Sample Query form for Acute Tubular Necrosis / Query example form for Acute Tubular Necrosis / When to query Acute Tubular Necrosis / Query format for Acute Tubular Necrosis.
Acute Tubular Necrosis (ATN) Query form
Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having ACUTE KIDNEY INJURY. The following is also documented in the medical record:
- · Creatinine
levels [list all and dates]
- · FENa =
- · Urine
sodium concentration =
- · Urine
output of _________ over ___ hours
- · IV
contrast
- · Medication
[if potentially neurotoxic]:
- · Other:
Based on your medical judgment, can you further clarify in
the progress notes confirmed or suspected underlying cause for this patient’s
condition such as:
- · Acute
Tubular Necrosis
- · Acute
Cortical Necrosis
- · Acute
Glomerulonephritis
- · Pre-Renal
Acute Kidney Injury
- · Other
condition: (please specify)
- · None
of the above /Not applicable
In responding to this request, please exercise your
independent professional judgment. The fact that a question is asked does not
imply that any particular diagnosis is desired or expected.
Thank you!
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