	1
5995088	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10178	{n/a}	1
5995089	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10178	{n/a}	1
5995090	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10178	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995096	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10831	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995097	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10831	{n/a}	1
5995098	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10831	{n/a}	1
5995099	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10184	{n/a}	1
5995100	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10184	{n/a}	1
5995101	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10184	{n/a}	1
5995102	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10184	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995103	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10184	{n/a}	1
5995104	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10184	{n/a}	1
5995105	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9524	{n/a}	1
5995106	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9524	{n/a}	1
5995107	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9524	{n/a}	1
5995108	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:9524	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995109	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9524	{n/a}	1
5995110	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9524	{n/a}	1
5995111	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10207	{n/a}	1
5995112	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10207	{n/a}	1
5995113	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10207	{n/a}	1
5995114	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10207	{n/a}	1
5995115	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10207	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995116	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10207	{n/a}	1
5995117	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2054023	{"G6PD status is predictive of hemolytic anemia with tafenoquine. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5995118	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2054023	{n/a}	1
5995119	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2054023	{"This patient has a result consistent with G6PD deficiency. Tafenoquine is likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided; tafenoquine safety was demonstrated only in those with G6PD activity ≥70% of normal. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient very closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5995120	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2054023	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Tafenoquine is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995121	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2054023	{"You are attempting to place an order for tafenoquine on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient or if G6PD activity is less than 70% of normal and tafenoquine is prescribed; in such cases, alternatives to tafenoquine should be strongly considered. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995122	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2054023	{"You are attempting to place an order for tafenoquine on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient or if G6PD activity is less than 70% of normal and tafenoquine is prescribed; in such cases, alternatives to tafenoquine should be strongly considered. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995123	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thioguanine is required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity."}	1
5995124	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
5995125	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995126	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995127	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995128	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, TPMT phenotype could not be assigned based on genotyping performed. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995159	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:10627	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
5995129	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995130	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5995131	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5995132	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5995133	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5995134	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g. 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
5995135	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995136	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5995137	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995138	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995139	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995140	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995141	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995142	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5995198	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:27392	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative drug may be recommended. Please consult a clinical pharmacist for more information."}	1
5995143	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995144	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g. 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995145	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995146	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995147	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995148	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5995149	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995150	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{n/a}	1
5995151	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995152	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
5995153	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
5995154	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
5995155	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995156	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995157	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995158	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
5995223	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:39786	{n/a}	1
5995224	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:39786	{n/a}	1
5995160	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
5995161	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{n/a}	1
5995162	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{n/a}	1
5995163	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10635	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995164	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10635	{n/a}	1
5995165	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10635	{n/a}	1
5995166	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10635	{n/a}	1
5995167	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10635	{n/a}	1
5995168	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10635	{n/a}	1
5995169	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10638	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Toluidine blue is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
5995170	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10638	{"G6PD status may be predictive of hemolytic anemia with toluidine blue. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
5995171	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10638	{n/a}	1
5995172	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10638	{"This patient has a result consistent with G6PD deficiency. Toluidine blue is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If this medication is the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
5995173	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10638	{"You are attempting to place an order for toluidine blue on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and toluidine blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995174	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10638	{"You are attempting to place an order for toluidine blue on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and toluidine blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
5995175	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:10689	{n/a}	1
5995176	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:10689	{n/a}	1
5995177	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:10689	{n/a}	1
5995178	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:10689	{"CYP2D6 genotype is important for tramadol and codeine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than codeine) may be recommended. Please consult a clinical pharmacist for more information."}	1
5995179	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995180	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995225	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:39786	{"CYP2D6 genotype may be important for venlafaxine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
5995181	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995182	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995183	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995184	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995185	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995186	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995187	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995188	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995189	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995190	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:10689	{n/a}	1
5995191	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:10689	{n/a}	1
5995192	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadole and codeine. Please consult a clinical pharmacist for more information."}	1
5995193	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995194	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995195	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995196	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 poor metabolizer and is at risk of having no analgesic response. Consider selecting an alternative analgesic agent to tramadol and codeine. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
5995197	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:10689	{n/a}	1
5995226	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:39786	{n/a}	1
5995199	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995200	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995201	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995202	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995203	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995204	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995205	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995206	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995207	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995208	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995209	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
5995210	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:27392	{n/a}	1
5995211	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:27392	{n/a}	1
5995212	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:27392	{n/a}	1
5995213	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:27392	{n/a}	1
5995214	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:27392	{n/a}	1
5995215	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:27392	{n/a}	1
5995216	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:27392	{n/a}	1
5995217	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:27392	{n/a}	1
5995218	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:27392	{n/a}	1
5995219	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:27392	{n/a}	1
5995220	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:27392	{n/a}	1
5995221	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:39786	{n/a}	1
5995222	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:39786	{n/a}	1
5995242	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:39786	{"Based on the genotype result, this patient is predicted to be a CYP2D6 poor metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6. Please consult a clinical pharmacist for more information."}	1
5995243	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:39786	{n/a}	1
5995244	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1151	{n/a}	1
5995245	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1151	{n/a}	1
5995246	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1151	{n/a}	1
5995247	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1151	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995248	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1151	{n/a}	1
5995249	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1151	{n/a}	1
5995250	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:11258	{n/a}	1
5995251	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:11258	{n/a}	1
5995252	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:11258	{n/a}	1
5995253	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:11258	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
5995254	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:11258	{n/a}	1
5995255	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:11258	{n/a}	1
5995256	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:1455099	{"CYP2D6 genotype may be important for vortioxetine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
5995257	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995258	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995259	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995260	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995261	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995262	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995263	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995264	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995265	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995266	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995267	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
5995268	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:1455099	{n/a}	1
5995269	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:1455099	{n/a}	1
5995270	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:1455099	{n/a}	1
5995271	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:1455099	{n/a}	1
5995272	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:1455099	{n/a}	1
5995273	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:1455099	{n/a}	1
5995274	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:1455099	{n/a}	1
5995275	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:1455099	{n/a}	1
5995276	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:1455099	{n/a}	1
5995277	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 poor metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6. Please consult a clinical pharmacist for more information."}	1
5995278	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:1455099	{n/a}	1
\.


--
-- Name: cpic_id; Type: SEQUENCE SET; Schema: cpic; Owner: -
--

SELECT pg_catalog.setval('cpic.cpic_id', 5995278, true);


--
-- Name: allele_definition allele_definition_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_definition
    ADD CONSTRAINT allele_definition_pkey PRIMARY KEY (id);


--
-- Name: allele_definition allele_definition_unique; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_definition
    ADD CONSTRAINT allele_definition_unique UNIQUE (genesymbol, name);


--
-- Name: allele_frequency allele_frequency_alleleid_population_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_frequency
    ADD CONSTRAINT allele_frequency_alleleid_population_key UNIQUE (alleleid, population);


--
-- Name: allele allele_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele
    ADD CONSTRAINT allele_pkey PRIMARY KEY (id);


--
-- Name: allele allele_unique; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele
    ADD CONSTRAINT allele_unique UNIQUE (genesymbol, name);


--
-- Name: sequence_location chromosomelocation_unique; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.sequence_location
    ADD CONSTRAINT chromosomelocation_unique UNIQUE (chromosomelocation);


--
-- Name: drug drug_name_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.drug
    ADD CONSTRAINT drug_name_key UNIQUE (name);


--
-- Name: drug drug_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.drug
    ADD CONSTRAINT drug_pkey PRIMARY KEY (drugid);


--
-- Name: file_artifact file_artifact_filename_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.file_artifact
    ADD CONSTRAINT file_artifact_filename_key UNIQUE (filename);


--
-- Name: file_artifact_history file_artifact_history_fileid_changedate_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.file_artifact_history
    ADD CONSTRAINT file_artifact_history_fileid_changedate_key UNIQUE (fileid, changedate);


--
-- Name: file_artifact_history file_artifact_history_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.file_artifact_history
    ADD CONSTRAINT file_artifact_history_pkey PRIMARY KEY (id);


--
-- Name: file_artifact file_artifact_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.file_artifact
    ADD CONSTRAINT file_artifact_pkey PRIMARY KEY (id);


--
-- Name: flyway_schema_history flyway_schema_history_pk; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.flyway_schema_history
    ADD CONSTRAINT flyway_schema_history_pk PRIMARY KEY (installed_rank);


--
-- Name: gene gene_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene
    ADD CONSTRAINT gene_pkey PRIMARY KEY (symbol);


--
-- Name: gene_result_diplotype gene_result_diplotype_functionphenotypeid_diplotypekey_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result_diplotype
    ADD CONSTRAINT gene_result_diplotype_functionphenotypeid_diplotypekey_key UNIQUE (functionphenotypeid, diplotypekey);


--
-- Name: gene_result_diplotype gene_result_diplotype_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result_diplotype
    ADD CONSTRAINT gene_result_diplotype_pkey PRIMARY KEY (id);


--
-- Name: gene_result gene_result_genesymbol_result_activityscore_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result
    ADD CONSTRAINT gene_result_genesymbol_result_activityscore_key UNIQUE (genesymbol, result, activityscore);


--
-- Name: gene_result_lookup gene_result_lookup_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result_lookup
    ADD CONSTRAINT gene_result_lookup_pkey PRIMARY KEY (id);


--
-- Name: gene_result gene_result_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result
    ADD CONSTRAINT gene_result_pkey PRIMARY KEY (id);


--
-- Name: guideline guideline_name_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.guideline
    ADD CONSTRAINT guideline_name_key UNIQUE (name);


--
-- Name: guideline guideline_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.guideline
    ADD CONSTRAINT guideline_pkey PRIMARY KEY (id);


--
-- Name: guideline guideline_url_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.guideline
    ADD CONSTRAINT guideline_url_key UNIQUE (url);


--
-- Name: pair pair_genesymbol_drugid_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.pair
    ADD CONSTRAINT pair_genesymbol_drugid_key UNIQUE (genesymbol, drugid);


--
-- Name: pair pair_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.pair
    ADD CONSTRAINT pair_pkey PRIMARY KEY (pairid);


--
-- Name: population population_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.population
    ADD CONSTRAINT population_pkey PRIMARY KEY (id);


--
-- Name: publication publication_doi; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_doi UNIQUE (doi);


--
-- Name: publication publication_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_pkey PRIMARY KEY (id);


--
-- Name: publication publication_pmcid; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_pmcid UNIQUE (pmcid);


--
-- Name: publication publication_pmid; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_pmid UNIQUE (pmid);


--
-- Name: publication_supplement publication_supplement_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication_supplement
    ADD CONSTRAINT publication_supplement_pkey PRIMARY KEY (id);


--
-- Name: publication_supplement publication_supplement_publicationid_url_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication_supplement
    ADD CONSTRAINT publication_supplement_publicationid_url_key UNIQUE (publicationid, url);


--
-- Name: publication publication_title_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_title_key UNIQUE (title);


--
-- Name: recommendation recommendation_guidelineid_drugid_population_lookupkey_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.recommendation
    ADD CONSTRAINT recommendation_guidelineid_drugid_population_lookupkey_key UNIQUE (guidelineid, drugid, population, lookupkey);


--
-- Name: recommendation recommendation_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.recommendation
    ADD CONSTRAINT recommendation_pkey PRIMARY KEY (id);


--
-- Name: sequence_location sequence_location_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.sequence_location
    ADD CONSTRAINT sequence_location_pkey PRIMARY KEY (id);


--
-- Name: statistic statistic_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.statistic
    ADD CONSTRAINT statistic_pkey PRIMARY KEY (createdon, stattype);


--
-- Name: term term_category_term_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.term
    ADD CONSTRAINT term_category_term_key UNIQUE (category, term);


--
-- Name: term term_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.term
    ADD CONSTRAINT term_pkey PRIMARY KEY (id);


--
-- Name: test_alert test_alert_drugid_population_lookupkey_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.test_alert
    ADD CONSTRAINT test_alert_drugid_population_lookupkey_key UNIQUE (drugid, population, lookupkey);


--
-- Name: test_alert test_alert_pkey; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.test_alert
    ADD CONSTRAINT test_alert_pkey PRIMARY KEY (id);


--
-- Name: flyway_schema_history_s_idx; Type: INDEX; Schema: cpic; Owner: -
--

CREATE INDEX flyway_schema_history_s_idx ON cpic.flyway_schema_history USING btree (success);


--
-- Name: publication_guidelineid_idx; Type: INDEX; Schema: cpic; Owner: -
--

CREATE INDEX publication_guidelineid_idx ON cpic.publication USING btree (guidelineid);


--
-- Name: publication_guidelineid_idx1; Type: INDEX; Schema: cpic; Owner: -
--

CREATE INDEX publication_guidelineid_idx1 ON cpic.publication USING btree (guidelineid);


--
-- Name: allele version_allele; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_allele BEFORE UPDATE ON cpic.allele FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: allele_definition version_allele_definition; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_allele_definition BEFORE UPDATE ON cpic.allele_definition FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: allele_frequency version_allele_frequency; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_allele_frequency BEFORE UPDATE ON cpic.allele_frequency FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: allele_location_value version_allele_location_value; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_allele_location_value BEFORE UPDATE ON cpic.allele_location_value FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: change_log version_change_log; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_change_log BEFORE UPDATE ON cpic.change_log FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: drug version_drug; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_drug BEFORE UPDATE ON cpic.drug FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: file_note version_file_note; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_file_note BEFORE UPDATE ON cpic.file_note FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: gene version_gene; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_gene BEFORE UPDATE ON cpic.gene FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: gene_result version_gene_result; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_gene_result BEFORE UPDATE ON cpic.gene_result FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: guideline version_guideline; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_guideline BEFORE UPDATE ON cpic.guideline FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: pair version_pair; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_pair BEFORE UPDATE ON cpic.pair FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: population version_population; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_population BEFORE UPDATE ON cpic.population FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: publication version_publication; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_publication BEFORE UPDATE ON cpic.publication FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: publication_supplement version_publication_supplement; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_publication_supplement BEFORE UPDATE ON cpic.publication_supplement FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: recommendation version_recommendation; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_recommendation BEFORE UPDATE ON cpic.recommendation FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: sequence_location version_sequence_location; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_sequence_location BEFORE UPDATE ON cpic.sequence_location FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: term version_term; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_term BEFORE UPDATE ON cpic.term FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: test_alert version_test_alert; Type: TRIGGER; Schema: cpic; Owner: -
--

CREATE TRIGGER version_test_alert BEFORE UPDATE ON cpic.test_alert FOR EACH ROW EXECUTE FUNCTION cpic.increment_version();


--
-- Name: allele allele_definitionid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele
    ADD CONSTRAINT allele_definitionid_fkey FOREIGN KEY (definitionid) REFERENCES cpic.allele_definition(id);


--
-- Name: allele_definition allele_definitions_for_gene; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_definition
    ADD CONSTRAINT allele_definitions_for_gene FOREIGN KEY (genesymbol) REFERENCES cpic.gene(symbol);


--
-- Name: allele_frequency allele_frequency_alleleid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_frequency
    ADD CONSTRAINT allele_frequency_alleleid_fkey FOREIGN KEY (alleleid) REFERENCES cpic.allele(id);


--
-- Name: allele_frequency allele_frequency_population_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_frequency
    ADD CONSTRAINT allele_frequency_population_fkey FOREIGN KEY (population) REFERENCES cpic.population(id);


--
-- Name: allele allele_genesymbol_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele
    ADD CONSTRAINT allele_genesymbol_fkey FOREIGN KEY (genesymbol) REFERENCES cpic.gene(symbol);


--
-- Name: allele_location_value allele_location_value_alleledefinitionid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_location_value
    ADD CONSTRAINT allele_location_value_alleledefinitionid_fkey FOREIGN KEY (alleledefinitionid) REFERENCES cpic.allele_definition(id);


--
-- Name: allele_location_value allele_location_value_locationid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.allele_location_value
    ADD CONSTRAINT allele_location_value_locationid_fkey FOREIGN KEY (locationid) REFERENCES cpic.sequence_location(id);


--
-- Name: file_artifact_history file_artifact_history_fileid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.file_artifact_history
    ADD CONSTRAINT file_artifact_history_fileid_fkey FOREIGN KEY (fileid) REFERENCES cpic.file_artifact(id);


--
-- Name: gene_result_diplotype gene_result_diplotype_functionphenotypeid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result_diplotype
    ADD CONSTRAINT gene_result_diplotype_functionphenotypeid_fkey FOREIGN KEY (functionphenotypeid) REFERENCES cpic.gene_result_lookup(id);


--
-- Name: gene_result gene_result_genesymbol_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result
    ADD CONSTRAINT gene_result_genesymbol_fkey FOREIGN KEY (genesymbol) REFERENCES cpic.gene(symbol);


--
-- Name: gene_result_lookup gene_result_lookup_phenotypeid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.gene_result_lookup
    ADD CONSTRAINT gene_result_lookup_phenotypeid_fkey FOREIGN KEY (phenotypeid) REFERENCES cpic.gene_result(id);


--
-- Name: drug guideline_for_drug; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.drug
    ADD CONSTRAINT guideline_for_drug FOREIGN KEY (guidelineid) REFERENCES cpic.guideline(id);


--
-- Name: pair pair_drugid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.pair
    ADD CONSTRAINT pair_drugid_fkey FOREIGN KEY (drugid) REFERENCES cpic.drug(drugid);


--
-- Name: pair pair_genesymbol_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.pair
    ADD CONSTRAINT pair_genesymbol_fkey FOREIGN KEY (genesymbol) REFERENCES cpic.gene(symbol);


--
-- Name: pair pair_guidelineid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.pair
    ADD CONSTRAINT pair_guidelineid_fkey FOREIGN KEY (guidelineid) REFERENCES cpic.guideline(id);


--
-- Name: population population_publicationid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.population
    ADD CONSTRAINT population_publicationid_fkey FOREIGN KEY (publicationid) REFERENCES cpic.publication(id);


--
-- Name: publication publication_guidelineid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication
    ADD CONSTRAINT publication_guidelineid_fkey FOREIGN KEY (guidelineid) REFERENCES cpic.guideline(id);


--
-- Name: publication_supplement publication_supplement_publicationid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.publication_supplement
    ADD CONSTRAINT publication_supplement_publicationid_fkey FOREIGN KEY (publicationid) REFERENCES cpic.publication(id);


--
-- Name: recommendation recommendation_drugid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.recommendation
    ADD CONSTRAINT recommendation_drugid_fkey FOREIGN KEY (drugid) REFERENCES cpic.drug(drugid);


--
-- Name: recommendation recommendation_guidelineid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.recommendation
    ADD CONSTRAINT recommendation_guidelineid_fkey FOREIGN KEY (guidelineid) REFERENCES cpic.guideline(id);


--
-- Name: sequence_location sequence_location_genesymbol_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.sequence_location
    ADD CONSTRAINT sequence_location_genesymbol_fkey FOREIGN KEY (genesymbol) REFERENCES cpic.gene(symbol);


--
-- Name: test_alert test_alert_drugid_fkey; Type: FK CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.test_alert
    ADD CONSTRAINT test_alert_drugid_fkey FOREIGN KEY (drugid) REFERENCES cpic.drug(drugid);


--
--

