7592010	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 ultrarapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7592011	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 ultrarapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7592012	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 intermediate metabolizer and a CYP2C19 ultrarapid metabolizer. The patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
7592013	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
7592014	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
7592015	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
7592016	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
7592017	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
7592018	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
7592256	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2551	{n/a}	1
7592019	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
7592020	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
7592021	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
7592022	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
7592023	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
7592024	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
7592025	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
7592026	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
7592027	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
7592028	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
7592257	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2551	{n/a}	1
7592460	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:6918	{n/a}	1
7592029	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
7592030	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
7592031	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
7592032	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
7592033	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
7592034	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
7592035	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
7592036	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
7592037	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
7592038	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
7592461	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:6918	{n/a}	1
7592039	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
7592040	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
7592041	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
7592042	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
7592043	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
7592044	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
7592045	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
7592046	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
7592047	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
7592048	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
7592049	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
7592050	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
7592051	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
7592052	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
7592053	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
7592054	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
7592055	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
7592056	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
7592057	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
7592058	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
7592059	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
7592462	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:6918	{n/a}	1
7592060	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
7592061	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
7592062	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
7592063	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
7592064	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592065	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
7592066	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
7592067	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
7592068	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
7592069	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
7592083	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
7592070	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
7592071	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
7592072	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
7592073	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
7592074	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
7592075	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
7592076	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592077	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592078	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592079	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592080	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
7592081	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
7592082	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
7592109	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
7592084	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
7592085	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
7592086	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
7592087	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592088	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
7592089	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
7592090	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
7592091	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
7592092	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
7592093	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
7592094	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
7592143	aspirin <1g	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1191	{n/a}	1
7592144	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1191	{n/a}	1
7592095	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
7592096	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
7592097	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
7592098	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
7592099	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592100	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592101	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592102	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592103	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
7592104	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
7592105	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
7592106	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
7592107	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
7592108	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
7592110	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
7592111	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
7592112	adults	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
7592113	adults	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7592114	adults	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7592115	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
7592116	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
7592117	adults	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
7592118	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
7592119	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
7592120	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
7592121	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
7592122	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7592123	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
7592145	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1191	{n/a}	1
7592146	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
7592124	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
7592125	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
7592126	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
7592127	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
7592128	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*57:01 negative"}	{"HLA-B": "*57:01 negative"}	RxNorm:190521	{n/a}	1
7592129	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
7592130	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
7592131	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*58:01 negative"}	{"HLA-B": "*58:01 negative"}	RxNorm:519	{n/a}	1
7592132	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
7592133	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
7592134	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
7592135	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
7592136	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
7592137	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7833	{n/a}	1
7592138	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7833	{n/a}	1
7592139	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
7592140	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7833	{n/a}	1
7592141	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7833	{n/a}	1
7592142	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7833	{n/a}	1
7592149	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
7592150	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
7592151	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
7592152	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
7592153	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
7592154	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
7592155	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
7592156	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
7592157	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
7592463	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:6918	{n/a}	1
7592158	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
7592159	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
7592160	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
7592161	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
7592162	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
7592163	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
7592164	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
7592165	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
7592177	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
7592166	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
7592167	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
7592168	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
7592169	adults	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
7592170	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
7592171	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
7592172	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
7592173	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
7592174	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
7592175	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
7592176	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
7592178	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
7592179	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
7592180	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
7592181	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
7592182	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
7592183	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
7592184	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
7592185	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
7592186	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
7592187	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
7592258	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
7592188	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
7592189	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
7592190	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
7592191	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
7592192	pediatrics	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
7592193	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
7592194	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{n/a}	1
7592195	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 azathioprine is required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592196	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. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. 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 unreliable in the case of recent red blood cell transfusions. If azathioprine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592197	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. Based on that specific result, the patient may receive a standard starting dose of azathioprine. 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 unreliable in the case of recent red blood cell transfusions. If azathioprine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592198	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592259	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2551	{n/a}	1
7592260	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2551	{n/a}	1
7592199	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. 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 unreliable in the case of recent red blood cell transfusions. If azathioprine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592200	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 a TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. NUDT15 phenotype could not be assigned based on genotyping performed. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592201	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 a TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 20-50% of standard starting dose if the standard starting dose is ≥ 2 mg/kg/day. If starting dose is already below normal recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of azathioprine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592202	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 a TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592203	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 a TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592204	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592229	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. Based on that specific result, the patient may receive a standard starting dose of azathioprine. However, a NUDT15 genotype does not appear to have been ordered for this patient, and it is not known if NUDT15 results would further influence the recommended dose or drug. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592464	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:6918	{n/a}	1
7592205	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 a TPMT intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 20-50% of standard starting dose if the standard starting dose is ≥ 2 mg/kg/day. If starting dose is already below normal recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of azathioprine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592206	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. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine 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 azathioprine is required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7592207	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592208	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine 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 azathioprine is required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be unreliable in the case of recent red blood cell transfusions. Please consult a clinical pharmacist for more information."}	1
7592209	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. Based on that specific result, the patient may receive a standard starting dose of azathioprine. However, NUDT15 status could not be determined based on genotyping performed. If azathioprine is required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592210	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. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592211	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592230	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
7592231	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:194000	{n/a}	1
7592212	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 NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592213	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. Consider alternative non-thiopurine immunosuppressant therapy. NUDT15 status could not be determined based on genotyping performed. Please consult a clinical pharmacist for more information."}	1
7592214	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592215	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592216	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592217	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. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592218	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 NUDT15 possible intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592219	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 a TPMT possible metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. NUDT15 status could not be determined based on genotyping performed. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592220	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 a TPMT possible intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 20-50% of standard starting dose if the standard starting dose is ≥ 2 mg/kg/day. If starting dose is already below normal recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of azathioprine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592261	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
7592221	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 a TPMT possible metabolizer and is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine 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
7592222	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 a possible TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 30-80% of standard starting dose if the standard starting dose is > 2 mg/kg/day. If starting dose is already below standard recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592223	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 TPMT possible intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of azathioprine. Consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592224	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 a TPMT possible intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of azathioprine. Initiate azathioprine at 20-50% of standard starting dose if the standard starting dose is ≥ 2 mg/kg/day. If starting dose is already below normal recommended starting dose (i.e., <2 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of azathioprine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing azathioprine over other agents. Please consult a clinical pharmacist for more information."}	1
7592225	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. 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. If azathioprine is required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be unreliable in the case of recent red blood cell transfusions. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592226	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 unreliable in the case of recent red blood cell transfusions. NUDT15 phenotype could not be assigned based on genotyping performed. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592227	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 azathioprine is required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be unreliable in the case of recent red blood cell transfusions. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592228	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. Based on that specific result, the patient may receive a standard starting dose of azathioprine. However, a TPMT genotype does not appear to have been ordered for this patient, and it is not known if TPMT results would influence the recommended dose or drug. If azathioprine is required and TPMT genotype status is unknown, consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. Erythrocyte TPMT activity test results can be unreliable in the case of recent red blood cell transfusions. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592465	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:6918	{n/a}	1
7592232	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
7592233	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
7592234	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
7592235	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
7592236	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
7592237	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:140587	{n/a}	1
7592238	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:140587	{n/a}	1
7592239	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
7592240	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
7592241	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
7592242	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:140587	{n/a}	1
7592243	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2348	{n/a}	1
7592244	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2348	{n/a}	1
7592245	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2348	{n/a}	1
7592249	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2393	{n/a}	1
7592250	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2393	{n/a}	1
7592263	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
7592264	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
7592265	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
7592266	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
7592267	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
7592268	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
7592269	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
7592270	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
7592271	general	Post-test	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:2670	{"This patient is predicted to be a CYP2D6 ultrarapid metabolizer and may be at increased risk of developing toxicities to codeine and tramadol. Consider selecting an alternative analgesic agent. If opioid use is warranted, avoid codeine and tramadol. Please consult a clinical pharmacist for more information."}	1
7592272	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
7592273	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:2670	{n/a}	1
7592274	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:2670	{n/a}	1
7592275	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:2670	{n/a}	1
7592276	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:2670	{n/a}	1
7592277	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:2670	{n/a}	1
7592278	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
7592279	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
7592280	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
7592340	>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
7592281	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
7592282	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
7592283	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:2670	{n/a}	1
7592284	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
7592285	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3108	{n/a}	1
7592286	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
7592287	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
7592288	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
7592289	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
7592290	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
7592291	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
7592292	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
7592293	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
7592294	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3445	{n/a}	1
7592295	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3445	{n/a}	1
7592296	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3445	{n/a}	1
7592297	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
7592298	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3445	{n/a}	1
7592299	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3445	{n/a}	1
7592300	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3639	{n/a}	1
7592301	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3639	{n/a}	1
7592302	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3639	{n/a}	1
7592341	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Rapid Metabolizer"}	{}	{}	{"NAT2": "Rapid Metabolizer"}	RxNorm:5470	{n/a}	1
7592303	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
7592304	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3639	{n/a}	1
7592305	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3639	{n/a}	1
7592306	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
7592307	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:4492	{n/a}	1
7592308	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
7592309	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
7592310	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
7592311	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
7592312	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
7592313	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:4502	{n/a}	1
7592314	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:4502	{n/a}	1
7592315	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
7592316	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
7592342	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Intermediate Metabolizer"}	{}	{}	{"NAT2": "Intermediate Metabolizer"}	RxNorm:5470	{n/a}	1
7592466	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:6918	{n/a}	1
7592467	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:6918	{n/a}	1
7592317	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
7592318	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:4502	{n/a}	1
7592319	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4601	{n/a}	1
7592320	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4601	{n/a}	1
7592321	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4601	{n/a}	1
7592322	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
7592323	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4601	{n/a}	1
7592324	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4601	{n/a}	1
7592325	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
7592326	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
7592327	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
7592328	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
7592329	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4815	{n/a}	1
7592330	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4815	{n/a}	1
7592331	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4815	{n/a}	1
7592332	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
7592333	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4815	{n/a}	1
7592334	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4815	{n/a}	1
7592335	<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
7592336	<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
7592337	<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
7592338	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Poor Metabolizer"}	{}	{}	{"NAT2": "Poor Metabolizer"}	RxNorm:5470	{n/a}	1
7592339	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
7592468	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:6918	{n/a}	1
7592343	>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
7592344	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
7592345	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:5489	{n/a}	1
7592346	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:5489	{n/a}	1
7592347	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:5489	{n/a}	1
7592348	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:5489	{n/a}	1
7592349	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:5489	{n/a}	1
7592350	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:5489	{n/a}	1
7592351	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:5489	{n/a}	1
7592352	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:5489	{n/a}	1
7592353	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:5489	{n/a}	1
7592354	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
7592355	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:5489	{n/a}	1
7592356	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:5489	{n/a}	1
7592357	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:5489	{n/a}	1
7592358	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:5489	{n/a}	1
7592359	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:5489	{n/a}	1
7592360	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:5489	{n/a}	1
7592361	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:5489	{n/a}	1
7592362	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
7592363	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
7592364	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
7592365	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
7592366	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
7592367	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:5489	{n/a}	1
7592368	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:5521	{n/a}	1
7592369	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:5521	{n/a}	1
7592370	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:5521	{n/a}	1
7592371	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
7592372	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:5521	{n/a}	1
7592373	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:5521	{n/a}	1
7592374	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
7592375	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:5640	{n/a}	1
7592376	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:5640	{n/a}	1
7592377	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
7592378	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
7592379	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
7592380	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:5640	{n/a}	1
7592381	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
7592382	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
7592383	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
7592384	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
7592385	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
7592386	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:20890	{n/a}	1
7592387	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:20890	{n/a}	1
7592443	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
7592388	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
7592389	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
7592390	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
7592391	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:20890	{n/a}	1
7592392	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6572	{n/a}	1
7592393	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6572	{n/a}	1
7592394	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6572	{n/a}	1
7592395	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
7592396	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:6572	{n/a}	1
7592397	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:6572	{n/a}	1
7592398	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
7592399	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:41493	{n/a}	1
7592400	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:41493	{n/a}	1
7592401	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
7592402	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
7592444	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
7592403	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
7592404	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:41493	{n/a}	1
7592405	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{n/a}	1
7592406	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 6-mercaptopurine is required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592407	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. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. 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 6-mercaptopurine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592408	general	Post-test	{TPMT,NUDT15}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "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. Based on that specific result, the patient may receive a standard starting dose of 6-mercaptopurine. However, TPMT status could not be determined 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 6-mercaptopurine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592409	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. 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 6-mercaptopurine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592410	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. 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 6-mercaptopurine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592693	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
7592411	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 a TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate 6-mercaptopurine at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be necessary. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592412	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 a TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 20-50% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592413	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. Initiate therapy at 30-80% of standard starting dose if starting dose is if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine 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
7592414	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 a TPMT intermediate metabolizer and NUDT15 normal metabolizer. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592415	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592416	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 a TPMT intermediate metabolizer and possible NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 20-50% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592694	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:39786	{n/a}	1
7592695	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:39786	{n/a}	1
7592417	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. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine 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 6-mercaptopurine is 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
7592418	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, 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 6-mercaptopurine is 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
7592419	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 30-80% of standard starting dose If starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine 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 6-mercaptopurine is 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592420	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. Based on that specific result, the patient may receive a standard starting dose of 6-mercaptopurine. However, NUDT15 status could not be determined based on genotyping performed. If 6-mercaptopurine is required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592421	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. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592445	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
7592677	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
7592422	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592423	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 NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592424	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, 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
7592425	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592426	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, 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
7592427	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592446	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
7592428	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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592429	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 NUDT15 possible intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of 6-mercaptopurine and should receive drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592430	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 a TPMT possible intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 30-80% of standard starting if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592431	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 a TPMT possible intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 20-50% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592432	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 a TPMT possible intermediate metabolizer and is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate therapy at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be recommended. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine 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
7592433	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 a TPMT possible intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate 6-mercaptopurine at 30-80% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., <75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be necessary. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592513	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8120	{n/a}	1
7592434	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 TPMT possible 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 drastically reduced doses. For malignancy, reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily (e.g., 10 mg/m2/day given just 3 days/week). During therapy, adjust 6-mercaptopurine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing 6-mercaptopurine over other agents. For non-malignancy, consider alternative non-thiopurine immunosuppressant therapy. Please consult a clinical pharmacist for more information."}	1
7592435	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 a TPMT possible intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of 6-mercaptopurine. Initiate 6-mercaptopurine at 20-50% of standard starting dose if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for non-malignancy). If starting dose is already below normal recommended starting dose (i.e., < 75 mg/m2/day or <1.5 mg/kg/day), dose reduction might not be necessary. During therapy, adjust the doses of 6-mercaptopurine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing 6-mercaptopurine over other agents. Please consult a clinical pharmacist for more information."}	1
7592436	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 6-mercaptopurine is required and TPMT and NUDT15 statuses are unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592437	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 6-mercaptopurine is 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
7592438	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 6-mercaptopurine is 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
7592439	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. Based on that specific result, the patient may receive a standard starting dose of 6-mercaptopurine. However, a TPMT genotype does not appear to have been ordered for this patient, and it is not known if TPMT results would further influence the recommended dose or drug. If 6-mercaptopurine is 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592440	general	Pre-test	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	RxNorm:103	{"i would not say \\"there is no reason to adjust...\\"\n6-mercaptopurine can be affected by a patient's TPMT and NUDT15 phenotype. This patient is predicted to be a TPMT normal metabolizer. Based on that specific result, the patient may receive a standard starting dose of 6-mercaptopurine. However, a NUDT15 genotype does not appear to have been ordered for this patient, and it is not known if NUDT15 results would further influence the recommended dose or drug. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592441	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
7592442	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6878	{n/a}	1
7592514	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8120	{n/a}	1
7592469	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
7592470	general	No CDS	{CYP2D6}	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:6918	{n/a}	1
7592471	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7240	{n/a}	1
7592472	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7240	{n/a}	1
7592473	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7240	{n/a}	1
7592474	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
7592475	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7240	{n/a}	1
7592476	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7240	{n/a}	1
7592477	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
7592478	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
7592479	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
7592480	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
7592481	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
7592482	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
7592483	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
7592484	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
7592485	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
7592486	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
7592487	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
7592488	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7454	{n/a}	1
7592489	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
7592515	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8120	{n/a}	1
7592490	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
7592491	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7517	{n/a}	1
7592492	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7517	{n/a}	1
7592493	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7517	{n/a}	1
7592494	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
7592495	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7517	{n/a}	1
7592496	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7517	{n/a}	1
7592497	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7623	{n/a}	1
7592498	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7623	{n/a}	1
7592499	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7623	{n/a}	1
7592500	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
7592501	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7623	{n/a}	1
7592502	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7623	{n/a}	1
7592503	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
7592504	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
7592505	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
7592506	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
7592507	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
7592508	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1011650	{n/a}	1
7592509	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
7592510	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
7592511	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
7592512	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
7592516	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
7592517	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8120	{n/a}	1
7592518	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:8120	{n/a}	1
7592519	general	Pre-test	{MT-RNR1}	{"MT-RNR1": "No Result"}	{}	{}	{"MT-RNR1": "No Result"}	RxNorm:2049549	{"A MT-RNR1 genotype does not appear to have been ordered for this patient. MT-RNR1 genotype may be an important risk factor for aminoglycoside-induced hearing loss. Use of an alternative agent may be recommended. Please consult a clinical pharmacist for more information."}	1
7592520	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
7592521	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
7592522	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
7592523	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
7592524	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8687	{n/a}	1
7592525	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
7592526	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
7592527	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
7592528	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
7592529	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9071	{n/a}	1
7592530	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9071	{n/a}	1
7592531	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9071	{n/a}	1
7592532	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
7592533	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9071	{n/a}	1
7592534	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9071	{n/a}	1
7592535	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
7592536	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:283821	{n/a}	1
7592537	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
7592538	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
7592539	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
7592540	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
7592541	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
7592542	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
7592543	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
7592544	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
7592545	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
7592546	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
7592547	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
7592548	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
7592549	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10171	{n/a}	1
7592550	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10171	{n/a}	1
7592551	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10171	{n/a}	1
7592552	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
7592553	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10171	{n/a}	1
7592554	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10171	{n/a}	1
7592555	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10178	{n/a}	1
7592556	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10178	{n/a}	1
7592557	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10178	{n/a}	1
7592558	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
7592564	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
7592565	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10831	{n/a}	1
7592566	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10831	{n/a}	1
7592567	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10184	{n/a}	1
7592568	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10184	{n/a}	1
7592569	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10184	{n/a}	1
7592570	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
7592571	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10184	{n/a}	1
7592572	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10184	{n/a}	1
7592573	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9524	{n/a}	1
7592574	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9524	{n/a}	1
7592575	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9524	{n/a}	1
7592576	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
7592577	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9524	{n/a}	1
7592578	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9524	{n/a}	1
7592579	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10207	{n/a}	1
7592580	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10207	{n/a}	1
7592581	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10207	{n/a}	1
7592582	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10207	{n/a}	1
7592583	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
7592584	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10207	{n/a}	1
7592585	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
7592586	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2054023	{n/a}	1
7592587	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
7592588	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
7592589	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
7592678	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:27392	{n/a}	1
7592590	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
7592591	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{n/a}	1
7592592	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
7592593	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. Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day) dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing 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. 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 thioguanine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592594	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. Based on that specific result, the patient may receive a standard starting dose of thioguanine. However, TPMT status could not be determined 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 TPMT status is unknown, monitor closely for toxicity."}	1
7592595	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. 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 thioguanine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592596	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. 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 thioguanine is required and TPMT status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592622	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. 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. 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 TPMT and NUDT15 statuses are unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592597	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. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination 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 thioguanine is 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
7592598	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, 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 thioguanine is 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
7592599	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 NUDT15 possible intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., < 40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination 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 thioguanine is 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
7592600	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 a TPMT possible intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592601	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 a TPMT possible intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary.During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592640	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
7592679	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:27392	{n/a}	1
7592602	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 a TPMT possible intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 20-50% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592603	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 a TPMT possible intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592604	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 TPMT possible intermediate metabolizer and NUDT15 poor metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592605	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 a TPMT possible intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 20-50% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592606	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 a TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592607	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 a TPMT intermediate metabolizer and is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592641	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
7592608	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 a TPMT intermediate metabolizer and NUDT15 intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate therapy at 20-50% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be recommended. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592609	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 a TPMT intermediate metabolizer and NUDT15 normal metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592610	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592611	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 a TPMT intermediate metabolizer and NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 20-50% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592612	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. Based on that specific result, the patient may receive a standard starting dose of thioguanine. However, NUDT15 status could not be determined based on genotyping performed. If thioguanine is required and NUDT15 status is unknown, monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592613	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. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592614	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592680	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:27392	{n/a}	1
7592681	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:27392	{n/a}	1
7592615	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 NUDT15 possible intermediate metabolizer. This patient is at risk for myelosuppression with normal doses of thioguanine. Initiate thioguanine at 30-80% of standard starting dose if standard starting dose is ≥40 mg/m2/day. If starting dose is already below normal recommended starting dose (i.e., <40 mg/m2/day), dose reduction might not be necessary. During therapy, adjust the doses of thioguanine based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592616	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. NUDT15 phenotype could not be assigned based on genotyping. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592617	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592618	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592619	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592620	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 drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592621	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 NUDT15 possible intermediate metabolizer. This patient is at high risk for life threatening myelosuppression with normal doses of thioguanine and should receive drastically reduced doses. Reduce daily dose by 10-fold (~90% dose reduction) and reduce frequency to 3 times per week instead of daily. During therapy, adjust thioguanine doses based on degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing thioguanine over other agents. Please consult a clinical pharmacist for more information."}	1
7592682	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:27392	{n/a}	1
7592683	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:27392	{n/a}	1
7592623	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 thioguanine is 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
7592624	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 thioguanine is 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
7592625	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. Based on that specific result, the patient may receive a standard starting dose of thioguanine. However, a TPMT genotype does not appear to have been ordered for this patient, and it is not known if TPMT results would further influence the recommended dose or drug. If thioguanine is 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. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592626	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. Based on that specific result, the patient may receive a standard starting dose of thioguanine. However, a NUDT15 genotype does not appear to have been ordered for this patient, and it is not known if NUDT15 results would further influence the recommended dose or drug. Monitor closely for toxicity. Please consult a clinical pharmacist for more information."}	1
7592627	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
7592628	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
7592629	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
7592630	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
7592631	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
7592632	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10635	{n/a}	1
7592633	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10635	{n/a}	1
7592634	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10635	{n/a}	1
7592635	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10635	{n/a}	1
7592636	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10635	{n/a}	1
7592637	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
7592638	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
7592639	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10638	{n/a}	1
7592684	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:27392	{n/a}	1
7592642	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
7592643	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:10689	{n/a}	1
7592644	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:10689	{n/a}	1
7592645	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:10689	{n/a}	1
7592646	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
7592647	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
7592648	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
7592649	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
7592650	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
7592651	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
7592652	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
7592653	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
7592654	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
7592655	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
7592656	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
7592657	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
7592658	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:10689	{n/a}	1
7592659	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:10689	{n/a}	1
7592660	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
7592661	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
7592662	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
7592663	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
7592664	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
7592665	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:10689	{n/a}	1
7592666	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
7592667	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
7592668	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
7592669	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
7592670	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
7592671	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
7592672	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
7592673	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
7592674	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
7592675	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
7592676	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
7592710	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
7592711	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:39786	{n/a}	1
7592712	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1151	{n/a}	1
7592713	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1151	{n/a}	1
7592714	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1151	{n/a}	1
7592715	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
7592716	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1151	{n/a}	1
7592717	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1151	{n/a}	1
7592718	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:11258	{n/a}	1
7592719	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:11258	{n/a}	1
7592720	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:11258	{n/a}	1
7592721	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
7592722	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:11258	{n/a}	1
7592723	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:11258	{n/a}	1
7592724	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
7592725	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
7592726	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
7592727	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
7592728	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
7592729	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
7592730	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
7592731	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
7592732	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
7592733	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
7592734	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
7592735	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
7592736	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:1455099	{n/a}	1
7592737	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:1455099	{n/a}	1
7592738	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:1455099	{n/a}	1
7592739	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:1455099	{n/a}	1
7592740	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:1455099	{n/a}	1
7592741	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:1455099	{n/a}	1
7592742	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:1455099	{n/a}	1
7592743	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:1455099	{n/a}	1
7592744	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:1455099	{n/a}	1
7592745	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
7592746	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', 7594310, 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 6LWd2XNyLePtEhm25q37lUJ4KliVjgZxcalG8R6VS0X7P8hoQ9v2JaT4cPlBYg2

