Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by entering the demographic information in section A. Fill in the last name, first name, middle name, date of birth, and patient ID. Select sex and race from the provided options.
3. In section B, input the patient's zip code, arrival date and time, and admit source. Specify the insurance payors by checking all that apply.
4. Section C requires you to note current health status by indicating smoking status, hypertension, dyslipidemia, family history of cardiac issues, and any previous medical procedures. Be thorough in documenting the patient's history and risk factors.
5. Complete section D by detailing the clinical evaluation leading to the procedure, including CAD presentation, symptoms, and the dates and times of relevant events.
6. In section E, fill out information related to the diagnostic catheterization procedure, including operator details, the procedure status, and any recommendations.
7. Section F includes details about the coronary anatomy. Enter data about percent stenosis for various coronary arteries as applicable.
8. Proceed to section G for PCI procedure information, including operator details, procedure indication, and medication administered during the procedure.
9. Document any lesions or devices in section H, ensuring you describe details and characteristics of each lesion.
10. Fill in the labs and intra- and post-procedure events in sections I and J, ensuring accurate recording of any complications or events.
11. Finally, complete section K regarding discharge information, including discharge status and medications prescribed at discharge.
12. Once all sections are complete, save your changes and choose to download, print, or share the form as needed.

Complete the CathPCI Version 4.4 Data Collection Form online today to ensure accurate patient information is recorded and submitted.