8354414	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 ultrarapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
8354661	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2551	{n/a}	1
8354415	general	Post-test	{CYP2D6,CYP2C19}	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Ultrarapid Metabolizer"}	RxNorm:10834	{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 normal metabolizer and CYP2C19 ultrarapid metabolizer. Based on the CYP2C19 result, the patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug not metabolized by CYP2C19. If trimipramine is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}	1
8354416	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
8354417	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
8354418	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
8354419	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
8354420	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
8354421	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
8354422	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
8354423	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
8354424	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
8354662	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2551	{n/a}	1
8354425	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
8354426	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
8354427	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
8354428	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
8354429	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
8354430	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
8354431	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
8354432	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
8354433	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
8354434	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
8354663	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2551	{n/a}	1
8354866	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:6918	{n/a}	1
8354435	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
8354436	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
8354437	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
8354438	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
8354439	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
8354440	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
8354441	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
8354442	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
8354443	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
8354444	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
8354867	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:6918	{n/a}	1
8354445	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
8354446	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
8354447	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
8354448	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
8354449	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
8354450	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
8354451	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
8354452	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
8354453	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
8354454	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
8354455	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
8354456	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
8354457	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
8354458	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
8354459	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
8354460	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
8354461	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
8354462	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
8354463	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
8354464	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
8354465	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
8354868	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:6918	{n/a}	1
8354466	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
8354467	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
8354468	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
8354469	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
8354470	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354471	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
8354472	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
8354473	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
8354474	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
8354475	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
8354489	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
8354476	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
8354477	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
8354478	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
8354479	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
8354480	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
8354481	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
8354482	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354483	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354484	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354485	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354486	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	RxNorm:10834	{n/a}	1
8354487	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
8354488	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
8354515	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
8354490	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
8354491	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
8354492	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
8354493	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354494	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
8354495	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
8354496	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
8354497	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
8354498	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
8354499	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
8354500	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
8354549	aspirin <1g	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1191	{n/a}	1
8354550	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1191	{n/a}	1
8354501	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
8354502	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
8354503	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
8354504	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
8354505	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354506	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354507	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354508	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354509	general	No CDS	{CYP2D6,CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	RxNorm:10834	{n/a}	1
8354510	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
8354511	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
8354512	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
8354513	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
8354514	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
8354516	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
8354517	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
8354518	adults	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
8354519	adults	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
8354520	adults	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
8354521	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
8354522	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
8354523	adults	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
8354524	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
8354525	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
8354526	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
8354527	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	RxNorm:121243	{n/a}	1
8354528	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
8354529	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	RxNorm:121243	{n/a}	1
8354551	aspirin <1g	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1191	{n/a}	1
8354552	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
8354530	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
8354531	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
8354532	pediatrics	No CDS	{CYP2C19}	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	RxNorm:121243	{n/a}	1
8354533	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
8354534	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*57:01 negative"}	{"HLA-B": "*57:01 negative"}	RxNorm:190521	{n/a}	1
8354535	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
8354536	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
8354537	general	No CDS	{HLA-B}	{}	{}	{"HLA-B": "*58:01 negative"}	{"HLA-B": "*58:01 negative"}	RxNorm:519	{n/a}	1
8354538	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
8354539	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
8354540	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
8354541	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
8354542	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
8354543	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7833	{n/a}	1
8354544	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7833	{n/a}	1
8354545	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
8354546	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7833	{n/a}	1
8354547	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7833	{n/a}	1
8354548	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7833	{n/a}	1
8354555	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
8354556	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
8354557	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
8354558	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
8354559	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
8354560	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
8354561	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
8354562	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
8354563	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
8354869	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:6918	{n/a}	1
8354564	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
8354565	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
8354566	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
8354567	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
8354568	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
8354569	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
8354570	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
8354571	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
8354583	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
8354572	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
8354573	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
8354574	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
8354575	adults	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
8354576	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
8354577	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
8354578	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
8354579	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
8354580	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
8354581	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
8354582	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
8354584	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
8354585	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
8354586	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
8354587	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
8354588	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
8354589	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
8354590	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
8354591	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
8354592	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
8354593	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
8354664	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
8354594	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
8354595	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
8354596	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
8354597	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
8354598	pediatrics	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:38400	{n/a}	1
8354599	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
8354600	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:1256	{n/a}	1
8354601	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
8354602	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
8354603	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
8354604	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
8354665	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:2551	{n/a}	1
8354666	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:2551	{n/a}	1
8354605	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
8354606	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
8354607	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
8354608	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
8354609	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
8354610	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
8354635	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
8354870	general	No CDS	{CYP2D6}	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:6918	{n/a}	1
8354611	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
8354612	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
8354613	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
8354614	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
8354615	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
8354616	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
8354617	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
8354636	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
8354637	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:194000	{n/a}	1
8354618	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
8354619	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
8354620	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
8354621	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
8354622	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
8354623	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
8354624	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
8354625	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
8354626	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
8354667	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
8354627	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
8354628	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
8354629	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
8354630	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
8354631	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
8354632	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
8354633	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
8354634	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
8354871	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:6918	{n/a}	1
8354638	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
8354639	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
8354640	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
8354641	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
8354642	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
8354643	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:140587	{n/a}	1
8354644	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:140587	{n/a}	1
8354645	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
8354646	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
8354647	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
8354648	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:140587	{n/a}	1
8354649	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2348	{n/a}	1
8354650	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2348	{n/a}	1
8354651	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:2348	{n/a}	1
8354655	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:2393	{n/a}	1
8354656	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2393	{n/a}	1
8354669	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
8354670	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
8354671	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
8354672	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
8354673	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
8354674	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
8354675	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
8354676	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
8354677	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
8354678	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
8354679	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:2670	{n/a}	1
8354680	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:2670	{n/a}	1
8354681	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:2670	{n/a}	1
8354682	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:2670	{n/a}	1
8354683	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:2670	{n/a}	1
8354684	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
8354685	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
8354686	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
8354746	>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
8354687	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
8354688	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
8354689	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:2670	{n/a}	1
8354690	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
8354691	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3108	{n/a}	1
8354692	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
8354693	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
8354694	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
8354695	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
8354696	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
8354697	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
8354698	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
8354699	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
8354700	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3445	{n/a}	1
8354701	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3445	{n/a}	1
8354702	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3445	{n/a}	1
8354703	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
8354704	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3445	{n/a}	1
8354705	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3445	{n/a}	1
8354706	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:3639	{n/a}	1
8354707	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:3639	{n/a}	1
8354708	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:3639	{n/a}	1
8354747	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Rapid Metabolizer"}	{}	{}	{"NAT2": "Rapid Metabolizer"}	RxNorm:5470	{n/a}	1
8354709	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
8354710	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:3639	{n/a}	1
8354711	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:3639	{n/a}	1
8354712	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
8354713	general	No CDS	{DPYD}	{}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	RxNorm:4492	{n/a}	1
8354714	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
8354715	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
8354716	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
8354717	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
8354718	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
8354719	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:4502	{n/a}	1
8354720	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:4502	{n/a}	1
8354721	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
8354722	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
8354748	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Intermediate Metabolizer"}	{}	{}	{"NAT2": "Intermediate Metabolizer"}	RxNorm:5470	{n/a}	1
8354872	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:6918	{n/a}	1
8354873	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:6918	{n/a}	1
8354723	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
8354724	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:4502	{n/a}	1
8354725	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4601	{n/a}	1
8354726	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4601	{n/a}	1
8354727	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4601	{n/a}	1
8354728	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
8354729	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4601	{n/a}	1
8354730	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4601	{n/a}	1
8354731	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
8354732	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
8354733	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
8354734	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
8354735	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:4815	{n/a}	1
8354736	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:4815	{n/a}	1
8354737	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:4815	{n/a}	1
8354738	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
8354739	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:4815	{n/a}	1
8354740	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:4815	{n/a}	1
8354741	<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
8354742	<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
8354743	<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
8354744	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Poor Metabolizer"}	{}	{}	{"NAT2": "Poor Metabolizer"}	RxNorm:5470	{n/a}	1
8354745	<50mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
8354874	general	No CDS	{CYP2D6}	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:6918	{n/a}	1
8354749	>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
8354750	>200mg TDD HTN	No CDS	{NAT2}	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	RxNorm:5470	{n/a}	1
8354751	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:5489	{n/a}	1
8354752	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:5489	{n/a}	1
8354753	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:5489	{n/a}	1
8354754	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:5489	{n/a}	1
8354755	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	RxNorm:5489	{n/a}	1
8354756	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	RxNorm:5489	{n/a}	1
8354757	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	RxNorm:5489	{n/a}	1
8354758	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	RxNorm:5489	{n/a}	1
8354759	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:5489	{n/a}	1
8354760	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
8354761	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:5489	{n/a}	1
8354762	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:5489	{n/a}	1
8354763	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	RxNorm:5489	{n/a}	1
8354764	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	RxNorm:5489	{n/a}	1
8354765	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	RxNorm:5489	{n/a}	1
8354766	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	RxNorm:5489	{n/a}	1
8354767	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	RxNorm:5489	{n/a}	1
8354768	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
8354769	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
8354770	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
8354771	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
8354772	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
8354773	Hydrocodone	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:5489	{n/a}	1
8354774	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:5521	{n/a}	1
8354775	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:5521	{n/a}	1
8354776	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:5521	{n/a}	1
8354777	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
8354778	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:5521	{n/a}	1
8354779	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:5521	{n/a}	1
8354780	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
8354781	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:5640	{n/a}	1
8354782	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:5640	{n/a}	1
8354783	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
8354784	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
8354785	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
8354786	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:5640	{n/a}	1
8354787	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
8354788	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
8354789	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
8354790	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
8354791	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
8354792	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:20890	{n/a}	1
8354793	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:20890	{n/a}	1
8354849	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
8354794	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
8354795	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
8354796	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
8354797	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:20890	{n/a}	1
8354798	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:6572	{n/a}	1
8354799	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6572	{n/a}	1
8354800	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:6572	{n/a}	1
8354801	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
8354802	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:6572	{n/a}	1
8354803	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:6572	{n/a}	1
8354804	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
8354805	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	RxNorm:41493	{n/a}	1
8354806	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	RxNorm:41493	{n/a}	1
8354807	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
8354808	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
8354850	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
8354809	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
8354810	general	No CDS	{CYP2C9}	{}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	RxNorm:41493	{n/a}	1
8354811	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:103	{n/a}	1
8354812	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
8354813	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
8354814	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
8354815	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
8354816	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
8355099	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
8354817	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
8354818	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
8354819	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
8354820	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
8354821	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
8354822	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
8355100	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	RxNorm:39786	{n/a}	1
8355101	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	RxNorm:39786	{n/a}	1
8354823	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
8354824	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
8354825	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
8354826	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
8354827	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
8354851	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
8355083	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
8354828	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
8354829	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
8354830	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
8354831	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
8354832	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
8354833	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
8354852	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
8354834	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
8354835	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
8354836	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
8354837	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
8354838	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
8354839	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
8354919	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:8120	{n/a}	1
8354840	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
8354841	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
8354842	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
8354843	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
8354844	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
8354845	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
8354846	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
8354847	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
8354848	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:6878	{n/a}	1
8354920	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8120	{n/a}	1
8354875	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
8354876	general	No CDS	{CYP2D6}	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:6918	{n/a}	1
8354877	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7240	{n/a}	1
8354878	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7240	{n/a}	1
8354879	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7240	{n/a}	1
8354880	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
8354881	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7240	{n/a}	1
8354882	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7240	{n/a}	1
8354883	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
8354884	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
8354885	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
8354886	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
8354887	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
8354888	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
8354889	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
8354890	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
8354891	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
8354892	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
8354893	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
8354894	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7454	{n/a}	1
8354895	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
8354921	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:8120	{n/a}	1
8354896	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
8354897	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7517	{n/a}	1
8354898	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7517	{n/a}	1
8354899	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7517	{n/a}	1
8354900	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
8354901	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7517	{n/a}	1
8354902	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7517	{n/a}	1
8354903	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:7623	{n/a}	1
8354904	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:7623	{n/a}	1
8354905	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:7623	{n/a}	1
8354906	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
8354907	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:7623	{n/a}	1
8354908	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:7623	{n/a}	1
8354909	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
8354910	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
8354911	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
8354912	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
8354913	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
8354914	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1011650	{n/a}	1
8354915	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
8354916	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
8354917	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
8354918	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
8354922	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
8354923	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:8120	{n/a}	1
8354924	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:8120	{n/a}	1
8354925	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
8354926	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
8354927	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
8354928	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
8354929	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
8354930	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:8687	{n/a}	1
8354931	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
8354932	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
8354933	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
8354934	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
8354935	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9071	{n/a}	1
8354936	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9071	{n/a}	1
8354937	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9071	{n/a}	1
8354938	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
8354939	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9071	{n/a}	1
8354940	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9071	{n/a}	1
8354941	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
8354942	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:283821	{n/a}	1
8354943	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
8354944	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
8354945	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
8354946	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
8354947	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
8354948	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
8354949	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
8354950	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
8354951	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
8354952	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
8354953	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
8354954	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
8354955	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10171	{n/a}	1
8354956	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10171	{n/a}	1
8354957	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10171	{n/a}	1
8354958	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
8354959	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10171	{n/a}	1
8354960	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10171	{n/a}	1
8354961	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10178	{n/a}	1
8354962	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10178	{n/a}	1
8354963	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10178	{n/a}	1
8354964	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
8354970	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
8354971	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10831	{n/a}	1
8354972	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10831	{n/a}	1
8354973	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10184	{n/a}	1
8354974	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10184	{n/a}	1
8354975	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10184	{n/a}	1
8354976	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
8354977	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10184	{n/a}	1
8354978	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10184	{n/a}	1
8354979	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:9524	{n/a}	1
8354980	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:9524	{n/a}	1
8354981	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:9524	{n/a}	1
8354982	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
8354983	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:9524	{n/a}	1
8354984	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:9524	{n/a}	1
8354985	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10207	{n/a}	1
8354986	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10207	{n/a}	1
8354987	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10207	{n/a}	1
8354988	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10207	{n/a}	1
8354989	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
8354990	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10207	{n/a}	1
8354991	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
8354992	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:2054023	{n/a}	1
8354993	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
8354994	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
8354995	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
8355084	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:27392	{n/a}	1
8354996	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
8354997	general	No CDS	{TPMT,NUDT15}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	RxNorm:10485	{n/a}	1
8354998	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
8354999	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
8355000	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
8355001	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
8355002	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
8355028	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
8355003	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
8355004	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
8355005	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
8355006	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
8355007	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
8355046	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
8355085	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:27392	{n/a}	1
8355008	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
8355009	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
8355010	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
8355011	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
8355012	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
8355013	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
8355047	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
8355014	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
8355015	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
8355016	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
8355017	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
8355018	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
8355019	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
8355020	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
8355086	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:27392	{n/a}	1
8355087	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:27392	{n/a}	1
8355021	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
8355022	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
8355023	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
8355024	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
8355025	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
8355026	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
8355027	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
8355088	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:27392	{n/a}	1
8355089	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:27392	{n/a}	1
8355029	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
8355030	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
8355031	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
8355032	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
8355033	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
8355034	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
8355035	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
8355036	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
8355037	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
8355038	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:10635	{n/a}	1
8355039	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:10635	{n/a}	1
8355040	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:10635	{n/a}	1
8355041	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10635	{n/a}	1
8355042	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:10635	{n/a}	1
8355043	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
8355044	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
8355045	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:10638	{n/a}	1
8355090	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:27392	{n/a}	1
8355048	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
8355049	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:10689	{n/a}	1
8355050	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:10689	{n/a}	1
8355051	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:10689	{n/a}	1
8355052	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
8355053	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
8355054	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
8355055	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
8355056	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
8355057	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
8355058	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
8355059	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
8355060	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
8355061	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
8355062	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
8355063	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
8355064	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:10689	{n/a}	1
8355065	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:10689	{n/a}	1
8355066	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
8355067	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
8355068	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
8355069	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
8355070	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
8355071	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:10689	{n/a}	1
8355072	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
8355073	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
8355074	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
8355075	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
8355076	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
8355077	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
8355078	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
8355079	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
8355080	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
8355081	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
8355082	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
8355116	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
8355117	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	RxNorm:39786	{n/a}	1
8355118	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:1151	{n/a}	1
8355119	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:1151	{n/a}	1
8355120	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:1151	{n/a}	1
8355121	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
8355122	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:1151	{n/a}	1
8355123	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:1151	{n/a}	1
8355124	general	No CDS	{G6PD}	{"G6PD": "No Result"}	{}	{}	{"G6PD": "No Result"}	RxNorm:11258	{n/a}	1
8355125	general	No CDS	{G6PD}	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	RxNorm:11258	{n/a}	1
8355126	general	No CDS	{G6PD}	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	RxNorm:11258	{n/a}	1
8355127	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
8355128	general	No CDS	{G6PD}	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	RxNorm:11258	{n/a}	1
8355129	general	No CDS	{G6PD}	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	RxNorm:11258	{n/a}	1
8355130	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
8355131	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
8355132	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
8355133	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
8355134	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
8355135	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
8355136	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
8355137	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
8355138	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
8355139	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
8355140	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
8355141	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
8355142	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	RxNorm:1455099	{n/a}	1
8355143	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	RxNorm:1455099	{n/a}	1
8355144	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	RxNorm:1455099	{n/a}	1
8355145	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	RxNorm:1455099	{n/a}	1
8355146	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	RxNorm:1455099	{n/a}	1
8355147	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	RxNorm:1455099	{n/a}	1
8355148	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	RxNorm:1455099	{n/a}	1
8355149	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	RxNorm:1455099	{n/a}	1
8355150	general	No CDS	{CYP2D6}	{}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	RxNorm:1455099	{n/a}	1
8355151	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
8355152	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', 8355152, 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_clinpgxid_key; Type: CONSTRAINT; Schema: cpic; Owner: -
--

ALTER TABLE ONLY cpic.guideline
    ADD CONSTRAINT guideline_clinpgxid_key UNIQUE (clinpgxid);


--
-- 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 417wzl7ZoEQHCBLTnyE5SqMH3LSkHnZDIeYXy4W0EG6t5wg1imnhLAIEbsxbz3P

