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Cardiology Department Procedure Sheet DATE Patient Name DOB PHONE

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Cardiology Department Procedure Sheet DATE Patient Name DOB PHONE Powered By Docstoc
					                                Cardiology Department Procedure Sheet

 DATE ________________           Patient Name___________________________
 DOB_________________            PHONE #______________________________
 SSN#: _______________________Insurance / Precert (if known)_____________________________
 Diagnosis __________________________________________________________________________________
 Date & Time of Procedure_____________________ Date to Pre-Admit__________________________________
 Physician Name: __________________________Scheduler Name: _________________________________
       Previous Open Heart Surgery: Location _______________________________
       Initiate Standing orders for Cardiology Procedure
                 Omit Lab               Omit EKG
       Initiate Standing Orders for Cardiac Pathway for Procedure as Indicated
       Initiate Pre-Hydration Orders
       Dye Allergy               Pre medication for dye on arrival Pre medicated at home
                                         LEFT & RIGHT HEART               SUPERIOR MESENTERIC ARTERY
                                         CATH(L/RHC)                      STENT
   Invasive Cardiology                   LEFT HEART CATH (LHC)            TEMPORARY PACEMAKER
      ABD AORTAGRAM WITH BILAT           LOOP RECORDER IMPLANT            THROMBOLITE INFUSION
      RUN-OFF'S (Abd/Ro)                 LOOP RECORDER REMOVAL            THROMBOLITE INFUSION -
      ABD AORTAGRAM WITH RUN-OFF         NON INVASIVE PACEMAKER           RECHECK
      ARTHRECTOMY - LASER                STUDY                            VEIN GRAFT STENT
      ATRIAL VENTRICULAR ABLATION        OTHER PERIPHERAL                 VERTEBRAL STENT
      BALLOON PUMP (IABP )               PROCEDURES
      BI VENTRIC PACEMAKER
                                                                       Echocardiology
                                         PACEMAKER - DDD or VVI           ECHO DOBUTAMINE STRESS
      BI VENTRIC INTERNAL CARD           PACEMAKER GENERATOR
      DEFIB UPGRADE (Bi V AICD/ICD)                                       ECHO LIMITED
                                         CHANGE
      BI VENTRICULAR INTERNAL                                             ECHO STRESS
                                         PACEMAKER REMOVAL
      DEFIBRILAT (Bi V AICD/ICD)                                          ECHO STRESS LIMITED
                                         PERC TRANSLUM ANGIOPLASTY -
      CARDIOVERSION                                                       ECHO TRANSESOPHAGEAL (TEE)
                                         LEFT ILIAC (PTA)
      CAROTID ANGIOGRAM                                                   ECHO WITH BUBBLE STUDY
                                         PERC TRANSLUM ANGIOPLASTY -
      CAROTID STENT                                                       ECHO WITH CONTRAST
                                         LEFT SFA (PTA)
      CELIAC ANGIOGRAM                                                    ECHOCARDIOGRAM
                                         PERC TRANSLUM ANGIOPLASTY -
      CELIAC STENT                       RIGHT ILIAC (PTA)             Stress Lab
      CEREBRAL ANGIOGRAM                 PERC TRANSLUM ANGIOPLASTY -      STRESS ADENOSINE C LITE
      CORONARY STENT                     RIGHT SFA (PTA)                  STRESS ADENOSINE STRESS
      CRYOABLATION                       PERC TRANSLUM CORONARY           TEST
      ELECTROPHYSIOLOGY STUDY            ANGIOPLASTY (PTCA)               STRESS ADENOSINE THALLIUM
      (EP)                               PERCUTANEOUS TRANSLUMINAL        STRESS CARDIOLITE ETT
      GRAFT STUDY                        ANGIOPLASTY (PTA)                STRESS DAY 1 OF 2 DAY
      ILIAC STENT                        PERICARDIOCENTESIS               CARDIOLITE
      INFERIOR VENA CAVA FILTER          PERIPHERAL ARTHRECTOMY           STRESS DAY 2 OF 2 DAY
      (IVC)                              POCKET REVISION                  CARDIOLITE
      INTERNAL CARD DEFIB single or      PRESSURE WIRE - CORONARIES       STRESS DAY1 OF 2DAY PERS
      dual                               PULMONARY ANGIOGRAM              CARDIOLITE
      INTERNAL CARD DEFIB                RADIO FREQUENCY ABLATION         STRESS DAY2 OF 2DAY PERS
      GENERATOR CHANGE (AICD/ICD)        RENAL ANGIOGRAM                  CARDIOLITE
      INTERNAL CARDIAC                   RENAL STENT                      STRESS DOBUTAMINE CLITE
      DEFIBRILATOR REMOVAL               RIGHT HEART CATH (RHC)           STRESS DOBUTAMINE THALLIUM
      INTRA CARDIAC (ICE)                ROTATIONAL ARTHRECTOMY           STRESS ETT W DUAL ISOTOPES
      ECHOCARDIOGRAM                     SINGLE CHAMBER INTERNAL          STRESS EXERCISE TOLERANCE
      INTRA VASCULAR ULTRASOUND –        CARD DEFIBRILAT (AICD/ICD)       TEST
      AORTA (IVUS)                       SUBCLAVIAN ANGIOGRAM             STRESS PERSANTINE C-LITE
      INTRA VASCULAR ULTRASOUND -        SUBCLAVIAN STENT                 STRESS PERSANTINE THALLIUM
      CORONARIES (IVUS)                  SUPERIOR FEMORAL ARTERY          STRESS PERSANTINE W/ DUAL
      INTRA VASCULAR ULTRASOUND -        STENT (SFA)                      ISOTOPES
      PERIPHERAL (IVUS)                  SUPERIOR MESENTERIC ARTERY       STRESS THALLIUM ETT
      LEAD REVISION                      ANGIOGRAM (SMA)                  STRESS TILT TABLE

Physician Signature: _____________________________         Date: ___________________________

				
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Description: Cardiology Stent document sample