RESEARCH SCREENING PRO0009707 MTG-REIC-PC003 MILES		version 3/7/2023		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Partial thromboplastin time, activated	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Prothrombin time with INR	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Magnesium level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	LDH	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Prostate specific antigen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	Release to patient (Note: If manual release option is selected, result will auto release 5 days from finalization.): Immediate		
	☐	Interleukin 6	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Adenovirus by PCR	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Tumor necrosis factor - alpha	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Adenovirus antigen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Hepatitis C antibody	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Hepatitis B surface antigen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	HIV 1/2 antigen/antibody, fourth generation, with reflexes	Once	S	1 treatment	
		Normal, Clinic Collect		
	☐	RESEARCH study specimen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, EXTERNAL LAB NON-INTERFACED
	Lymphocytes (flow cytometry),   Serum Cytokines (IL-6, IL-12, TNF-a, IFNy)		
	☐	POC urinalysis dipstick	Once	S	1 treatment	
		No details available for preview		

Imaging 	

	
	Interval	Defer Until	Duration	
	☐	EKG	Once	S	1 treatment	
		Ancillary Performed, Status: Future, Expires: S+366
	Triplicate EKG readings to be taken 30 seconds apart.
	Scheduling note: Research Study PRO00009707 Triplicate EKG readings 30 seconds apart.		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Nursing communication	Once	S	1 treatment	
		Triplicate EKG reading should be taken approximately 30 seconds apart.  The combined QTcF values from these EKG readings will be averaged to provide a single baseline value.		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Once	S	1 treatment	
		Digital rectal exam to be performed