Johnson County Imaging Center CT Pre-Exam Interview Name: ________________________________ Phone: _________________ Attempted Call: ________________________ Procedure: ____________________________ Date/Time: ____________________ X-ray #: ______________Gender: _____________Age: ________ DOB: ________________ WT: ___ HT: _____ LMP: ____________ Reason for Exam: _____________________________________________________________________________________ Prior Exams/Locations: _________________________________________________________________________________ Ordering Physician name & phone #: _____________________________
Have you had any studies using injected contrast media?
Have you had any allergies/reactions? Specify:
Do you have any allergies to latex or rubber products?
Do you have asthma or pulmonary diseases?
Do you have any heart disease (MI, Angina, CHF, Arrythmias?)
If yes, what medication do you use? □ Insulin □ Glucophage/Metformin □ Other oral medication:
Do you have any kidney disease (one kidney, transplant, etc.?)
Do you have any blood disorders (sickle cell, hepatitis, AIDS?)
Do you, or have you ever had cancer? Type:
Have you had a PET Scan? If yes, when & where:
Multiple myeloma (cancer of the bone marrow)?
Are you currently or have you had chemotherapy or radiation?
Pheochromocytoma (Tumor or adrenal medulla)?
Neurological problems (seizure disorder, stroke, brain tumor)?
Have you had any previous surgeries? List:
Recent Trauma(s) including description and date of occurrence:
Are you currently taking any medications? List:
Date interview was completed: _________________Technologist taking history: _________________________ Ifhistory was taken 48 hours prior to exam history MUST be reviewed the day of the exam: Date: ________________ Technologist reviewing history: __________________________________________ Prep Instructions: ________________________________________________________________________________________________________________________________ ________________________________________________________ If patient was pre-medicated; verify patient followed pre-medication instructions. ___________________ IV Contrast:
IV Contrast: ___________________________ Lot #: _________________________ Amount: ______________________ Injection site: __________________________ Number of attempts: _____________ Needle Gauge Sz: _______________ Injected by: ______________________________________ Labs: Date of labs: _______________________________
BUN: _____________ CR: ___________________ □INHOUSE LABS □ OUTSIDE LABS Oral Contrast: _______________________________ IV Contrast: ________________________________________________ Scan Protocol: _______________________________ Extra views or comments: _____________________________________ Radiologist Signature: _____________________________________ Dictation Code: ________________________________ If pt was on Glucophage/Metformin, did they receive aftercare instructions? YES NO ____________Tech Initials
Drug and Alcohol Review (July 2007), 26, 405 – 410Mortality related to pharmacotherapies for opioid dependence: acomparative analysis of coronial recordsNational Drug and Alcohol Research Centre, University of New South Wales, AustraliaAbstractIntroduction and Aims. The aim of this study was to compare the mortality associated with oral naltrexone, methadoneand buprenorphine in opioid depende
12 Publireportage MITTWOCH, 7. JULI 2010 | ANZEIGENANNAHME TEL. 052 633 31 11 FAX 052 633 34 02 | WWW. SHN.CH | E-MAIL [email protected] Ein unterschätztes Gesundheitsproblem Was istInkontinenz oder Blasenschwäche – könne ein erstes Symptom für eine ernsthafte Erkrankung sein, sagt dieInkontinenz, also die Unfähigkeit, den Urinin der Blase zu halten, wird HarninkontinenzUrologin