Get Thrombolytic Screening Form

Filling out the Thrombolytic Screening Form online is a vital step in ensuring that patients receive timely and appropriate care. This guide will provide you with detailed instructions on how to accurately complete each section of the form.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the Thrombolytic Screening Form and view it in your online editor.
2. Begin by entering the patient's full name in the designated fields for Last Name and First Name.
3. Fill in the patient information section by providing the patient's age, sex, past medical history, current medications, and any drug allergies.
4. Record the initial blood pressure readings for both arms in military time format.
5. Indicate whether the patient is less than or equal to 18 years of age by selecting 'YES' or 'NO.'
6. Answer the questions related to the onset of symptoms, indicating whether it has been greater than or equal to 3 hours, if the patient was asleep when the symptoms started, and whether they are rapidly improving or have minor symptoms by selecting 'YES' or 'NO' for each.
7. Assess and answer questions regarding any history of intracranial hemorrhage, seizures at the onset of symptoms, recent strokes or serious head injuries, major surgeries or serious trauma, gastrointestinal or urinary tract hemorrhages, and blood pressure readings exceeding specified thresholds.
8. Complete the questions regarding blood glucose levels and symptoms indicative of subarachnoid hemorrhage.
9. Finally, determine if there's been an arterial puncture at a non-compressible site or lumbar puncture within the past week, as well as if the patient is pregnant or lactating.
10. Once all applicable responses are recorded, ensure to alert the receiving facility of a potential thrombolytic candidate if all criteria are met, otherwise, resume the appropriate treatment protocol.
11. Fill in the section for who completed the form with your name.
12. After reviewing the form for completeness, you can save your changes, download a copy, print the document, or share it as necessary.

Complete your forms online to ensure efficient and accurate patient care.