6475671	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid 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 doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475672	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475673	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475674	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475675	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475676	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475677	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475678	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476983	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:6918	{n/a}	1
6475679	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475680	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475681	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475682	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475683	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475684	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475685	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475686	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:3638	{"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 ultarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2D6 genotype does not appear to have been ordered for this patient. CYP2D6 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475687	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475688	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 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.Please consult a clinical pharmacist for more information."}	1
6475872	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "1.5"}	RxNorm:72236	{"HLA-B*15:02 genotype may be important for fosphenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6475689	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475690	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475691	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475692	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475693	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475694	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475695	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin 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
6475696	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475697	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475698	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475699	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475873	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.5"}	RxNorm:72236	{n/a}	1
6476984	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:6918	{n/a}	1
6475700	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475701	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475702	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475703	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475704	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475705	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475706	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475707	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Indeterminate"}	RxNorm:3638	{n/a}	1
6475708	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Indeterminate"}	RxNorm:3638	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. 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
6475709	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475710	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475898	general	No CDS	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:5095	{n/a}	1
6476985	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:6918	{n/a}	1
6475711	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475712	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475713	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475714	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475715	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475716	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475717	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475718	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475719	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475720	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475721	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475722	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475723	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475899	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "No Result"}	RxNorm:5691	{"CYP2C19 genotype may be important for imipramine dosing and use. A CYP2C19 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
6475724	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475725	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475726	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475727	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475728	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475729	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475730	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475731	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{n/a}	1
6475732	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:3638	{"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 likely 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
6475733	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475734	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476986	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:6918	{n/a}	1
6475735	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475736	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475737	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475738	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475739	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475740	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475741	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475742	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475743	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475744	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475745	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475746	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475747	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475748	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475749	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475750	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475751	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475752	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475753	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475754	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:3638	{"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 likely 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 doxepin 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
6475900	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "No Result"}	RxNorm:5691	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. Neither a CYP2D6 nor CYP2C19 genotype appears to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
6475755	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 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. 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
6475756	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "No Result"}	RxNorm:3638	{"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 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. 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
6475757	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "No Result"}	RxNorm:3638	{"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 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. 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
6475758	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "No Result"}	RxNorm:3638	{"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 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. 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
6475759	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "No Result"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475760	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475761	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "No Result"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475762	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "No Result"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475763	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "No Result"}	RxNorm:3638	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475764	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476987	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:6918	{n/a}	1
6475765	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475766	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475767	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475768	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475769	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475770	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475771	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475772	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475773	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476988	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:6918	{n/a}	1
6475774	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475775	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "No Result"}	RxNorm:3638	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475776	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "No Result"}	RxNorm:3638	{"CYP2C19 genotype may be important for doxepin dosing and use. A CYP2C19 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
6475777	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "No Result"}	RxNorm:3638	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. Neither a CYP2D6 nor CYP2C19 genotype appears to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
6475778	general	No CDS	{CYP2B6}	{"CYP2B6": "Indeterminate"}	{}	{}	{"CYP2B6": "Indeterminate"}	RxNorm:195085	{n/a}	1
6475779	general	Pre-test	{CYP2B6}	{"CYP2B6": "No Result"}	{}	{}	{"CYP2B6": "No Result"}	RxNorm:195085	{"CYP2B6 genetic status may be predictive of adverse events with efavirenz. A CYP2B6 genotype does not appear to have been ordered for this patient. A decreased dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6475780	general	No CDS	{CYP2B6}	{"CYP2B6": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer"}	RxNorm:195085	{n/a}	1
6475781	general	No CDS	{CYP2B6}	{"CYP2B6": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer"}	RxNorm:195085	{n/a}	1
6475782	general	No CDS	{CYP2B6}	{"CYP2B6": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer"}	RxNorm:195085	{n/a}	1
6475783	general	Post-test	{CYP2B6}	{"CYP2B6": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer"}	RxNorm:195085	{"This patient is predicted to be a CYP2B6 intermediate metabolizer and may be at an increased risk of adverse events due to higher plasma concentrations of efavirenz. Consider initiating efavirenz with a decreased dose of 400 mg/day. Please consult a clinical pharmacist for more information."}	1
6475784	general	Post-test	{CYP2B6}	{"CYP2B6": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer"}	RxNorm:195085	{"This patient is predicted to be a CYP2B6 poor metabolizer and may be at an increased risk of adverse events due to higher plasma concentrations of efavirenz. Consider initiating efavirenz with a decreased dose of 200 or 400 mg/day. Please consult a clinical pharmacist for more information."}	1
6475785	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:3920	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6475786	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:3920	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6475787	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:3920	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475788	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:3920	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475789	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "No Result"}	RxNorm:3920	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475792	general	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. If escitalopram is clinically appropriate, and adequate efficacy is not achieved at standard maintenance dosing, consider titrating to a higher maintenance dose. Please consult a clinical pharmacist for more information."}	1
6475793	general	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer and may be at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Initiate therapy with recommended starting dose. If patient does not adequately respond, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6475794	general	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:321988	{n/a}	1
6475795	general	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 intermediate metabolizer and is at risk for higher plasma concentrations and increased probability of side effects with standard dosing. Initiate therapy with recommended starting dose, but consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6475796	general	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer and is at risk for higher plasma concentrations and increased probability of side effects with standard dosing. Initiate therapy with recommended starting dose, but consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6475797	general	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 poor metabolizer and is at risk for higher plasma concentrations and increased probability of side effects with standard dosing. Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If escitalopram is clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose. Please consult a clinical pharmacist for more information."}	1
6475798	general	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:321988	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and is at risk for higher plasma concentrations and increased probability of side effects with standard dosing. Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If escitalopram is clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose. Please consult a clinical pharmacist for more information."}	1
6475799	general	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:321988	{n/a}	1
6475800	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "No Result"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 normal metabolizer. Based on CYP2C9 phenotype there is no reason to adjust the dose of fluvastatin. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475801	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 possible decreased function. The patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475802	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{n/a}	1
6475803	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475804	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475805	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{n/a}	1
6475806	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475807	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475808	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{n/a}	1
6475809	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Indeterminate"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Indeterminate"}	RxNorm:41127	{"CYP2C9 and SLCO1B1 genetic status may be predictive of the risk of fluvastatin-induced myopathydue to altered drug exposure. Because a CYP2C9 genotype does not appear to have been ordered for this patient and SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475810	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "No Result"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475811	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "No Result"}	RxNorm:41127	{"CYP2C9 and SLCO1B1 genetic status may be predictive of the risk of myopathy to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C9 intermediate metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy). Because a SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475812	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "No Result"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475813	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "No Result"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because a SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475814	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "No Result"}	RxNorm:41127	{"CYP2C9 and SLCO1B1 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Because an SLCO1B1 genotype does not appear to have been ordered for this patient and CYP2C9 phenotype could not be assigned based on genotyping performed, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475815	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "No Result"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "No Result"}	RxNorm:41127	{"CYP2C9 and SLCO1B1 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Neither a CYP2C9 nor SLCO1B1 genotype appears to have been ordered for this patient. Use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
6475816	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 decreased function. The patient may be at an increased risk of a fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy). Please consult a clinical pharmacist for more information."}	1
6475817	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 decreased function. Thise patient may be at an increased risk of a fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475818	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{n/a}	1
6475819	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 decreased function. This patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475820	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 decreased function. The patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475821	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{n/a}	1
6475822	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Decreased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Decreased Function"}	RxNorm:41127	{"CYP2C9 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Because a CYP2C9 genotype does not appear to have been ordered for this patient, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475823	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Normal Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 normal function. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475824	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Normal Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 normal function. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475825	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Normal Function"}	RxNorm:41127	{n/a}	1
6475826	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Normal Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 normal function. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475827	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Normal Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 normal function. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy). Please consult a clinical pharmacist for more information."}	1
6475828	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Normal Function"}	RxNorm:41127	{n/a}	1
6475829	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Normal Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Normal Function"}	RxNorm:41127	{"CYP2C9 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Because a CYP2C9 genotype does not appear to have been ordered for this patient, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475830	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 poor function. Thise patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475831	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 poor function. This patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475832	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 normal metabolizer and to have SLCO1B1 poor function. The patient may be at an increased risk of a fluvastatin-induced myopathy. Prescribe ≤40mg as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose > 40mg is needed for desired efficacy, consider a higher dose (>40mg) if patient is tolerating 40mg per day or an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475833	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 poor function. The patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475834	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 poor function. The patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475835	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to have SLCO1B1 poor function and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed, consider a higher dose (>40mg) if patient is tolerating 40mg per day or an alternative statin or combination therapy. Because CYP2C9 phenotype could not be assigned based on genotyping performed, it is not known if CYP2C9 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475836	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Poor Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Poor Function"}	RxNorm:41127	{"This patient is predicted to have SLCO1B1 poor function and may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed, consider a higher dose (>40mg) if patient s tolerating 40mg per day or an alternative statin or combination therapy. Because a CYP2C9 genotype does not appear to have been ordered for this patient, it is not known if CYP2C9 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475837	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Increased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 increased. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475838	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Increased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 increased. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >40mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475839	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Increased Function"}	RxNorm:41127	{n/a}	1
6475840	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Increased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 increased. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475841	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Increased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 increased. This patient may be at an increased risk of fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy). Please consult a clinical pharmacist for more information."}	1
6475842	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Increased Function"}	RxNorm:41127	{n/a}	1
6475843	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Increased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Increased Function"}	RxNorm:41127	{"CYP2C9 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Because a CYP2C9 genotype does not appear to have been ordered for this patient, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476199	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6475844	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 possible decreased function. The patient may be at an increased risk of a fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy). Please consult a clinical pharmacist for more information."}	1
6475845	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 intermediate metabolizer and to have SLCO1B1 possible decreased function. Thise patient may be at an increased risk of a fluvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6475846	general	No CDS	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{n/a}	1
6475847	general	Post-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{"This patient is predicted to be a CYP2C9 poor metabolizer and to have SLCO1B1 poor function. This patient is at an increased risk of a fluvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6475848	general	Pre-test	{SLCO1B1,CYP2C9}	{"SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Possible Decreased Function"}	RxNorm:41127	{"CYP2C9 genetic status may be predictive of the risk of fluvastatin-induced myopathy due to altered drug exposure. Because a CYP2C9 genotype does not appear to have been ordered for this patient, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6475849	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:42355	{"CYP2D6 genotype may be important for fluvoxamine 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
6475850	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:42355	{n/a}	1
6475851	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:42355	{n/a}	1
6475852	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:42355	{n/a}	1
6475853	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:42355	{n/a}	1
6475854	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:42355	{n/a}	1
6475855	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:42355	{n/a}	1
6475856	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:42355	{n/a}	1
6475857	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:42355	{n/a}	1
6475858	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:42355	{n/a}	1
6475859	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:42355	{n/a}	1
6475860	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:42355	{n/a}	1
6475861	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:42355	{n/a}	1
6475862	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:42355	{n/a}	1
6475863	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:42355	{n/a}	1
6475864	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:42355	{n/a}	1
6475865	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:42355	{n/a}	1
6475866	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:42355	{n/a}	1
6475867	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:42355	{n/a}	1
6475868	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:42355	{n/a}	1
6475869	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:42355	{n/a}	1
6475870	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:42355	{"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 25-50% reduction in recommended starting dose and slower titration schedule or consider a clinicaly appropriate alternative not predominantly metabolized by CYP2D6. Please consult a clinical pharmacist for more information."}	1
6475871	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:42355	{n/a}	1
6476989	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:6918	{n/a}	1
6475874	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.0"}	RxNorm:72236	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. Please consult a clinical pharmacist for more information"}	1
6475875	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "2.0"}	RxNorm:72236	{n/a}	1
6475876	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	RxNorm:72236	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. Please consult a clinical pharmacist for more information."}	1
6475877	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	RxNorm:72236	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. Please consult a clinical pharmacist for more information."}	1
6475878	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	RxNorm:72236	{n/a}	1
6475879	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	RxNorm:72236	{"CYP2C9 diplotype may be important for fosphenytoin dosing. A CYP2C9 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
6475880	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475881	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475882	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475883	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475884	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475885	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476990	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:6918	{n/a}	1
6475886	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	RxNorm:72236	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to fosphenytoin. DO NOT prescribe fosphenytoin, fosfosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used fosphenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of fosphenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6475887	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "1.0"}	RxNorm:72236	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to fosphenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information"}	1
6475888	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "2.0"}	RxNorm:72236	{"HLA-B*15:02 genotype may be important for fosphenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6475889	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "0.5"}	RxNorm:72236	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to fosphenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6475890	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "0.0"}	RxNorm:72236	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to fosphenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing fosphenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6475891	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "n/a"}	RxNorm:72236	{"HLA-B*15:02 genotype may be important for fosphenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6475892	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "No Result"}	RxNorm:72236	{"A CYP2C9 and HLA-B*15:02 genotype does not appear to have been ordered for this patient. HLA-B and CYP2C9 genotype may be important for fosphenytoin dosing and use.Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6475893	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:5095	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6475894	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:5095	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6475895	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:5095	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475896	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:5095	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475897	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "No Result"}	RxNorm:5095	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6475901	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475902	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475903	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475904	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475905	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475906	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475907	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475908	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475909	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476991	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:6918	{n/a}	1
6475910	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475911	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475912	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "No Result"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475913	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475914	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "No Result"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475915	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "No Result"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475916	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "No Result"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6475917	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 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. 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
6475918	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "No Result"}	RxNorm:5691	{"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 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. 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
6475919	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "No Result"}	RxNorm:5691	{"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 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. 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
6476992	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:6918	{n/a}	1
6475920	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "No Result"}	RxNorm:5691	{"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 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. 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
6475921	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "No Result"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475922	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475923	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475924	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475925	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475926	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475927	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475928	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475929	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476993	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:6918	{n/a}	1
6475930	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475931	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475932	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475933	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475934	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475935	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475936	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475937	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475938	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6475939	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely 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 imipramine 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
6477088	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10831	{n/a}	1
6475940	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475941	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475942	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475943	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475944	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 poor metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475945	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely 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
6475946	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475947	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475948	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475949	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475950	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476994	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:6918	{n/a}	1
6475951	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475952	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475953	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475954	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475955	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475956	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475957	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475958	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475959	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475960	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475961	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475962	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6475963	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475975	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475964	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475965	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475966	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475967	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:5691	{"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 likely CYP2C19 intermediate metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475968	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Indeterminate"}	RxNorm:5691	{n/a}	1
6475969	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. 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
6475970	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475971	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475972	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475973	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475974	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476995	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:6918	{n/a}	1
6477089	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10831	{n/a}	1
6475976	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475977	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475978	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475979	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475980	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475981	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475982	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475983	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475984	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475985	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6475986	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475987	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 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.Please consult a clinical pharmacist for more information."}	1
6475988	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475989	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 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. Please consult a clinical pharmacist for more information."}	1
6475990	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Indeterminate"}	RxNorm:5691	{"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 may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If imipramine 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
6475991	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475992	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2D6 genotype does not appear to have been ordered for this patient. CYP2D6 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6475993	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475994	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475995	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475996	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475997	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6477090	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10831	{n/a}	1
6477222	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:39786	{n/a}	1
6475998	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6475999	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476000	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476001	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476002	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476003	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476004	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid 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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476005	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid 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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476006	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid 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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476007	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid 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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6477223	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:39786	{n/a}	1
6476008	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid 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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476009	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476010	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476011	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476012	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476013	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:5691	{"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 ultrarapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476014	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 rapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476015	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 rapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. A CYP2D6 genotype does not appear to have been ordered for this patient. CYP2D6 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476016	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476017	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6477224	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:39786	{n/a}	1
6476018	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476019	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476020	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476021	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476022	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476023	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476024	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476025	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476026	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476027	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476200	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476028	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476029	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476030	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476031	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476032	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476033	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476034	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476035	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476036	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476037	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6477225	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:39786	{n/a}	1
6476038	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476039	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476040	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476041	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476042	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476043	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476044	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476045	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476046	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476047	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476048	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6477226	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:39786	{n/a}	1
6476049	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476050	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476051	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476052	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476053	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476054	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476055	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476056	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476057	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476058	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476059	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476060	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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
6476061	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476062	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476063	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476064	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476065	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476066	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476067	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476068	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476120	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476069	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476070	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476071	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476072	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476073	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476074	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476075	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476076	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476077	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{n/a}	1
6476078	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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
6476079	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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
6476080	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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
6476081	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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
6476121	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:17128	{n/a}	1
6476330	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	RxNorm:36437	{"CYP2C19 genotype may be important for the use of sertraline. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476082	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:5691	{"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 imipramine 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
6476083	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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
6476084	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476085	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476086	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476087	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476088	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476089	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476090	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476091	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476092	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476202	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476093	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476094	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476095	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476096	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476097	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476098	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476099	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476100	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{n/a}	1
6476101	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476102	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476103	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476104	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476105	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:5691	{"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 imipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476122	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476106	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:6026	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476107	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:6026	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476108	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:6026	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476109	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:6026	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476110	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "No Result"}	RxNorm:6026	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476111	general	No CDS	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:6026	{n/a}	1
6476112	H.pylori_erosive eso	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:17128	{n/a}	1
6476113	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476114	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476115	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476116	H.pylori_erosive eso	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:17128	{"CYP2C19 genotype may be important for this proton pump inhibitor's dosing. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476117	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 normal metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476118	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476119	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476123	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:17128	{n/a}	1
6477227	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:39786	{n/a}	1
6476125	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476126	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476127	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476128	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:17128	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476129	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:17128	{n/a}	1
6476130	general	Pre-test	{SLCO1B1}	{"SLCO1B1": "No Result"}	{}	{}	{"SLCO1B1": "No Result"}	RxNorm:6472	{"SLCO1B1 genetic status may be predictive of the risk of lovastatin-induced myopathy due to altered drug exposure. An SLCO1B1 genotype does not appear to have been ordered for this patient. Use of an alternative drug or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6476131	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Increased Function"}	{}	{}	{"SLCO1B1": "Increased Function"}	RxNorm:6472	{n/a}	1
6476132	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	RxNorm:6472	{n/a}	1
6476133	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	RxNorm:6472	{"This patient is predicted to have SLCO1B1 decreased function and is at increased risk for developing lovastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. If lovastatin therapy is warranted, limit dose to ≤20mg per day. Please consult a clinical pharmacist for more information."}	1
6476134	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	RxNorm:6472	{"This patient is predicted to have SLCO1B1 possible decreased function and is at increased risk for developing lovastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. If lovastatin therapy is warranted, limit dose to ≤20mg per day. Please consult a clinical pharmacist for more information."}	1
6476135	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	RxNorm:6472	{"This patient is predicted to have SLCO1B1 poor function and is at increased risk for developing lovastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6476136	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	RxNorm:6472	{n/a}	1
6476137	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:6857	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476138	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:6857	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476139	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:6857	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476140	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:6857	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476145	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476146	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476147	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476148	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476149	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476150	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476151	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476152	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476153	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476154	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and may have lower than expected plasma concentrations resulting in an increased probability of pharmacotherapy failure. Consider alternative drug not metabolized by CYP2D6. If nortriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476155	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:7531	{n/a}	1
6476156	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:7531	{n/a}	1
6476157	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:7531	{n/a}	1
6476158	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:7531	{n/a}	1
6476159	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:7531	{n/a}	1
6476160	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and may experience higher than expected plasma concentrations of nortriptyline resulting in an increased the probability of adverse reactions. Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476201	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476161	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and may experience higher than expected plasma concentrations of nortriptyline resulting in an increased the probability of adverse reactions. Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476162	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and may experience higher than expected plasma concentrations of nortriptyline resulting in an increased the probability of adverse reactions. Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476163	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and may experience higher than expected plasma concentrations of nortriptyline resulting in an increased the probability of adverse reactions. Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476164	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:7531	{"Based on the genotype result, this patient is predicted to be a CYP2D6 poor metabolizer and may experience higher than expected plasma concentrations of nortriptyline resulting in an increased the probability of adverse reactions. Consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476165	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:7531	{n/a}	1
6476166	H.pylori_erosive eso	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:7646	{"CYP2C19 genotype may be important for this proton pump inhibitor's dosing. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476167	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476168	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476169	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 normal metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476170	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476171	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476172	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476173	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476174	H.pylori_erosive eso	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:7646	{n/a}	1
6476175	non-H.pylori_erosive	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:7646	{"CYP2C19 genotype may be important for this proton pump inhibitor's dosing. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476176	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476177	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:7646	{n/a}	1
6476178	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:7646	{n/a}	1
6476179	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476180	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476181	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476182	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:7646	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476183	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:7646	{n/a}	1
6476184	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:26225	{n/a}	1
6476185	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:26225	{n/a}	1
6476186	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:26225	{n/a}	1
6476187	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:26225	{n/a}	1
6476188	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:26225	{n/a}	1
6476189	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:26225	{n/a}	1
6476190	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:26225	{n/a}	1
6476191	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:26225	{n/a}	1
6476192	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:26225	{n/a}	1
6476193	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:26225	{n/a}	1
6476194	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:26225	{n/a}	1
6476195	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:26225	{"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
6476196	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476197	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476198	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6477228	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:39786	{n/a}	1
6476203	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476204	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476205	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476206	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:26225	{"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 ondansetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
6476207	general	Pre-test	{HLA-B}	{}	{}	{"HLA-B": "No *15:02 result on file"}	{"HLA-B": "No *15:02 result on file"}	RxNorm:32624	{"HLA-B*15:02 genetic status may be predictive of a severe cutaneous adverse reaction to oxcarbazepine, including Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). A HLA-B*15:02 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
6476208	general	Post-test	{HLA-B}	{}	{}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive"}	RxNorm:32624	{"HLA-B*15:02 genetic status may be predictive of a severe cutaneous adverse reaction to oxcarbazepine. This patient is HLA-B*15:02 positive and may be at an increased risk of oxcarbazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). If the patient is oxcarbazepine-naive and alternative agents are available, do not use oxcarbazepine. The latency period for SJS/TEN is short (< 8 weeks); therefore, if the patient has previously used oxcarbazepine for longer than 3 months without incidence of cutaneous adverse reactions, cautiously consider use of oxcarbazepine. Please consult a clinical pharmacist for more information."}	1
6476209	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative"}	RxNorm:32624	{n/a}	1
6476210	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 normal metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476211	H.pylori_erosive eso	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:40790	{"CYP2C19 genotype may be important for this proton pump inhibitor's dosing. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476212	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476213	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer. The patient may be at risk for therapeutic failure at standard doses. Consider increasing the dose by 50-100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476214	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476215	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476216	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6477229	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:39786	{n/a}	1
6476217	H.pylori_erosive eso	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476218	H.pylori_erosive eso	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:40790	{n/a}	1
6476219	non-H.pylori_erosive	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:40790	{"CYP2C19 genotype may be important for this proton pump inhibitor's dosing. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476220	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and is at risk for decreased plasma concentrations and therapeutic failure with standard dosing. Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. Please consult a clinical pharmacist for more information."}	1
6476221	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:40790	{n/a}	1
6476222	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:40790	{n/a}	1
6476223	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476224	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476225	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476226	non-H.pylori_erosive	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:40790	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer. Initiate standard starting daily dose. If this proton pump inhibitor has been given for chronic therapy (>12 weeks) and after efficacy has been achieved, consider 50% reduction in daily dose to minimize the incidence of adverse events and monitor for continued efficacy. Please consult a clinical pharmacist for more information."}	1
6476227	non-H.pylori_erosive	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:40790	{n/a}	1
6476228	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:32937	{"CYP2D6 genotype may be important for paroxetine 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
6476229	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476230	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476231	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476232	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476325	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476233	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476234	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476235	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476236	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476237	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476238	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476239	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:32937	{"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. Please consult a clinical pharmacist for more information."}	1
6476240	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:32937	{n/a}	1
6476241	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:32937	{n/a}	1
6476242	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:32937	{n/a}	1
6476243	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:32937	{n/a}	1
6476244	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:32937	{n/a}	1
6476245	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:32937	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a lower starting dose and slower titration schedule. Please consult a clinical pharmacist for more information."}	1
6476246	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:32937	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a lower starting dose and slower titration schedule. Please consult a clinical pharmacist for more information."}	1
6476247	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:32937	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a lower starting dose and slower titration schedule. Please consult a clinical pharmacist for more information."}	1
6476248	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:32937	{"Based on the genotype result, this patient is predicted to be a CYP2D6 intermediate metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a lower starting dose and slower titration schedule. Please consult a clinical pharmacist for more information."}	1
6476249	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:32937	{"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 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476250	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:32937	{n/a}	1
6476251	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.5"}	RxNorm:8183	{n/a}	1
6476326	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{n/a}	1
6477230	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:39786	{n/a}	1
6476252	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.0"}	RxNorm:8183	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. Please consult a clinical pharmacist for more information"}	1
6476253	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "2.0"}	RxNorm:8183	{n/a}	1
6476254	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	RxNorm:8183	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. Please consult a clinical pharmacist for more information."}	1
6476255	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	RxNorm:8183	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. Please consult a clinical pharmacist for more information."}	1
6476256	general	No CDS	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	RxNorm:8183	{n/a}	1
6476257	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	RxNorm:8183	{"CYP2C9 diplotype may be important for phenytoin dosing. A CYP2C9 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
6476258	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476259	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476260	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476261	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476262	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476263	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476327	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476264	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	RxNorm:8183	{"The HLA-B*15:02 allele has been detected in this patient. This allele is associated with high risk of cutaneous adverse drug reaction to phenytoin. DO NOT prescribe phenytoin, fosphenytoin, carbamazepine, or oxcarbazepine. Choose an alternate antiepileptic drug. If the patient has previously used phenytoin consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. For more information, please consult a clinical pharmacist."}	1
6476265	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.5"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "1.5"}	RxNorm:8183	{"HLA-B*15:02 genotype may be important for phenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6476266	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "1.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "1.0"}	RxNorm:8183	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to phenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information"}	1
6476267	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "2.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "2.0"}	RxNorm:8183	{"HLA-B*15:02 genotype may be important for phenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6476268	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.5"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "0.5"}	RxNorm:8183	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to phenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6476269	general	Post-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "0.0"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "0.0"}	RxNorm:8183	{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to phenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6476270	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "n/a"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "n/a"}	RxNorm:8183	{"HLA-B*15:02 genotype may be important for phenytoin adverse events. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information."}	1
6476271	general	Pre-test	{CYP2C9,HLA-B}	{}	{"CYP2C9": "No Result"}	{"HLA-B": "No *15:02 result"}	{"HLA-B": "No *15:02 result", "CYP2C9": "No Result"}	RxNorm:8183	{"A CYP2C9 and HLA-B*15:02 genotype does not appear to have been ordered for this patient. HLA-B and CYP2C9 genotype may be important for phenytoin dosing and use.Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6476272	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:8356	{"CYP2C9 genotype may be important for piroxicam 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
6476273	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:8356	{n/a}	1
6476274	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:8356	{n/a}	1
6476275	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:8356	{"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 piroxicam 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
6476276	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:8356	{"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 piroxicam 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
6477231	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:39786	{n/a}	1
6476277	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:8356	{"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 piroxicam 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
6476278	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:8356	{n/a}	1
6476279	general	Pre-test	{SLCO1B1}	{"SLCO1B1": "No Result"}	{}	{}	{"SLCO1B1": "No Result"}	RxNorm:861634	{"SLCO1B1 genetic status may be predictive of the risk of pitavastatin-induced myopathy due to altered drug exposure. An SLCO1B1 genotype does not appear to have been ordered for this patient. Use of an alternative statin or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6476280	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Increased Function"}	{}	{}	{"SLCO1B1": "Increased Function"}	RxNorm:861634	{n/a}	1
6476281	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	RxNorm:861634	{n/a}	1
6476282	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	RxNorm:861634	{"This patient is predicted to have SLCO1B1 decreased function and may be at increased risk for developing pitavastatin-induced myopathy. Prescribe ≤2mg as a starting dose and adjust doses of pitavastatin based on disease-spesific guidelines. If a dose >2mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476283	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	RxNorm:861634	{"This patient is predicted to have SLCO1B1 possible decreased function and may be at increased risk for developing pitavastatin-induced myopathy. Prescribe ≤2mg as a starting dose and adjust doses of pitavastatin based on disease-spesific guidelines. If a dose >2mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476284	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	RxNorm:861634	{"This patient is predicted to have SLCO1B1 poor function and may be at increased risk for developing pitavastatin-induced myopathy. Prescribe ≤1mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. If a dose >1mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476285	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	RxNorm:861634	{n/a}	1
6476286	general	Pre-test	{SLCO1B1}	{"SLCO1B1": "No Result"}	{}	{}	{"SLCO1B1": "No Result"}	RxNorm:42463	{"SLCO1B1 genetic status may be predictive of the risk of pravastatin-induced myopathy due to altered drug exposure. An SLCO1B1 genotype does not appear to have been ordered for this patient. Use of an alternative statin or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
6476287	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Increased Function"}	{}	{}	{"SLCO1B1": "Increased Function"}	RxNorm:42463	{n/a}	1
6476288	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	RxNorm:42463	{n/a}	1
6476289	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	RxNorm:42463	{n/a}	1
6476290	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	RxNorm:42463	{n/a}	1
6476291	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	RxNorm:42463	{"This patient is predicted to have SLCO1B1 poor function and may be at increased risk for developing pravastatin-induced myopathy. Prescribe ≤40mg per day as a starting dose and adjust doses of pravastatin based on disease-specific guidelines. If a dose >40mg is needed, consider a higher dose (>40mg) if patient is tolerating 40mg or an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476292	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	RxNorm:42463	{n/a}	1
6476293	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Indeterminate"}	RxNorm:301542	{"This patient is predicted to have ABCG2 decreased function. Based on ABCG2 phenotype there is no reason to adjust the dose of rosuvastatin. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476294	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Indeterminate"}	RxNorm:301542	{"This patient is predicted to have ABCG2 normal function. Based on ABCG2 phenotype there is no reason to adjust the dose of rosuvastatin. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476328	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{"CYP2B6 genotype may be important for the use of sertraline and does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6477232	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:39786	{n/a}	1
6476295	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Indeterminate"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and may be at an increased risk of rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Because SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476296	general	Pre-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Indeterminate"}	RxNorm:301542	{"ABCG2 and SLCO1B1 genetic status may be predictive of the risk of rosuvastatin-induced myopathy due to altered drug exposure. Because an ABCG2 genotype does not appear to have been ordered for this patient and SLCO1B1 phenotype could not be assigned based on genotyping performed, it is not known if these results would influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476297	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "No Result"}	RxNorm:301542	{"This patient is predicted to have ABCG2 decreased function. Based on ABCG2 phenotype there is no reason to adjust the dose of rosuvastatin. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476298	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "No Result"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and may be at an increased risk of rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose > 20mg is needed for desired efficacy, consider combination therapy. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476299	general	Pre-test	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "No Result"}	RxNorm:301542	{"This patient is predicted to have ABCG2 normal function. Based on ABCG2 phenotype there is no reason to adjust the dose of rosuvastatin. Because an SLCO1B1 genotype does not appear to have been ordered for this patient, it is not known if SLCO1B1 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476300	general	Pre-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "No Result"}	RxNorm:301542	{"ABCG2 and SLCO1B1 genetic status may be predictive of the risk of rosuvastatin-induced myopathy due to altered drug exposure. Neither a ABCG2 nor SLCO1B1 genotype appears to have been ordered for this patient. Use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
6476301	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Decreased Function"}	RxNorm:301542	{n/a}	1
6476302	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Decreased Function"}	RxNorm:301542	{n/a}	1
6476303	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Decreased Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and SLCO1B1 decreased function. This patient may be at an increased risk of a rosuvastatin-induced myopathy. Prescribe ≤10mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >10mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476304	general	Pre-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Decreased Function"}	RxNorm:301542	{"This patient is predicted to have SLCO1B1 decreased function. Based on SLCO1B1 phenotype there is no reason to adjust the dose of rosuvastatin. Because a ABCG2 genotype does not appear to have been ordered for this patient, it is not known if ABCG2 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476305	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Normal Function"}	RxNorm:301542	{n/a}	1
6476306	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Normal Function"}	RxNorm:301542	{n/a}	1
6476307	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Normal Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and SLCO1B1 normal function. This patient may be at an increased risk of rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476308	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Normal Function"}	RxNorm:301542	{"This patient is predicted to have SLCO1B1 normal function. Based on SLCO1B1 phenotype there is no reason to adjust the dose of rosuvastatin. Because a ABCG2 genotype does not appear to have been ordered for this patient, it is not known if ABCG2 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476309	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Poor Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 decreased function and SLCO1B1 poor function. This patient may be at an increased risk of a rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >20mg is needed for desired efficacy, consider combination therapy. Please consult a clinical pharmacist for more information."}	1
6476310	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Poor Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 normal function and SLCO1B1 poor function. This patient may be at an increased risk of a rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >20mg is needed for desired efficacy, consider combination therapy. Please consult a clinical pharmacist for more information."}	1
6476311	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Poor Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and SLCO1B1 poor function. This patient may be at an increased risk of a rosuvastatin-induced myopathy. Prescribe ≤10mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >10mg is needed for desired efficacy, consider combination therapy. Please consult a clinical pharmacist for more information."}	1
6476312	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Poor Function"}	RxNorm:301542	{"This patient is predicted to have SLCO1B1 poor function and may be at an increased risk of rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose > 20mg is needed for desired efficacy, consider combination therapy. Because an ABCG2 genotype does not appear to have been ordered for this patient, it is not known if ABCG2 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476313	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Possible Decreased Function"}	RxNorm:301542	{n/a}	1
6476314	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Possible Decreased Function"}	RxNorm:301542	{n/a}	1
6476315	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Possible Decreased Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and SLCO1B1 possible decreased function. This patient may be at an increased risk of a rosuvastatin-induced myopathy. Prescribe ≤10mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If a dose >10mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476316	general	Pre-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Possible Decreased Function"}	RxNorm:301542	{"This patient is predicted to have SLCO1B1 possible decreased function. Based on SLCO1B1 phenotype there is no reason to adjust the dose of rosuvastatin. Because a ABCG2 genotype does not appear to have been ordered for this patient, it is not known if ABCG2 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476317	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Decreased Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Increased Function"}	RxNorm:301542	{n/a}	1
6476318	general	No CDS	{SLCO1B1,ABCG2}	{"ABCG2": "Normal Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Increased Function"}	RxNorm:301542	{n/a}	1
6476319	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "Poor Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Increased Function"}	RxNorm:301542	{"This patient is predicted to have ABCG2 poor function and SLCO1B1 increased function. This patient may be at an increased risk of rosuvastatin-induced myopathy. Prescribe ≤20mg per day as a starting dose and adjust doses of rosuvastatin based on disease-specific guidelines. If a dose >20mg is needed for desired efficacy, consider an alternative statin or combination therapy. Please consult a clinical pharmacist for more information."}	1
6476320	general	Post-test	{SLCO1B1,ABCG2}	{"ABCG2": "No Result", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Increased Function"}	RxNorm:301542	{"This patient is predicted to have SLCO1B1 increased function. Based on SLCO1B1 phenotype there is no reason to adjust the dose of rosuvastatin. Because a ABCG2 genotype does not appear to have been ordered for this patient, it is not known if ABCG2 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476321	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{n/a}	1
6476322	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{n/a}	1
6476323	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{n/a}	1
6476324	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476331	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "No Result"}	RxNorm:36437	{"CYP2C19 genotype may be important for the use of sertraline. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476332	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "No Result"}	RxNorm:36437	{"CYP2C19 genotype may be important for the use of sertraline. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476333	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Because a CYP2C19 genotype does not appear to have been ordered for this patient, it is not known if CYP2C19 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476334	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "No Result"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6. Because a CYP2C19 genotype does not appear to have been ordered for this patient, it is not known if CYP2C19 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476335	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "No Result"}	RxNorm:36437	{"CYP2C19 genotype may be important for the use of sertraline. A CYP2C19 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476336	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "No Result"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "No Result"}	RxNorm:36437	{"CYP2C19 and CYP2B6 genotypes may be important for the use of sertraline and do not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476337	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and a CYP2B6 ultrarapid metabolizer and may be at risk for lower plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476338	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer and a CYP2B6 rapid metabolizer and may be at risk for lower plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476339	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476340	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476341	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476342	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{n/a}	1
6476343	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:36437	{"CYP2B6 genotype may be important for the use of sertraline and does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476344	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer and a CYP2B6 ultrarapid metabolizer and may be at risk for lower plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476383	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Indeterminate"}	RxNorm:36437	{"CYP2B6 genotype may be important for the use of sertraline and does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476345	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer and a CYP2B6 rapid metabolizer and may be at risk for lower plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476346	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 normal metabolizer and a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476347	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{n/a}	1
6476348	general	Pre-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Normal Metabolizer"}	RxNorm:36437	{"CYP2B6 genotype may be important for the use of sertraline and does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
6476349	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{n/a}	1
6476350	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{n/a}	1
6476351	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer and a CYP2B6 normal metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476352	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer and a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476353	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer and a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476354	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely intermediate metabolizer may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476355	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 intermediate metabolizer and may be at risk for higer plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Because a CYP2B6 genotype does not appear to have been ordered for this patient, it is not known if CYP2B6 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information.Please consult a clinical pharmacist for more information."}	1
6476356	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{n/a}	1
6476357	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{n/a}	1
6476358	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer and a CYP2B6 normal metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6477233	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:39786	{n/a}	1
6476359	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer and a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476360	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer and a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476361	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476362	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 intermediate metabolizer and may be at risk for higer plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Because a CYP2B6 genotype does not appear to have been ordered for this patient, it is not known if CYP2B6 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information.Please consult a clinical pharmacist for more information."}	1
6476363	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 ultrarapid metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476364	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 rapid metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476365	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 normal metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476366	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476367	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476368	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476369	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476370	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and a CYP2B6 ultrarapid metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476371	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 likely poor metabolizer and a CYP2B6 rapid metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476372	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and a CYP2B6 normal metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476373	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476374	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and a CYP2B6 poor metabolizer and may be at risk for higher plasma concentrations with standard dosing. Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476375	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Please consult a clinical pharmacist for more information."}	1
6476376	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "No Result", "CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2B6": "No Result", "CYP2C19": "Poor Metabolizer"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer and may be at risk for higer plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. Because a CYP2B6 genotype does not appear to have been ordered for this patient, it is not known if CYP2B6 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
6476377	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	RxNorm:36437	{n/a}	1
6476378	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Indeterminate"}	RxNorm:36437	{n/a}	1
6476379	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	RxNorm:36437	{n/a}	1
6476380	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2B6 intermediate metabolizer and may be at risk for higher plasma concentrations with standard dosing. Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Please consult a clinical pharmacist for more information."}	1
6476381	general	Post-test	{CYP2B6,CYP2C19}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Indeterminate"}	RxNorm:36437	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer may be at risk for higher plasma concentrations with standard dosing. Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6. Please consult a clinical pharmacist for more information."}	1
6476382	general	No CDS	{CYP2B6,CYP2C19}	{"CYP2B6": "Indeterminate", "CYP2C19": "Indeterminate"}	{}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Indeterminate"}	RxNorm:36437	{n/a}	1
6477234	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:39786	{n/a}	1
6477235	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:39786	{n/a}	1
6476384	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:36453	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476385	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:36453	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476386	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:36453	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476387	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:36453	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476388	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "No Result"}	RxNorm:36453	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476389	general	No CDS	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:36453	{n/a}	1
6476390	general	Pre-test	{SLCO1B1}	{"SLCO1B1": "No Result"}	{}	{}	{"SLCO1B1": "No Result"}	RxNorm:36567	{"SLCO1B1 genetic status may be predictive of the risk of simvastatin-induced myopathy due to altered drug exposure. An SLCO1B1 genotype does not appear to have been ordered for this patient. Use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
6476391	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Increased Function"}	{}	{}	{"SLCO1B1": "Increased Function"}	RxNorm:36567	{n/a}	1
6476392	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	RxNorm:36567	{n/a}	1
6476393	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	RxNorm:36567	{"This patient is predicted to have SLCO1B1 decreased function and is at increased risk for developing simvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. If simvastatin therapy is warranted, limit dose to <20mg per day. Please consult a clinical pharmacist for more information."}	1
6476394	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	RxNorm:36567	{"This patient is predicted to have SLCO1B1 possible decreased function and is at increased risk for developing simvastatin-induced myopathy. Prescribe an alternative statin depending on the desired potency. If simvastatin therapy is warranted, limit dose to <20mg per day. Please consult a clinical pharmacist for more information."}	1
6476395	general	Post-test	{SLCO1B1}	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	RxNorm:36567	{"This patient is predicted to have SLCO1B1 poor function and is at increased risk for developing simvastatin-inducedmyopathy. Prescribe an alternative statin depending on the desired potency. Please consult a clinical pharmacist for more information."}	1
6476396	general	No CDS	{SLCO1B1}	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	RxNorm:36567	{n/a}	1
6476397	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Malignant Hyperthermia Susceptibility"}	RxNorm:10154	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476398	general	Post-test	{RYR1,CACNA1S}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Malignant Hyperthermia Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:10154	{"Based on genotype, this patient is predicted to be malignant hyperthermia susceptible. Halogenated volatile anesthetics or depolarizing muscle relaxants are relatively contraindicated in persons with MHS. They should not be used, except in extraordinary circumstances where the benefits outweigh the risks. In general, alternative anesthetics are widely available, effective, and safe in patients with MHS. Please consult an anesthesiologist or clinical pharmacist for more information."}	1
6476399	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "No Result"}	RxNorm:10154	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476400	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:10154	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476401	general	Pre-test	{RYR1,CACNA1S}	{"RYR1": "No Result", "CACNA1S": "No Result"}	{}	{}	{"RYR1": "No Result", "CACNA1S": "No Result"}	RxNorm:10154	{"Malignant Hyperthermia Susceptibility is an inherited trait linked to changes within the RYR1 and CACNA1S genes. Genetic testing can help to guide anesthetic agent use."}	1
6476402	general	No CDS	{RYR1,CACNA1S}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	{}	{}	{"RYR1": "Uncertain Susceptibility", "CACNA1S": "Uncertain Susceptibility"}	RxNorm:10154	{n/a}	1
6476403	general	Pre-test	{CYP3A5}	{"CYP3A5": "No Result"}	{}	{}	{"CYP3A5": "No Result"}	RxNorm:42316	{"CYP3A5 results may be important for tacrolimus dosing. A CYP3A5 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
6476404	general	Post-test	{CYP3A5}	{"CYP3A5": "Normal Metabolizer"}	{}	{}	{"CYP3A5": "Normal Metabolizer"}	RxNorm:42316	{"Based on the genotype result, this patient is predicted to have lower tacrolimus serum drug levels if initiated on a standard tacrolimus starting dose. Consider increasing the starting dose to 1.5 times to 2 times the standard dose. Total starting dose should not exceed 0.3mg/kg/day. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Use therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476405	general	Post-test	{CYP3A5}	{"CYP3A5": "Intermediate Metabolizer"}	{}	{}	{"CYP3A5": "Intermediate Metabolizer"}	RxNorm:42316	{"Based on the genotype result, this patient is predicted to have lower tacrolimus serum drug levels if initiated on a standard tacrolimus starting dose. Consider increasing the starting dose to 1.5 times to 2 times the standard dose. Total starting dose should not exceed 0.3mg/kg/day. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Use therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476406	general	Post-test	{CYP3A5}	{"CYP3A5": "Possible Intermediate Metabolizer"}	{}	{}	{"CYP3A5": "Possible Intermediate Metabolizer"}	RxNorm:42316	{"Based on the genotype result, this patient is predicted to have lower tacrolimus serum drug levels if initiated on a standard tacrolimus starting dose. Consider increasing the starting dose to 1.5 times to 2 times the standard dose. Total starting dose should not exceed 0.3mg/kg/day. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Use therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476407	general	No CDS	{CYP3A5}	{"CYP3A5": "Poor Metabolizer"}	{}	{}	{"CYP3A5": "Poor Metabolizer"}	RxNorm:42316	{n/a}	1
6476408	general	No CDS	{CYP3A5}	{"CYP3A5": "Indeterminate"}	{}	{}	{"CYP3A5": "Indeterminate"}	RxNorm:42316	{n/a}	1
6476409	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:10324	{n/a}	1
6476410	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:10324	{n/a}	1
6476411	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:10324	{n/a}	1
6476412	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:10324	{n/a}	1
6476413	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:10324	{n/a}	1
6476414	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:10324	{n/a}	1
6476415	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:10324	{n/a}	1
6476416	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:10324	{n/a}	1
6476417	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:10324	{n/a}	1
6476418	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:10324	{n/a}	1
6476419	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:10324	{n/a}	1
6476420	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:10324	{n/a}	1
6476421	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:10324	{n/a}	1
6476422	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:10324	{"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 or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
6476423	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:10324	{n/a}	1
6476424	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:10324	{n/a}	1
6476425	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:10324	{n/a}	1
6477236	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:39786	{n/a}	1
6476426	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:10324	{"This patient is predicted to have lower than normal CYP2D6 activity and may be at an increased risk of a poor tamoxifen response due to low endoxifen (active component of tamoxifen) concentrations. Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women. If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day). Avoid CYP2D6 inhibitors. Please consult a clinical pharmacist for more information."}	1
6476427	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:10324	{"This patient is predicted to have lower than normal CYP2D6 activity and may be at an increased risk of a poor tamoxifen response due to low endoxifen (active component of tamoxifen) concentrations. Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women. If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day). Avoid CYP2D6 inhibitors. Please consult a clinical pharmacist for more information."}	1
6476428	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:10324	{"This patient is predicted to have lower than normal CYP2D6 activity and may be at an increased risk of a poor tamoxifen response due to low endoxifen (active component of tamoxifen) concentrations. Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women. If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day). Avoid CYP2D6 inhibitors. Please consult a clinical pharmacist for more information."}	1
6476429	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:10324	{"This patient is predicted to have lower than normal CYP2D6 activity and may be at an increased risk of a poor tamoxifen response due to low endoxifen (active component of tamoxifen) concentrations. Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women. If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day). Avoid CYP2D6 inhibitors. Please consult a clinical pharmacist for more information."}	1
6476430	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:10324	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at an increased risk of a poor tamoxifen response due to low endoxifen (active component of tamoxifen) concentrations. Recommend alternative hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women. Note, higher dose tamoxifen (40 mg/day) increases but does not normalize endoxifen concentrations in CYP2D6 poor metabolizers. Please consult a clinical pharmacist for more information."}	1
6476431	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:10324	{n/a}	1
6476432	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:37790	{"CYP2C9 genotype may be important for Tenoxicam 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
6476433	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:37790	{n/a}	1
6476434	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:37790	{n/a}	1
6476435	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:37790	{"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 Tenoxicam 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
6476436	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:37790	{"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 Tenoxicam 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
6476437	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:37790	{"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 Tenoxicam 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
6476438	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:37790	{n/a}	1
6476439	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "No Result"}	RxNorm:10834	{"CYP2C19 genotype may be important for trimipramine dosing and use. A CYP2C19 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
6476925	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:41493	{"CYP2C9 genotype may be important for meloxicam 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
6476440	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "No Result"}	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. Neither a CYP2D6 nor CYP2C19 genotype appears to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
6476441	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476442	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476443	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476444	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476445	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476446	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476447	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476448	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476806	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
6476449	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476450	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476451	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476452	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "No Result"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6476453	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "No Result"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6476454	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "No Result"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6476455	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "No Result"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6476456	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "No Result"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Because 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
6476457	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "No Result"}	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 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. 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
6476458	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "No Result"}	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 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. 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
6476926	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:41493	{n/a}	1
6476459	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "No Result"}	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 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. 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
6476460	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "No Result"}	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 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. 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
6476461	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "No Result"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "No Result"}	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 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. A CYP2C19 genotype does not appear to have been ordered for this patient. CYP2C19 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476462	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely 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 likely 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
6476463	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely 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 likely 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
6476464	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely 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 likely 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
6476465	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely 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 likely 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
6476466	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely 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 likely 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
6476467	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely 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 likely 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
6476468	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely 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 likely 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
6476927	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:41493	{n/a}	1
6476469	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely 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 likely 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
6476470	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely 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 likely 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
6476471	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely 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 likely 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
6476472	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely 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 likely 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
6476473	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely 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 likely 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
6476474	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely 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 likely 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
6476475	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely 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 likely 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
6476476	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely 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 likely 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
6476477	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely 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 likely 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
6476478	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely 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 likely 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
6476479	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely 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 likely 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
6476480	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely 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 likely 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
6476481	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely 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 likely 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
6476482	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely 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 likely 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
6476483	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely 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 likely 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
6476484	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely 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 likely 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
6476485	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely 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 likely 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
6476486	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476487	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely 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 likely 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
6476488	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely 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 likely 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
6476489	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely 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 likely 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
6476490	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely 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 likely 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
6476491	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely 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 likely 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
6476492	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely 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 likely 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
6476493	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely 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 likely 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
6476494	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely 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 likely 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
6476495	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely 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 likely 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
6476496	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely 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 likely 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
6476497	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely 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 likely 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
6476498	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476499	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476500	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476501	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476502	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
6476503	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely 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 likely 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
6476504	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely 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 likely 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
6476505	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely 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 likely 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
6476506	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely 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 likely 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
6476507	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely 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 likely 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
6476508	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Indeterminate"}	RxNorm:10834	{n/a}	1
6476509	general	Pre-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Indeterminate"}	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. 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
6476510	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Indeterminate"}	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 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
6476511	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Indeterminate"}	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 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
6476512	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Indeterminate"}	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 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
6476513	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Indeterminate"}	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 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
6476514	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Indeterminate"}	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 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
6476515	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Indeterminate"}	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 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
6476516	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Indeterminate"}	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 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
6476517	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Indeterminate"}	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 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
6476518	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Indeterminate"}	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 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
6476519	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Indeterminate"}	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 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
6476520	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Indeterminate"}	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 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
6476521	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Indeterminate"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6476522	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Indeterminate"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6476523	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Indeterminate"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6476524	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Indeterminate"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6476525	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Indeterminate"}	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. There is no reason to selectively adjust the dose of this medication based on the CYP2D6 result. Please consult a clinical pharmacist for more information."}	1
6476807	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
6476526	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Indeterminate"}	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 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. Please consult a clinical pharmacist for more information."}	1
6476527	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Indeterminate"}	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 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.Please consult a clinical pharmacist for more information."}	1
6476528	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Indeterminate"}	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 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. Please consult a clinical pharmacist for more information."}	1
6476529	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Indeterminate"}	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 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. Please consult a clinical pharmacist for more information."}	1
6476530	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Indeterminate"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Indeterminate"}	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 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
6476531	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Ultrarapid 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 ultarapid 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 utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
6476532	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Ultrarapid 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 ultarapid 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 utilize therapeutic drug monitoring to guide dose adjustments. A CYP2D6 genotype does not appear to have been ordered for this patient. CYP2D6 genetic status may be important for alternative drugs. Please consult a clinical pharmacist for more information."}	1
6476533	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476534	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476535	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476808	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	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
6476536	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476537	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476538	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476539	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476540	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476541	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476542	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476543	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476544	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476545	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476851	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:4502	{n/a}	1
6476546	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476547	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476548	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476549	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476550	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476551	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Ultrarapid 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 ultrarapid 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
6476552	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Ultrarapid 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 ultrarapid 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
