Get Therapeutic Drug Monitoring (tdm) Test Request Form Clinical Centre Information Lab21 Id Dd1105

Completing the therapeutic drug monitoring test request form is essential for ensuring accurate analysis and patient care. This guide will walk you through each section of the form to help you fill it out accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your editor of choice.
2. In the ‘Requesting doctor’ section, enter the doctor's name and the hospital or clinic's name, specifically ‘Homerton University Hospital’. Provide the address, including ‘Department of Sexual Health,’ the telephone number, and the email address for communication.
3. Next, locate the ‘Patient Information’ section. Affix the clinic label in the designated area. Fill in the hospital/clinic number, weight, patient ID, height, sample ID, viral load, and date of birth. Additionally, include the CD4 count.
4. For the ‘Sample to be tested’ section, please specify the sample type, which should be ‘Plasma Only’. Fill in the date taken, constituent drug(s) to be analysed, dosing information, and tick the box if the patient is receiving . Enter the dose in milligrams and the time taken.
5. Indicate the dosing frequency by selecting from the options available, such as OD (once daily), BD equal, BD unequal, and fill out the time elapsed since the last dose.
6. Complete the ‘Other antiretroviral therapy’ section as needed.
7. In the ‘Reason for TDM’ section, tick all that apply, including options like pregnancy, dialysis, paediatric, renal failure, possible drug interaction, suspected treatment failure, liver failure, inpatient/ITU, suspected toxicity, and any other reasons relevant.
8. Include any additional comments if necessary in the designated area.
9. Review all filled-out sections for accuracy. Once confirmed, save your changes, and you may also choose to download, print, or share the form as required.

Start completing the therapeutic drug monitoring test request form online today for prompt processing.