Get Percutaneous Coronary Intervention Report (12/01) Doh-3331. Percutaneous Coronary Intervention 2020-2025

The Percutaneous Coronary Intervention Report (12/01) DOH-3331 is a critical document used for capturing essential data regarding percutaneous coronary interventions. This guide provides a step-by-step approach to help you complete the report accurately and efficiently online.

Follow the steps to successfully complete your report.

1. Select the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling out the ‘Facility Name’ and ‘PFI Number’ at the top of the form. Ensure that this information is correct as it identifies the reporting facility.
3. In Section I, 'Patient Information', enter the patient's full name, medical record number, social security number, age, date of birth, sex, ethnicity, race, and residence. Make sure all fields are populated accurately.
4. In Section II, 'Procedural Information', provide details about the hospital performing the diagnostic catheterization, including the hospital name and PFI. Fill in the name of the primary physician performing the PCI and their license number, as well as the date the PCI took place.
5. Indicate whether a diagnostic catheterization happened during the same lab visit by checking the appropriate box. Also, provide details on any prior PCIs during this admission.
6. Report the cardiac enzymes in the Post-Procedure section by entering the values for Troponin, CK, and other specified measures for pre- and post-procedure timings.
7. In Section III, 'Major Events Following PCI', mark all applicable events, such as renal failure or stent thrombosis.
8. Proceed to Section IV, 'Discharge Information', and specify where the patient was discharged, the discharge date, and any other relevant details.
9. In Section V, 'Peri-Procedural Information', complete timings, wall motion abnormalities, and any ongoing ischemia details.
10. Fill out Section VI, 'Pre-intervention Risk Factors', marking any applicable risk factors such as ejection fraction, angina type, and previous PCI.
11. Complete Section VII with the name of the person responsible for completing the report, ensuring correct spelling.
12. Review all entered information for accuracy. Once all required fields are completed, save any changes, then download, print, or share the document as necessary.

Fill out your Percutaneous Coronary Intervention Report online today to ensure accurate and timely documentation.