Non-cancer diagnoses referral guide

ALS

• Significant decline in function
• Rapid progression of ALS
• Affected respiratory status
• Secondary conditions such as:
– Weight loss or recurrent infections

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Heart Disease

• Patient is symptomatic despite maximum medical management with diuretics and vasodilators
• Shortness of breath with minimal activity
• Significant symptoms of recurrent CHF at rest

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HIV/AIDS

• CD4+ count <25 OR viral load >100,000
• Not responding to treatment
• Weight loss
• Comorbid conditions
• Decreased performance status

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Liver Disease

• PT >5 over control or INR >1.5
• Serum albumin <2.5
• Secondary conditions such as:
– Jaundice and/or ascites
– Peritonitis
– Hepatorenal syndrome
– Hepatic encephalopathy
– Recurrent variceal bleeding

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Neurological Disease (Alzheimer’s/Dementia)

• Alzheimer’s that is FAST 7a*
• Speaking ability limited to 5 words or less
Plus either:
• Dependent in 3/6 ADLs with disease-related complications (weight loss 10%, etc.)
• Significant comorbidity (heart failure, advanced cancer, COPD)

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Lung Disease

• Disabling dyspnea (SOB at rest/minimal exertion, continuous oxygen or chronic oral steroids)
• Plus progressive disease (frequent ED visits, hospitalizations or cor pulmonale)

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Renal Disease

• Patient is not seeking the initiation of dialysis
• Creatinine clearance <10cc/min • Serum creatinine >8.0 mg/dl
• Not a candidate for transplant

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Stroke

• Unable to bathe/dress without assistance
• Weight loss
• Serum Albumin <2.5 gm/dl
• Current history of pulmonary aspiration
• Food and fluid intake is reduced