Coumadin adjustment calculator



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Coumadin Adjustment Calculator [comment memo="This calculator guides a medical provider through adjustment of coumadin (warfarin) dosing."]
1. Bleeding activity:
[select name="Bleeding" memo="<--- Is bleeding present?" value="No significant bleeding.=0|Serious bleeding is present.=10000|Life-threatening bleeding is present.=100000"]
2. Current weekly dose:
[select name="WeeklyDose" memo="<--- Add up all days' doses to get the current weekly dose (from 2.5 mg to 70 mg total per week)" value="2.5 mg=2.5|5.0 mg=5|7.5 mg=7.5|10.0 mg=10|12.5 mg=12.5|15.0 mg=15|17.5 mg=17.5|20.0 mg=20|22.5 mg=22.5|25.0 mg=25|27.5 mg=27.5|30.0 mg=30|32.5 mg=32.5|35.0 mg=35|37.5 mg=37.5|40.0 mg=40|42.5 mg=42.5|45.0 mg=45|47.5 mg=47.5|50.0 mg=50|52.5 mg=52.5|55.0 mg=55|57.5 mg=57.5|60.0 mg=60|62.5 mg=62.5|65.0 mg=65|67.5 mg=67.5|70.0 mg=70"]
3. INR Goal:
[select name="INRGoal" memo="<--- Select the INR goal" value="2 to 3|2.5 to 3.5"]
4. Current INR:
[conditional field="INRGoal" condition="(INRGoal).is('2 to 3')"][select name="INR2to3" memo="<--- Select the current INR" value="INR < 1.5 (below goal)|INR 1.5 - 1.7 (below goal)|INR 1.8 - 1.9 (below goal)|INR 2.0 - 3.0 (at goal)|INR 3.1 - 3.2 (above goal)|INR 3.3 - 3.9 (above goal)|INR 4.0 - 4.9 (above goal)|INR 5.0 - 8.9 (above goal)|INR 9.0+ (above goal)"][/conditional][conditional field="INRGoal" condition="(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3Half" memo="<--- Select the current INR" value="INR < 1.5 (below goal)|INR 1.5 - 2.2 (below goal)|INR 2.3 - 2.4 (below goal)|INR 2.5 - 3.5 (at goal)|INR 3.6 - 3.7 (above goal)|INR 3.8 - 4.4 (above goal)|INR 4.5 - 5.9 (above goal)|INR 6.0 - 8.9 (above goal)|INR 9.0+ (above goal)"][/conditional]
5. Assessment and recommendations based on current INR zone:
[conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR < 1.5 (below goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3Low1" memo="INR < 1.5. Recommended increase is 10 to 20%." value="Choose percentage increase.=0|10% increase. Recheck in 4-8 days.=1.1|15% increase. Recheck in 4-8 days.=1.15|20% increase. Recheck in 4-8 days.=1.2"][comment memo="12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 1.5 - 1.7 (below goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3Low2" memo="INR 1.5 to 1.7. Recommended increase is 5 to 10%." value="Choose percentage increase.=0|5% increase. Recheck in 1 week.=1.05|7.5% increase. Recheck in 1 week.=1.075|10% increase. Recheck in 1 week.=1.1"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 1.8 - 1.9 (below goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3Low3" memo="INR 1.8 to 1.9. Recommended increase is 5 to 10%." value="Choose percentage increase, if any.=0|No change. Recheck in 1 week.=1|5% increase. Recheck in 1 week.=1.05|7.5% increase. Recheck in 1 week.=1.075|10% increase. Recheck in 1 week.=1.1"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. For this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 days. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 2.0 - 3.0 (at goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3Controlled" memo="INR 2 to 3. No change is recommended." value="Choose below.=0|No change.=1"]
[select name="Duration" memo="Number of consecutive weekly in-range INRs prior to this INR?" value="No consecutive weeks in range, recheck in 5-10 days.=0|1 consecutive week in range, recheck in 5-10 days.=1|2 consecutive weeks in range, recheck in 2 weeks.=2|3 consecutive weeks in range, recheck in 3 weeks.=3|4 or more consecutive weeks in range, recheck in 4 weeks.=4"][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 3.1 - 3.2 (above goal)')"][select name="INR2to3High1" memo="INR 3.1 to 3.2. Recommended decrease is 5 to 10%." value="Choose percentage decrease, if any.=0|No change. Recheck in 1 week.=1|5% decrease. Recheck in 1 week.=0.95|7.5% decrease. Recheck in 1 week.=0.925|10% decrease. Recheck in 1 week.=0.90"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. For this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 days. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 3.3 - 3.9 (above goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3High2" memo="INR 3.3 to 3.9. Recommended decrease is 5 to 10%." value="Choose percentage decrease.=0|5% decrease. Recheck in 1 week.=0.95|7.5% decrease. Recheck in 1 week.=0.925|10% decrease. Recheck in 1 week.=0.90"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 4.0 - 4.9 (above goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3High3" memo="INR 4.0 to 4.9. Recommendation is to hold for 0 - 1 day, then decrease 10%." value="Choose intervention.=0|10% decrease. Recheck in 4-8 days.=0.9|Hold for 1 day then 10% decrease. Recheck in 4-8 days.=0.9"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 5.0 - 8.9 (above goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3High4" memo="INR 5.0 to 8.9. Recommendation is to hold for 1 - 2 days, decrease 10 to 20%, and consider vitamin K." value=" Choose intervention.=0|Hold for 1 day, then 10% decrease.=0.9|Hold for 2 days, then 10% decrease.=0.9|Hold for 1 day, then 15% decrease.=0.85|Hold for 2 days, then 15% decrease.=0.85|Hold for 1 day, then 20% decrease.=0.8|Hold for 2 days, then 20% decrease.=0.8|Vitamin K 1.0 mg orally, monitor frequently.=1000|Vitamin K 2.5 mg orally, monitor frequently.=1000"][comment memo="12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2to3" condition="(INR2to3).is('INR 9.0+ (above goal)')&&(INRGoal).is('2 to 3')"][select name="INR2to3High5" memo="INR 9.0 or more. Recommendation is to hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic." value="Choose below.=0|Hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic.=1000"][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR < 1.5 (below goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfLow1" memo="INR < 1.5. Recommended increase is 10 to 20%." value="Choose percentage increase.=0|10% increase. Recheck in 4-8 days.=1.1|15% increase. Recheck in 4-8 days.=1.15|20% increase. Recheck in 4-8 days.=1.2"][comment memo="12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 1.5 - 2.2 (below goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfLow2" memo="INR 1.5 to 2.2. Recommended increase is 5 to 10%." value="Choose percentage increase.=0|5% increase. Recheck in 1 week.=1.05|7.5% increase. Recheck in 1 week.=1.075|10% increase. Recheck in 1 week.=1.1"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 2.3 - 2.4 (below goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfLow3" memo="INR 2.3 to 2.4. Recommended increase is 5 to 10%." value="Choose percentage increase, if any.=0|No change. Recheck in 1 week.=1|5% increase. Recheck in 1 week.=1.05|7.5% increase. Recheck in 1 week.=1.075|10% increase. Recheck in 1 week.=1.1"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. For this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 days. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 2.5 - 3.5 (at goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfControlled" memo="INR 2.5 to 3.5. No change is recommended." value="Choose below.=0|No change.=1"]
[select name="Duration" memo="Number of consecutive weekly in-range INRs prior to this INR?" value="No consecutive weeks in range, recheck in 5-10 days.=0|1 consecutive week in range, recheck in 5-10 days.=1|2 consecutive weeks in range, recheck in 2 weeks.=2|3 consecutive weeks in range, recheck in 3 weeks.=3|4 or more consecutive weeks in range, recheck in 4 weeks.=4"][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 3.6 - 3.7 (above goal)')"][select name="INR2Halfto3HalfHigh1" memo="INR 3.6 to 3.7. Recommended decrease is 5 to 10%." value="Choose percentage decrease, if any.=0|No change. Recheck in 1 week.=1|5% decrease. Recheck in 1 week.=0.95|7.5% decrease. Recheck in 1 week.=0.925|10% decrease. Recheck in 1 week.=0.90"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. For this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 days. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 3.8 - 4.4 (above goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfHigh2" memo="INR 3.8 to 4.4. Recommended decrease is 5 to 10%." value="Choose percentage decrease.=0|5% decrease. Recheck in 1 week.=0.95|7.5% decrease. Recheck in 1 week.=0.925|10% decrease. Recheck in 1 week.=0.90"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 4.5 - 5.9 (above goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfHigh3" memo="INR 4.5 to 5.9. Recommendation is to hold for 1 - 2 day, then decrease 10%." value="Choose intervention.=0|Hold for 1 day then 10% decrease. Recheck in 4-8 days.=0.9|Hold for 2 days then 10% decrease. Recheck in 4-8 days.=0.9"][comment memo="25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 6.0 - 8.9 (above goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfHigh4" memo="INR 6.0 to 8.9. Recommendation is to hold for 1 - 2 days, decrease 10 to 20%, and consider vitamin K." value="Choose intervention.=0|Hold for 1 day, then 10% decrease.=0.9|Hold for 2 days, then 10% decrease.=0.9|Hold for 1 day, then 15% decrease.=0.85|Hold for 2 days, then 15% decrease.=0.85|Hold for 1 day, then 20% decrease.=0.8|Hold for 2 days, then 20% decrease.=0.8|Vitamin K 1.0 mg orally, monitor frequently.=1000|Vitamin K 2.5 mg orally, monitor frequently.=1000"][comment memo="12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually overriding if desired (see below)."][/conditional][conditional field="INRGoal|INR2Halfto3Half" condition="(INR2Halfto3Half).is('INR 9.0+ (above goal)')&&(INRGoal).is('2.5 to 3.5')"][select name="INR2Halfto3HalfHigh5" memo="INR 9.0 or more. Recommendation is to hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic." value="Choose below.=0|Hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic.=1000"][/conditional]
6. Pill size:
[select name="Pill" memo="<--- Select pill size" value="2.5 mg|5 mg"]
[conditional field="INR2to3|INR2Halfto3Half" condition="(INR2Halfto3Half).isNot('INR 2.5 - 3.5 (at goal)')&&(INR2to3).isNot('INR 2.0 - 3.0 (at goal)')"]7. Extra doses (override recommendations):
[select name="Override" memo="<--- Manual override: Add or subtract a 2.5 mg or 5 mg dose to new weekly total?" value="No=0|Override. Add 2.5 mg dose.=2.5|Override. Add 5 mg dose.=5|Override. Subtract 2.5 mg dose.=-2.5|Override. Subtract 5 mg dose.=-5"][/conditional]
Adjustment selected:
[conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR < 1.5 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3Low1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 1.5 - 1.7 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3Low2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 1.8 - 1.9 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3Low3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 2.0 - 3.0 (at goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3Controlled)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 3.1 - 3.2 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3High1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 3.3 - 3.9 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3High2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 4.0 - 4.9 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3High3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 5.0 - 8.9 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3High4)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 9.0+ (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2to3High5)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR < 1.5 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3Low1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 1.5 - 1.7 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3Low2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 1.8 - 1.9 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3Low3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 2.0 - 3.0 (at goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3Controlled)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 3.1 - 3.2 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3High1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 3.3 - 3.9 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3High2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 4.0 - 4.9 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3High3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 5.0 - 8.9 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3High4)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2to3|Pill" condition="(INRGoal).is('2 to 3')&&(INR2to3).is('INR 9.0+ (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2to3High5)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR < 1.5 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfLow1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 1.5 - 2.2 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfLow2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 2.3 - 2.4 (below goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfLow3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 2.5 - 3.5 (at goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfControlled)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 3.6 - 3.7 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfHigh1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 3.8 - 4.4 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfHigh2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 4.5 - 5.9 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfHigh3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 6.0 - 8.9 (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfHigh4)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 9.0+ (above goal)')&&(Pill).is('5 mg')"][calc value="score=(((INR2Halfto3HalfHigh5)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>64.9?'NEW DOSE: 65 mg weekly (M 1 1/2, Tu 2, W 2, Th 2, F 1 1/2, Sa 2, Su 2)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 1 1/2, Tu 2, W 1 1/2, Th 2, F 1 1/2, Sa 2, Su 2)':score>59.9?'NEW DOSE: 60 mg weekly (M 2, Tu 1 1/2, W 2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 2, Sa 1 1/2, Su 1 1/2)':score>54.9?'NEW DOSE: 55 mg weekly (M 2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 1 1/2, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>49.9?'NEW DOSE: 50 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1 1/2, Sa 1 1/2, Su 1 1/2)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 1, Tu 1 1/2, W 1 1/2, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>44.9?'NEW DOSE: 45 mg weekly (M 1, Tu 1 1/2, W 1, Th 1 1/2, F 1, Sa 1 1/2, Su 1 1/2)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 1 1/2, Tu 1, W 1 1/2, Th 1, F 1 1/2, Sa 1, Su 1)':score>39.9?'NEW DOSE: 40 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1 1/2, Sa 1, Su 1)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 1 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>34.9?'NEW DOSE: 35 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>29.9?'NEW DOSE: 30 mg weekly (M 1/2, Tu 1, W 1, Th 1, F 1/2, Sa 1, Su 1)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1/2, Tu 1, W 1/2, Th 1, F 1/2, Sa 1, Su 1)':score>24.9?'NEW DOSE: 25 mg weekly (M 1, Tu 1/2, W 1, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1, Sa 1/2, Su 1/2)':score>19.9?'NEW DOSE: 20 mg weekly (M 1, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1/2, Tu 1/2, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>14.9?'NEW DOSE: 15 mg weekly (M 1/2, Tu 0, W 1/2, Th 1/2, F 1/2, Sa 1/2, Su 1/2)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 1/2, Su 1/2)':score>9.9?'NEW DOSE: 10 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 1/2)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1/2, Tu 0, W 1/2, Th 0, F 1/2, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 1/2, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1/2, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR < 1.5 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfLow1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 1.5 - 2.2 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfLow2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 2.3 - 2.4 (below goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfLow3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 2.5 - 3.5 (at goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfControlled)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 3.6 - 3.7 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfHigh1)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 3.8 - 4.4 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfHigh2)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 4.5 - 5.9 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfHigh3)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 6.0 - 8.9 (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfHigh4)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional][conditional field="INRGoal|INR2Halfto3Half|Pill" condition="(INRGoal).is('2.5 to 3.5')&&(INR2Halfto3Half).is('INR 9.0+ (above goal)')&&(Pill).is('2.5 mg')"][calc value="score=(((INR2Halfto3HalfHigh5)*(WeeklyDose))+(Bleeding)+(Override));score>99999?'Life-threatening bleeding, at any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed':score>9999?'Serious bleeding, at any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency; repeat vitamin K1 every 12 hours as needed':score>999?'Very high INR indicates more frequent monitoring':score>72.4?'That dosage is out of range':score>69.9?'NEW DOSE: 70 mg weekly (M 4, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>67.4?'NEW DOSE: 67.5 mg weekly (M 3, Tu 4, W 4, Th 4, F 4, Sa 4, Su 4)':score>64.9?'NEW DOSE: 65 mg weekly (M 3, Tu 4, W 4, Th 4, F 3, Sa 4, Su 4)':score>62.4?'NEW DOSE: 62.5 mg weekly (M 3, Tu 4, W 3, Th 4, F 3, Sa 4, Su 4)':score>59.9?'NEW DOSE: 60 mg weekly (M 4, Tu 3, W 4, Th 3, F 4, Sa 3, Su 3)':score>57.4?'NEW DOSE: 57.5 mg weekly (M 4, Tu 3, W 3, Th 3, F 4, Sa 3, Su 3)':score>54.9?'NEW DOSE: 55 mg weekly (M 4, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>52.4?'NEW DOSE: 52.5 mg weekly (M 3, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>49.9?'NEW DOSE: 50 mg weekly (M 2, Tu 3, W 3, Th 3, F 3, Sa 3, Su 3)':score>47.4?'NEW DOSE: 47.5 mg weekly (M 2, Tu 3, W 3, Th 3, F 2, Sa 3, Su 3)':score>44.9?'NEW DOSE: 45 mg weekly (M 2, Tu 3, W 2, Th 3, F 2, Sa 3, Su 3)':score>42.4?'NEW DOSE: 42.5 mg weekly (M 3, Tu 2, W 3, Th 2, F 3, Sa 2, Su 2)':score>39.9?'NEW DOSE: 40 mg weekly (M 3, Tu 2, W 2, Th 2, F 3, Sa 2, Su 2)':score>37.4?'NEW DOSE: 37.5 mg weekly (M 3, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>34.9?'NEW DOSE: 35 mg weekly (M 2, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>32.4?'NEW DOSE: 32.5 mg weekly (M 1, Tu 2, W 2, Th 2, F 2, Sa 2, Su 2)':score>29.9?'NEW DOSE: 30 mg weekly (M 1, Tu 2, W 2, Th 2, F 1, Sa 2, Su 2)':score>27.4?'NEW DOSE: 27.5 mg weekly (M 1, Tu 2, W 1, Th 2, F 1, Sa 2, Su 2)':score>24.9?'NEW DOSE: 25 mg weekly (M 2, Tu 1, W 2, Th 1, F 2, Sa 1, Su 1)':score>22.4?'NEW DOSE: 22.5 mg weekly (M 2, Tu 1, W 1, Th 1, F 2, Sa 1, Su 1)':score>19.9?'NEW DOSE: 20 mg weekly (M 2, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>17.4?'NEW DOSE: 17.5 mg weekly (M 1, Tu 1, W 1, Th 1, F 1, Sa 1, Su 1)':score>14.9?'NEW DOSE: 15 mg weekly (M 1, Tu 0, W 1, Th 1, F 1, Sa 1, Su 1)':score>12.4?'NEW DOSE: 12.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 1, Su 1)':score>9.9?'NEW DOSE: 10 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 1)':score>7.4?'NEW DOSE: 7.5 mg weekly (M 1, Tu 0, W 1, Th 0, F 1, Sa 0, Su 0)':score>4.9?'NEW DOSE: 5 mg weekly (M 1, Tu 0, W 0, Th 0, F 1, Sa 0, Su 0)':score>2.4?'NEW DOSE: 2.5 mg weekly (M 1, Tu 0, W 0, Th 0, F 0, Sa 0, Su 0)':'That dosage is out of range!'" memo="score interpretation"][/conditional]
[comment memo="References"]
[link url="http://www.ncbi.nlm.nih.gov/pubmed/11157641" memo="Ansell (2001) Chest 119: 22S-38S"]
[link url="http://www.med.umich.edu/cvc/prof/anticoag/dose.htm" memo="University of Michigan Anticoagulation Management Service warfarin adjustment protocol"]
[link url="http://www.aafp.org/afp/2005/0515/p1979.html" memo="Ebell (2005) Am Fam Physician 71: 1979-82"]
Coumadin Adjustment Calculator This calculator guides a medical provider through adjustment of coumadin (warfarin) dosing.
1. Bleeding activity:
<--- Is bleeding present?
2. Current weekly dose:
<--- Add up all days' doses to get the current weekly dose (from 2.5 mg to 70 mg total per week)
3. INR Goal:
<--- Select the INR goal
4. Current INR:

5. Assessment and recommendations based on current INR zone:

6. Pill size:
<--- Select pill size

Adjustment selected:

References
Ansell (2001) Chest 119: 22S-38S
University of Michigan Anticoagulation Management Service warfarin adjustment protocol
Ebell (2005) Am Fam Physician 71: 1979-82
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