7089615	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
7089616	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
7089617	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
7089618	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "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 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 trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089619	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a 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 trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089620	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a 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 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
7089621	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089622	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089623	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089624	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089625	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089626	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089627	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089628	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089629	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089630	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089937	<50mg TDD HTN	Pre-test	{NAT2}	{"NAT2": "No Result"}	{}	{}	{"NAT2": "No Result"}	RxNorm:5470	{"The patient's NAT2 genotype may be important for hydralazine dosing in the setting of resistant hypertension. A NAT2 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
7089631	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 rapid metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089632	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 rapid metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089633	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089634	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089635	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089636	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089637	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 rapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089638	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089639	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089640	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089641	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Rapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 rapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089642	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 poor metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089643	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 poor metabolizer and may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089644	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089645	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089646	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089647	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089648	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089649	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089650	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089651	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089652	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089653	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089654	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 poor metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089655	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089656	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089657	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089658	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089659	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and a CYP2C19 poor metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089660	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089661	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089662	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089663	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 poor metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089664	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Poor Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 poor metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089665	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 normal metabolizer. There is no reason to selectively adjust the dose of this medication based on the CYP2C19 result. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089666	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089667	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089668	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089669	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089670	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089671	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089685	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
7089672	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089673	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089674	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089675	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089676	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089677	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089678	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089679	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089680	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089681	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089682	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7089683	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
7089684	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
7089711	adults	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:121243	{"CYP2C19 genotype may be important for voriconazole dosing and use. A CYP2C19 genotype does not appear to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089686	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, the patient may be at an increased risk of a sub-optimal response. Consider a 25% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments."}	1
7089687	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 normal metabolizer. Based on the CYP2D6 result, this patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2D6. If trimipramine is warranted, consider a 50% reduction of recommended starting dose and utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089688	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2C19 intermediate metabolizer. There is no reason to selectively adjust the dose of this medication based on the CYP2C19 result. Because a CYP2D6 genotype does not appear to have been ordered for this patient, use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089689	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089690	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089691	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089692	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089693	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089694	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089695	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089696	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089745	aspirin <1g	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1191	{n/a}	1
7089746	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1191	{n/a}	1
7089697	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089698	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089699	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089700	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 ultrarapid metabolizer and a CYP2C19 intermediate metabolizer. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089701	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089702	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089703	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089704	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089705	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7089706	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089707	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089708	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089709	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 intermediate metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089710	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 intermediate metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7089712	adults	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer, and the probability of attainment of therapeutic concentrations is small. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
7089713	adults	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer, and the probability of attainment of therapeutic concentrations is modest. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
7089714	adults	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
7089715	adults	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7089716	adults	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7089717	adults	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
7089718	adults	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as isavuconazole, liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
7089719	adults	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
7089720	pediatrics	Pre-test	{CYP2C19}	{"CYP2C19": "No Result"}	{}	{}	{"CYP2C19": "No Result"}	RxNorm:121243	{"CYP2C19 genotype may be important for voriconazole dosing and use. A CYP2C19 genotype does not appear to have been ordered for this patient. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089721	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 ultrarapid metabolizer, and the probability of attainment of therapeutic concentrations is small. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Please consult a clinical pharmacist for more information."}	1
7089722	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 rapid metabolizer, and the probability of attainment of therapeutic concentrations is variable. Initiate therapy with recommended standard of care dosing. Meticulous therapeutic drug monitoring to titrate dose to therapeutic trough concentrations is critical due to large variability in trough concentrations in rapid metabolizers. Please consult a clinical pharmacist for more information."}	1
7089723	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
7089724	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7089725	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7089747	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1191	{n/a}	1
7089748	aspirin <1g	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1191	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089726	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a likely CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely with normal starting dosages and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
7089727	pediatrics	Post-test	{CYP2C19}	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	RxNorm:121243	{"Based on the genotype result, this patient is predicted to be a CYP2C19 poor metabolizer, and higher than normal trough concentrations of voriconazole are likely with normal starting dosages and may increase the probability of adverse reactions. Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy instead of voriconazole such as liposomal amphotericin B or posaconazole. Selection of an alternative agent should be based upon other clinical factors such as drug interactions, hepatic and/or renal function, suspected or documented fungal species, site of infection, and comorbidities. Where voriconazole is strongly indicated for treatment of an invasive mycosis, administration of a lower dosage with meticulous therapeutic drug monitoring may be feasible. Please consult a clinical pharmacist for more information."}	1
7089728	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
7089729	general	Pre-test	{HLA-B}	{}	{}	{"HLA-B": "No *57:01 result on file"}	{"HLA-B": "No *57:01 result on file"}	RxNorm:190521	{"A HLA-B*57:01 genotype test is recommended before prescribing abacavir per the FDA's black box warning regarding the risk of serious hypersensitivity reactions in patients that carry this allele. A HLA-B*57:01 genotype test does not appear to have been ordered for this patient. Please do the following to order the HLA-B*57:01 genotype test (insert dialogue boxes here to order clinical HLA-B test)."}	1
7089730	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*57:01 negative"}	{"HLA-B": "*57:01 negative"}	RxNorm:190521	{n/a}	1
7089731	general	Post-test	{HLA-B}	{}	{}	{"HLA-B": "*57:01 positive"}	{"HLA-B": "*57:01 positive"}	RxNorm:190521	{"The HLA-B*57:01 allele has been detected in this patient. This allele is associated with high risk of severe hypersensitivity to abacavir. DO NOT prescribe abacavir per the FDA's black box warning. Please choose an alternate antiretroviral. For more information, please consult a clinical pharmacist."}	1
7089732	general	Pre-test	{HLA-B}	{}	{}	{"HLA-B": "No *58:01 result on file"}	{"HLA-B": "No *58:01 result on file"}	RxNorm:519	{"An HLA-B*58:01 genotype test does not appear to have been ordered for this patient. Patients who carry this allele are at increased risk of serious dermatologic reactions with the use of allopurinol, including Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Please consult a clinical pharmacist for more information."}	1
7089733	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*58:01 negative"}	{"HLA-B": "*58:01 negative"}	RxNorm:519	{n/a}	1
7089734	general	Post-test	{HLA-B}	{}	{}	{"HLA-B": "*58:01 positive"}	{"HLA-B": "*58:01 positive"}	RxNorm:519	{"The patient carries the HLA-B*58:01 allele, which indicates that the patient is at risk of developing a serious dermatologic reaction, including Toxic Epidermal Necrolysis or Stevens-Johnson Syndrome. Allopurinol is contraindicated. Please consult a clinical pharmacist for more information."}	1
7089735	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7089736	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{n/a}	1
7089737	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:641	{n/a}	1
7089738	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:641	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089739	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7833	{n/a}	1
7089740	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7833	{n/a}	1
7089741	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7833	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089742	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7833	{n/a}	1
7089743	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7833	{n/a}	1
7089744	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7833	{n/a}	1
7089751	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089752	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089753	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089754	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of atomoxetine-related adverse events. Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089755	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 Intermediate metabolizer and may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089756	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089757	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089758	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089759	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089760	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089761	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089762	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089763	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089764	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089765	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089766	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089767	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089779	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089768	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089769	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089770	adults	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Dosages greater than 100 mg/day may be needed to achieve target concentrations. Please consult a clinical pharmacist for more information."}	1
7089771	adults	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
7089772	adults	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:38400	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089773	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089774	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089775	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089776	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may be at an increased risk of a atomoxetine-related adverse events. Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2-4 h after dosing. If response is inadequate and concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose. Please consult a clinical pharmacist for more information."}	1
7089777	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 intermediate metabolizer and may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089778	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089780	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089781	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089782	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:38400	{"Although this patient is predicted to be a CYP2D6 normal metabolizer, this patient may not achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089783	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089784	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089785	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089786	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089787	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089788	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089789	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089867	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
7089790	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089791	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089792	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089793	pediatrics	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:38400	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and it is unlikely this patient would achieve adequate serum concentrations for the intended effect at standard dosing. Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/ml, consider a proportional increase in dose to approach 400 ng/ml. Please consult a clinical pharmacist for more information."}	1
7089794	pediatrics	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
7089795	pediatrics	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:38400	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089796	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089797	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089798	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
7089799	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7089800	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089801	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity."}	1
7089802	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089803	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089804	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089805	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7089806	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day, (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7089807	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7089868	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089808	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7089809	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day, (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7089810	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089811	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7089812	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089813	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089814	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7090229	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:10627	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089815	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089816	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089817	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7089818	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089819	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089820	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089821	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089822	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089823	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{n/a}	1
7089824	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089825	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089826	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7089827	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7089828	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089829	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089830	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089869	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089831	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:1256	{"Azathioprine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine and should receive greatly reduced doses. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. Please consult a clinical pharmacist for more information."}	1
7089832	general	Pre-test	{DPYD}	{}	{"DPYD": "No Result"}	{}	{"DPYD": "No Result"}	RxNorm:194000	{"DPYD genotype may be useful for capecitabine dosing and use. A DPYD genotype does not appear to have been ordered for this patient. Use of an alternative dose or agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089833	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:194000	{n/a}	1
7089834	general	Post-test	{DPYD}	{}	{"DPYD": "1.5"}	{}	{"DPYD": "1.5"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1.5) and has an increased risk of severe toxicity when treated with capecitabine. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
7089835	general	Post-test	{DPYD}	{}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1) and has an increased risk of severe toxicity when treated with capecitabine. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
7089836	general	Post-test	{DPYD}	{}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0.5) and has an increased risk of severe toxicity when treated with capecitabine. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, capecitabine should be administered at a strongly reduced dose with early therapeutic drug monitoring in order to immediately discontinue therapy if the drug level is too high. If available, a phenotyping test should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on capecitabine clearance. Please consult a clinical pharmacist for more information."}	1
7089837	general	Post-test	{DPYD}	{}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	RxNorm:194000	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0) and has an increased risk of severe toxicity when treated with capecitabine. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. Please consult a clinical pharmacist for more information."}	1
7089838	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:140587	{"CYP2C9 genotype may be important for celecoxib dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089839	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:140587	{n/a}	1
7089840	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:140587	{n/a}	1
7089841	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
7089842	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 8 days for celecoxib). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089870	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
7089843	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:140587	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of celecoxib which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 8 days for celecoxib). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089844	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:140587	{n/a}	1
7089845	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2348	{n/a}	1
7089846	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2348	{n/a}	1
7089847	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2348	{n/a}	1
7089848	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2348	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089849	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2348	{n/a}	1
7089850	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2348	{n/a}	1
7089851	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2393	{n/a}	1
7089852	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2393	{n/a}	1
7089853	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2393	{n/a}	1
7089854	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2393	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089855	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2393	{n/a}	1
7089856	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2393	{n/a}	1
7089857	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2551	{n/a}	1
7089858	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2551	{n/a}	1
7089859	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2551	{n/a}	1
7089860	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2551	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089861	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2551	{n/a}	1
7089862	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2551	{n/a}	1
7089863	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089864	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:2670	{"CYP2D6 genotype is important for codeine and tramadol dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than tramadol) may be recommended. Please consult a clinical pharmacist for more information."}	1
7089865	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089866	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089874	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089875	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:2670	{n/a}	1
7089876	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:2670	{n/a}	1
7089877	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:2670	{n/a}	1
7089878	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:2670	{n/a}	1
7089879	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:2670	{n/a}	1
7089880	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089881	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089882	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089883	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089884	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 poor metabolizer and is at risk of having no analgesic response to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089885	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:2670	{n/a}	1
7089886	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3108	{"G6PD status may be predictive of hemolytic anemia with dapsone. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7089887	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3108	{n/a}	1
7089888	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3108	{"This patient has a result consistent with G6PD deficiency. Dapsone is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Stronlgy consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient very closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7089889	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3108	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Dapsone is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7089890	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3108	{"You are attempting to place an order for dapsone on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and dapsone is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7089891	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3108	{"You are attempting to place an order for dapsone on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and dapsone is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7089892	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{n/a}	1
7089893	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:3328	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089894	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7089895	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:3328	{n/a}	1
7089896	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3445	{n/a}	1
7089897	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3445	{n/a}	1
7089898	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3445	{n/a}	1
7089899	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3445	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089900	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3445	{n/a}	1
7089901	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3445	{n/a}	1
7089902	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3639	{n/a}	1
7089903	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3639	{n/a}	1
7089904	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3639	{n/a}	1
7089905	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:3639	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089906	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3639	{n/a}	1
7089907	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3639	{n/a}	1
7089908	general	Pre-test	{DPYD}	{}	{"DPYD": "No Result"}	{}	{"DPYD": "No Result"}	RxNorm:4492	{"DPYD genotype may be useful for 5-fluorouracil dosing and use. A DPYD genotype does not appear to have been ordered for this patient. Use of an alternative dose or agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089909	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:4492	{n/a}	1
7089910	general	Post-test	{DPYD}	{}	{"DPYD": "1.5"}	{}	{"DPYD": "1.5"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1.5) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
7089911	general	Post-test	{DPYD}	{}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD intermediate metabolizer (activity score 1) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). To maintain efficacy, increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities. Please consult a clinical pharmacist for more information."}	1
7089912	general	Post-test	{DPYD}	{}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0.5) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, 5-fluorouracil should be administered at a strongly reduced dose with early therapeutic drug monitoring in order to immediately discontinue therapy if the drug level is too high. If available, a phenotyping test should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on 5-fluorouracil clearance. Please consult a clinical pharmacist for more information."}	1
7089913	general	Post-test	{DPYD}	{}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	RxNorm:4492	{"Based on the genotype result, this patient is predicted to be a DPYD poor metabolizer (activity score 0) and has an increased risk of severe toxicity when treated with 5-fluorouracil. Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens in this patient. Please consult a clinical pharmacist for more information."}	1
7089914	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:4502	{"CYP2C9 genotype may be important for flurbiprofen dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089915	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:4502	{n/a}	1
7089917	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
7089918	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for flurbiprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089919	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:4502	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of flurbiprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for flurbiprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089920	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:4502	{n/a}	1
7089921	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4601	{n/a}	1
7089922	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4601	{n/a}	1
7089923	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4601	{n/a}	1
7089924	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:4601	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089925	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4601	{n/a}	1
7089926	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4601	{n/a}	1
7089927	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	ATC:D06AX07	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089928	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7089929	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{n/a}	1
7089930	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	ATC:D06AX07	{n/a}	1
7089931	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4815	{n/a}	1
7089932	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4815	{n/a}	1
7089933	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4815	{n/a}	1
7089934	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:4815	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089935	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4815	{n/a}	1
7089936	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4815	{n/a}	1
7089938	<50mg TDD HTN	Post-test	{NAT2}	{"NAT2": "Rapid Metabolizer"}	{}	{}	{"NAT2": "Rapid Metabolizer"}	RxNorm:5470	{"Based on the genotype result, this patient is predicted to be a NAT2 Rapid Metabolizer. Consider a starting dose of at least 25 mg three times daily. Titrate up to 300 mg total daily hydralazine dose as tolerated. NAT2 rapid metabolizers typically require a 50-100% higher maintenance dose compared to poor metabolizers. Please consult a clinical pharmacist for more information."}	1
7089939	<50mg TDD HTN	Post-test	{NAT2}	{"NAT2": "Intermediate Metabolizer"}	{}	{}	{"NAT2": "Intermediate Metabolizer"}	RxNorm:5470	{"Based on the genotype result, this patient is predicted to be a NAT2 Intermediate Metabolizer. Consider a starting dose of at least 25 mg three times daily. Titrate up to 300 mg total daily hydralazine dose as tolerated. NAT2 intermediate metabolizers typically require a 50-100% higher maintenance dose compared to poor metabolizers. Please consult a clinical pharmacist for more information."}	1
7089940	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Poor Metabolizer"}	{}	{}	{"NAT2": "Poor Metabolizer"}	RxNorm:5470	{n/a}	1
7089941	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
7089942	>200mg TDD HTN	Pre-test	{NAT2}	{"NAT2": "No Result"}	{}	{}	{"NAT2": "No Result"}	RxNorm:5470	{"The patient's NAT2 genotype may be important for hydralazine dosing in the setting of resistant hypertension. A NAT2 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
7089943	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Rapid Metabolizer"}	{}	{}	{"NAT2": "Rapid Metabolizer"}	RxNorm:5470	{n/a}	1
7089944	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Intermediate Metabolizer"}	{}	{}	{"NAT2": "Intermediate Metabolizer"}	RxNorm:5470	{n/a}	1
7089945	>200mg TDD HTN	Post-test	{NAT2}	{"NAT2": "Poor Metabolizer"}	{}	{}	{"NAT2": "Poor Metabolizer"}	RxNorm:5470	{"Based on the genotype result, this patient is predicted to be a NAT2 Poor Metabolizer. Initiate therapy at 10 mg four times daily or 25 mg three times daily. Carefully titrate dose upward to clinical effect or guideline-recommended dose; use caution with total daily hydralazine doses of 200 mg or more due to the risk of drug-induced systemic lupus erythematosus. Please consult a clinical pharmacist for more information."}	1
7089946	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
7089947	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:5489	{n/a}	1
7089948	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:5489	{n/a}	1
7089949	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:5489	{n/a}	1
7089950	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:5489	{n/a}	1
7089951	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:5489	{n/a}	1
7089952	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:5489	{n/a}	1
7089953	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:5489	{n/a}	1
7089954	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:5489	{n/a}	1
7089955	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:5489	{n/a}	1
7089956	Hydrocodone	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:5489	{"CYP2D6 genotype may be important for hydrocodone dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than codeine and tramadol) may be recommended. Please consult a clinical pharmacist for more information."}	1
7089957	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:5489	{n/a}	1
7089958	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:5489	{n/a}	1
7089959	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:5489	{n/a}	1
7089960	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:5489	{n/a}	1
7089961	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:5489	{n/a}	1
7089962	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:5489	{n/a}	1
7089963	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:5489	{n/a}	1
7089964	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089965	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089966	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089967	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089968	Hydrocodone	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:5489	{"This patient is predicted to be a CYP2D6 poor metabolizer possibly resulting in decreased analgesia to hydrocodone, codeine and tramadol. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7089969	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:5489	{n/a}	1
7089970	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:5521	{n/a}	1
7089971	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:5521	{n/a}	1
7089972	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:5521	{n/a}	1
7089973	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:5521	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089974	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:5521	{n/a}	1
7089975	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:5521	{n/a}	1
7089976	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:5640	{"CYP2C9 genotype may be important for ibuprofen dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089977	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:5640	{n/a}	1
7089978	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:5640	{n/a}	1
7089979	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
7089980	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for ibuprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089981	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:5640	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of ibuprofen which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for ibuprofen). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089982	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:5640	{n/a}	1
7089983	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:6099	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7089984	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7089985	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{n/a}	1
7089986	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:6099	{n/a}	1
7089987	general	Pre-test	{CYP2C9}	{}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result"}	RxNorm:20890	{"CYP2C9 genotype may be important for lornoxicam dosing and use. A CYP2C9 genotype does not appear to have been ordered for this patient. Use of an alternative agent or dose may be recommended. Please consult a clinical pharmacist for more information."}	1
7089988	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:20890	{n/a}	1
7089989	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:20890	{n/a}	1
7089990	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with lowest recommended starting dose. Titrate dose to clinical effect or maximum recommended dose with caution. \nIn accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Please consult a clinical pharmacist for more information."}	1
7089991	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for lornoxicam). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089992	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:20890	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of lornoxicam which may increase the risk of toxicities. Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 5 days for lornoxicam). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo. Please consult a clinical pharmacist for more information."}	1
7089993	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:20890	{n/a}	1
7089994	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6572	{n/a}	1
7089995	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6572	{n/a}	1
7089996	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6572	{n/a}	1
7089997	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:6572	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7089998	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:6572	{n/a}	1
7089999	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:6572	{n/a}	1
7090000	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
7090001	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:41493	{n/a}	1
7090002	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:41493	{n/a}	1
7090092	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7454	{"You are attempting to place an order for nitrofurantoin on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and nitrofurantoin is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090003	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer with an activity score of 1 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Initiate therapy with 50% of the lowest recommended starting dose. Titrate dose to clinical effect or 50% of the maximum recommended dose with caution. In accordance with the meloxicam prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Dose titration should not occur until after steady state is reached (at least 7 days). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider alternative therapy. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, celecoxib, fluriprofen, lornoxicam, and ibuprofen). Please consult a clinical pharmacist for more information."}	1
7090004	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0.5 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, flurbiprofen, lornoxicam, or ibuprofen). Please consult a clinical pharmacist for more information."}	1
7090005	general	Post-test	{CYP2C9}	{}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	RxNorm:41493	{"Based on the genotype result, this patient is predicted to be a CYP2C9 Poor Metabolizer with an activity score of 0 and is expected to have higher plasma concentrations of meloxicam which may increase the risk of toxicities. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (such as celecoxib, flurbiprofen, lornoxicam, or ibuprofen). Please consult a clinical pharmacist for more information."}	1
7090006	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:41493	{n/a}	1
7090007	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090008	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090009	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090010	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090047	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:6878	{"You are attempting to place an order for methylene blue on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and methylene blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090011	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity."}	1
7090012	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. Initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090013	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090014	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090015	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090016	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090017	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090018	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. Initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090019	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090020	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090021	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090022	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090023	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already <75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090094	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7517	{n/a}	1
7090095	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7517	{n/a}	1
7090024	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090025	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090026	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090027	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090028	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090029	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already <75mg/m2/day or < 1.5mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090048	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:6878	{"You are attempting to place an order for methylene blue on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and methylene blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090119	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8120	{n/a}	1
7090030	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090031	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090032	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090033	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090034	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090035	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{n/a}	1
7090036	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Consider starting 6-mercaptopurine at 30-80% of normal dose if normal starting dose is ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents. If normal starting dose is already < 75mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. Please consult a clinical pharmacist for more information."}	1
7090037	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090049	general	Pre-test	{CYP2D6}	{"CYP2D6": "No Result"}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:6918	{"CYP2D6 genotype may be important for metoprolol dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
7090038	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090039	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090040	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090041	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week, (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090042	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:103	{"6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive greatly reduced doses. For malignancy, start with reducing the normal single dose for 6-mercaptopurine by 90% and administer three times a week (e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090043	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6878	{"G6PD status may be predictive of hemolytic anemia with methylene blue. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090044	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6878	{n/a}	1
7090045	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6878	{"This patient has a result consistent with G6PD deficiency. Methylene blue is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090046	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:6878	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Methylene blue is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090050	general	No CDS	{CYP2D6}	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": ">2.25"}	{}	{"CYP2D6": ">2.25"}	RxNorm:6918	{n/a}	1
7090071	general	Post-test	{CYP2D6}	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:6918	{"This patient is predicted to be a CYP2D6 poor metabolizer and may be at risk of greater heart rate and blood pressure reductions with metoprolol. Initiate therapy with lowest recommended starting dose. Carefully titrate dose upward to clinical effect or guideline-recommended dose; closely monitor for bradycardia. Alternatively, consider selecting another beta-blocker. Please consult a clinical pharmacist for more information."}	1
7090072	general	No CDS	{CYP2D6}	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:6918	{n/a}	1
7090073	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7240	{n/a}	1
7090074	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7240	{n/a}	1
7090075	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7240	{n/a}	1
7090076	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7240	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090077	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7240	{n/a}	1
7090078	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7240	{n/a}	1
7090079	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{n/a}	1
7090080	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7299	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7090081	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090082	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7299	{n/a}	1
7090083	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090084	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{n/a}	1
7090085	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7337	{n/a}	1
7090086	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7337	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7090087	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7454	{"This patient has a result consistent with G6PD deficiency. Use nitrofurantoin with caution and monitor the patient for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090088	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7454	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Nitrofurantoin may cause hemolytic anemia and worsen any existing anemia and should be avoided. Consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090089	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7454	{"G6PD status may be predictive of hemolytic anemia with nitrofurantoin. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Increased monitoring for signs of hemolysis may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090090	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7454	{n/a}	1
7090091	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7454	{"You are attempting to place an order for nitrofurantoin on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and nitrofurantoin is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090093	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7517	{n/a}	1
7090096	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7517	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090097	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7517	{n/a}	1
7090098	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7517	{n/a}	1
7090099	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7623	{n/a}	1
7090100	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7623	{n/a}	1
7090101	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7623	{n/a}	1
7090102	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:7623	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090103	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7623	{n/a}	1
7090104	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7623	{n/a}	1
7090105	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:7934	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7090106	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090107	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{n/a}	1
7090108	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:7934	{n/a}	1
7090109	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1011650	{"G6PD status may be predictive of hemolytic anemia with pegloticase. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090110	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1011650	{n/a}	1
7090111	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1011650	{"This patient has a result consistent with G6PD deficiency. Pegloticase is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090112	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1011650	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Pegloticase is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Stronlgy consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090113	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1011650	{"You are attempting to place an order for pegloticase on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and pegloticase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090114	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1011650	{"You are attempting to place an order for pegloticase on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and pegloticase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090115	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8120	{n/a}	1
7090116	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8120	{n/a}	1
7090117	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8120	{n/a}	1
7090118	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:8120	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090122	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090123	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{n/a}	1
7090124	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:2049549	{n/a}	1
7090125	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8687	{"G6PD status may be predictive of hemolytic anemia with primaquine, depending on the primaquine dosage regimen. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Increased monitoring for signs of hemolysis or alternative agent may be recommended if the patient is G6PD deficient, depending on dosage. Please consult a clinical pharmacist for more information."}	1
7090126	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8687	{n/a}	1
7090127	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8687	{"This patient has a result consistent with G6PD deficiency. Avoid primaquine, except in the following cases where established expert consensus guidelines for the treatment of malaria should be followed: (1) Treating Plasmodium falciparum malaria by using primaquine as a gametocytocide: 0.25 mg/kg x1 dose (WHO)--without need for monitoring for hemolysis; and (2) treating Plasmodium vivax or Plasmodium ovale malaria for radical cure of liver-stage infections: 0.75 mg/kg once weekly x8 weeks (WHO) or 45 mg once weekly x8 weeks (CDC)---with close monitoring for hemolysis. Please consult a clinical pharmacist for more information."}	1
7090128	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:8687	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Primaquine is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090129	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8687	{"You are attempting to place an order for primaquine on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and primaquine is prescribed, depending on the dose. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090130	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:8687	{"You are attempting to place an order for primaquine on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and primaquine is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090131	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9071	{n/a}	1
7090132	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9071	{n/a}	1
7090133	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9071	{n/a}	1
7090134	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:9071	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090135	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9071	{n/a}	1
7090136	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9071	{n/a}	1
7090137	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:283821	{"G6PD status may be predictive of hemolytic anemia with rasburicase. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent is recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090138	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:283821	{n/a}	1
7090139	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:283821	{"This patient has a result consistent with G6PD deficiency. Rasburicase is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090140	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:283821	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Rasburicase is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090141	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:283821	{"You are attempting to place an order for rasburicase on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and rasburicase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090142	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:283821	{"You are attempting to place an order for rasburicase on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient and rasburicase is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090143	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{n/a}	1
7090144	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:NA	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7090145	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090146	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:NA	{n/a}	1
7090147	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:10109	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7090148	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090149	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{n/a}	1
7090150	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:10109	{n/a}	1
7090151	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10171	{n/a}	1
7090152	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10171	{n/a}	1
7090153	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10171	{n/a}	1
7090154	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10171	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090155	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10171	{n/a}	1
7090156	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10171	{n/a}	1
7090157	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10178	{n/a}	1
7090158	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10178	{n/a}	1
7090159	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10178	{n/a}	1
7090160	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10178	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090161	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10178	{n/a}	1
7090162	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10178	{n/a}	1
7090163	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10831	{n/a}	1
7090164	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10831	{n/a}	1
7090165	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10831	{n/a}	1
7090166	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10831	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090167	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10831	{n/a}	1
7090168	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10831	{n/a}	1
7090169	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10184	{n/a}	1
7090170	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10184	{n/a}	1
7090171	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10184	{n/a}	1
7090172	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10184	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090173	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10184	{n/a}	1
7090174	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10184	{n/a}	1
7090175	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9524	{n/a}	1
7090176	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9524	{n/a}	1
7090177	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9524	{n/a}	1
7090178	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:9524	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090179	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9524	{n/a}	1
7090180	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9524	{n/a}	1
7090181	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10207	{n/a}	1
7090182	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10207	{n/a}	1
7090183	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10207	{n/a}	1
7090184	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10207	{n/a}	1
7090185	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10207	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090186	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10207	{n/a}	1
7090187	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2054023	{"G6PD status is predictive of hemolytic anemia with tafenoquine. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090188	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2054023	{n/a}	1
7090189	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2054023	{"This patient has a result consistent with G6PD deficiency. Tafenoquine is likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided; tafenoquine safety was demonstrated only in those with G6PD activity ≥70% of normal. Strongly consider use of an alternative agent. If it is deemed that this medication remains the preferred agent, monitor the patient very closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090190	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:2054023	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Tafenoquine is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090191	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2054023	{"You are attempting to place an order for tafenoquine on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient or if G6PD activity is less than 70% of normal and tafenoquine is prescribed; in such cases, alternatives to tafenoquine should be strongly considered. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090192	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2054023	{"You are attempting to place an order for tafenoquine on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient is at increased risk of developing hemolytic anemia if they are G6PD deficient or if G6PD activity is less than 70% of normal and tafenoquine is prescribed; in such cases, alternatives to tafenoquine should be strongly considered. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090193	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thioguanine is required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity."}	1
7090194	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. NUDT15 genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. Please consult a clinical pharmacist for more information."}	1
7090195	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090196	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090197	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090198	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, TPMT phenotype could not be assigned based on genotyping performed. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090230	general	Post-test	{MT-RNR1}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "increased risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{"Based on the MT-RNR1 genotype result, this patient is predicted to be at increased risk of aminoglycoside-induced hearing loss. Aminoglycosides are likely to cause IRREVERSIBLE hearing loss in this patient. For help with selecting an alternative agent, please consult a clinical pharmacist or Infectious Diseases Service."}	1
7090199	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. TPMT genotype does not appear to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090200	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "No Result"}	{}	{}	{"TPMT": "No Result", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. Neither a TPMT or NUDT15 genotype appears to have been ordered for this patient. Based on those results, use of an alternative dose or drug may be recommended. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090201	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090202	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the NUDT15 result. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090203	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a NUDT15 poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090204	general	Post-test	{TPMT,NUDT15}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible NUDT15 intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g. 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a TPMT genotype does not appear to have been ordered for this patient, it is not known if TPMT results would further influence the recommended dose or drug. If thiopurines are required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7090205	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090206	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090207	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090208	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090209	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a possible TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090210	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be possible TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090211	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090212	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090231	general	No CDS	{MT-RNR1}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "normal risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{n/a}	1
7090213	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090214	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g. 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090215	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090216	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be TPMT intermediate metabolizer and possible NUDT15 intermediate metabolizer. Start with reduced doses (20% to 50% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 8-30 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090217	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. However, NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090218	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer; there is no reason to selectively adjust the dose of this medication based on the TPMT result. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090219	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 intermediate metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090220	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{n/a}	1
7090221	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Reduce doses to 25% of normal dose and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. In setting of myelosuppression, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090222	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer and possible NUDT15 intermediate metabolizer. Start with reduced doses (50% to 80% of normal dose) if normal starting dose is ≥ 40-60 mg/m2/day (e.g., 20-48 mg/m2/day) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7090223	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. However, NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7090224	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Because a NUDT15 genotype does not appear to have been ordered for this patient, it is not known if NUDT15 results would further influence the recommended dose or drug. Please consult a clinical pharmacist for more information."}	1
7090225	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090226	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 normal metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090227	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090228	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	RxNorm:10485	{"Thioguanine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT poor metabolizer and possible NUDT15 intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive greatly reduced doses. Start with drastically reduced doses (reduce daily dose by 10 fold and dose thrice weekly instead of daily) and adjust doses of thioguanine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7090232	general	No CDS	{MT-RNR1}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	{}	{}	{"MT-RNR1": "uncertain risk of aminoglycoside-induced hearing loss"}	RxNorm:10627	{n/a}	1
7090233	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10635	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090234	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10635	{n/a}	1
7090235	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10635	{n/a}	1
7090236	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10635	{n/a}	1
7090237	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10635	{n/a}	1
7090238	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10635	{n/a}	1
7090239	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:10638	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Toluidine blue is very likely to cause hemolytic anemia and worsen any existing anemia and should be avoided. Strongly consider use of an alternative agent. Please consult a clinical pharmacist for more information."}	1
7090240	general	Pre-test	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10638	{"G6PD status may be predictive of hemolytic anemia with toluidine blue. A G6PD test does not appear to have been ordered for this patient. Consider ordering a G6PD genotype or enzyme activity test. Use of an alternative agent may be recommended if the patient is G6PD deficient. Please consult a clinical pharmacist for more information."}	1
7090241	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10638	{n/a}	1
7090242	general	Post-test	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10638	{"This patient has a result consistent with G6PD deficiency. Toluidine blue is very likely to cause hemolytic anemia in patients with G6PD deficiency and should be avoided. Strongly consider use of an alternative agent. If this medication is the preferred agent, monitor the patient closely for signs of hemolysis. Please consult a clinical pharmacist for more information."}	1
7090243	general	Post-test	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10638	{"You are attempting to place an order for toluidine blue on a patient whose G6PD genotype results in a phenotype assignment of variable G6PD activity (enzyme activity could range from normal to deficient). The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and toluidine blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090244	general	Post-test	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10638	{"You are attempting to place an order for toluidine blue on a patient whose G6PD genotype does not allow an assignment of G6PD phenotype. The patient may be at increased risk of developing hemolytic anemia if they are G6PD deficient and toluidine blue is prescribed. A test of G6PD enzyme activity may be informative. Please consult a clinical pharmacist for more information."}	1
7090245	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:10689	{n/a}	1
7090246	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:10689	{n/a}	1
7090247	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:10689	{n/a}	1
7090248	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:10689	{"CYP2D6 genotype is important for tramadol and codeine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative analgesic agent (other than codeine) may be recommended. Please consult a clinical pharmacist for more information."}	1
7090249	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090250	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090251	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090252	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090253	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090254	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090255	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090256	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090257	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090258	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090259	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to tramadol and codeine. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090260	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:10689	{n/a}	1
7090261	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:10689	{n/a}	1
7090262	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadole and codeine. Please consult a clinical pharmacist for more information."}	1
7090263	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090264	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090265	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 intermediate metabolizer possibly resulting in decreased analgesia to tramadol and codeine. Initiate therapy at the recommended age and weight specific dosing. If no adequate analgesic response, consider selecting an alternative agent. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090266	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:10689	{"This patient is predicted to be a CYP2D6 poor metabolizer and is at risk of having no analgesic response. Consider selecting an alternative analgesic agent to tramadol and codeine. If opioid use is warranted, avoid tramadol and codeine. Please consult a clinical pharmacist for more information."}	1
7090267	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:10689	{n/a}	1
7090268	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:27392	{"CYP2D6 genetic status may be predictive of poor response to this medication. A CYP2D6 genotype does not appear to have been ordered for this patient. Use of an alternative drug may be recommended. Please consult a clinical pharmacist for more information."}	1
7090269	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090270	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090297	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:39786	{n/a}	1
7090271	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090272	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090273	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090274	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090275	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090276	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090277	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090278	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090279	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:27392	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at an increased risk of a poor response due to low plasma concentrations of tropisetron. Consider selecting an alternative medication not extensively metabolized by CYP2D6 (i.e., granisetron). Please consult a clinical pharmacist for more information."}	1
7090280	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:27392	{n/a}	1
7090281	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:27392	{n/a}	1
7090282	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:27392	{n/a}	1
7090283	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:27392	{n/a}	1
7090284	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:27392	{n/a}	1
7090285	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:27392	{n/a}	1
7090286	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:27392	{n/a}	1
7090287	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:27392	{n/a}	1
7090288	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:27392	{n/a}	1
7090289	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:27392	{n/a}	1
7090290	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:27392	{n/a}	1
7090291	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:39786	{n/a}	1
7090292	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:39786	{n/a}	1
7090293	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:39786	{n/a}	1
7090294	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:39786	{n/a}	1
7090295	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:39786	{"CYP2D6 genotype may be important for venlafaxine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
7090296	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:39786	{n/a}	1
7090312	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:39786	{"Based on the genotype result, this patient is predicted to be a CYP2D6 poor metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6. Please consult a clinical pharmacist for more information."}	1
7090313	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:39786	{n/a}	1
7090314	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1151	{n/a}	1
7090315	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1151	{n/a}	1
7090316	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1151	{n/a}	1
7090317	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:1151	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090318	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1151	{n/a}	1
7090319	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1151	{n/a}	1
7090320	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:11258	{n/a}	1
7090321	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:11258	{n/a}	1
7090322	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:11258	{n/a}	1
7090323	general	Post-test	{G6PD}	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	RxNorm:11258	{"This patient has a result consistent with G6PD deficiency with chronic nonspherocytic hemolytic anemia (CNSHA). Increased monitoring for worsening of hemolytic anemia may be indicated for patients with G6PD deficiency with CNSHA who receive medications. Please consult a clinical pharmacist for more information."}	1
7090324	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:11258	{n/a}	1
7090325	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:11258	{n/a}	1
7090326	general	Pre-test	{CYP2D6}	{}	{"CYP2D6": "No Result"}	{}	{"CYP2D6": "No Result"}	RxNorm:1455099	{"CYP2D6 genotype may be important for vortioxetine dosing and use. A CYP2D6 genotype does not appear to have been ordered for this patient. Please consult a clinical pharmacist for more information."}	1
7090327	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090328	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090329	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090330	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090331	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090332	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090333	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090334	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090335	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090336	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090337	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 ultrarapid metabolizer and is at risk for lower plasma concentrations and increased probability of therapeutic failure with standard dosing. Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy. Please consult a clinical pharmacist for more information."}	1
7090338	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:1455099	{n/a}	1
7090339	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:1455099	{n/a}	1
7090340	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:1455099	{n/a}	1
7090341	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:1455099	{n/a}	1
7090342	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:1455099	{n/a}	1
7090343	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:1455099	{n/a}	1
7090344	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:1455099	{n/a}	1
7090345	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:1455099	{n/a}	1
7090346	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:1455099	{n/a}	1
7090347	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	RxNorm:1455099	{"Based on the genotype result, this patient is predicted to be a CYP2D6 poor metabolizer and is at risk for higer plasma concentrations and increased probability of side effects with standard dosing. Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6. Please consult a clinical pharmacist for more information."}	1
7090348	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:1455099	{n/a}	1
\.


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

SELECT pg_catalog.setval('cpic.cpic_id', 7090348, true);


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


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

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


--
--

\unrestrict Sfz1H6Rt2Cf7usbh8D6t9Ri2kjfD62TDiyYy2AfJ7py5gjMNVYW2UpelOoEfhwr

