Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the document and open it in the online editor.
2. Start by filling in the patient identifier section at the top of the form with the relevant patient’s details.
3. In the Regional Block Consent section, ensure to document the explanations provided regarding the alternatives, benefits, risks, and potential complications associated with the peripheral nerve block procedures. Ensure that the patient or guardian’s acknowledgment of these details is clearly recorded.
4. Move on to the Timeout section where you must confirm and document the correct patient identity, side, site marked, and ensure agreement on the procedure to be done. Record the correct patient position as well.
5. In the Anxiolysis section, enter the dosages administered for and as appropriate.
6. Document the Procedure details, making sure to note the technique used, site preparations, and equipment, including the catheter length and the type of needle used for both continuous and single shot procedures.
7. Fill in the section with the appropriate concentration percentage and milliliters used for the procedures.
8. Indicate whether ultrasound guidance was utilized during the procedure.
9. In the Billing Codes section, make the necessary selections based on the procedures performed and document any related details, if applicable.
10. Utilize the Notes section for any additional comments or important information pertinent to the patient's procedure.
11. Finally, ensure to have the Performing Physician sign the document, including their full name, date, and time of completion.
12. After filling in all fields and reviewing for accuracy, save the changes made to the document, and consider downloading or printing a copy for your records.

Complete your documentation promptly and accurately by filling out the AMSURA, LLC Peripheral Nerve Block Procedure Note - Amsura online.