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Atrial Fibrillation Clinic Name Royal Jubilee Hospital 1952 Bay Street Royal Block 3rd Floor Rm 343 Victoria B.C. V8R 1J8 Phone 250-370-8632 FAX NUMBER 250-595-1000 via Western Cardiology DOB M/F PHN MRN Address Telephone number REFERRAL FORM PLEASE NOTE ECG DOCUMENTATION OF AF IS REQUIRED Date Referring physician/NP please print Total pages Referred from Primary care Internist ED Other Please provide the following history AF diagnosis Check one Newly diagnosed Previously diagnosed Purpose of referral Check one Cardiologist assessment for Opinion Consultation and management Post-ablation follow-up Education Only no cardiologist assessment Symptoms when in AF Indications for referral Check all that apply Assistance with medication trials If cardiologist assessment requested request consult by Next Available Cardiologist wait times will vary to cardiologist C. Lane R* Leather P. Novak L* Sterns D. Massel AF treatment history med trials cardioversions ablations Cardiologist consult notes ....

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An ECG (electrocardiogram) records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction).

Turn the ECG machine on and ensure ECG paper has been loaded into the machine. Double-check all the electrodes are attached in the appropriate locations. Politely ask the patient to remain still and not talk during the recording as muscle activity can interfere with the ECG trace.

The interpretation should appear on the designated sections of a page formatted EKG or written in the clinical records. Interpretations should include appropriate comments on rhythm, axis intervals, acute or chronic changes and a comparison with the most recent tracing.

Share on Pinterest An EKG displays P Waves, T Waves, and the QRS Complex. These may have abnormalities in people with A-fib. A normal EKG is one that shows what is known as sinus rhythm. Sinus rhythm may look like a lot of little bumps, but each relays an important action in the heart.

Standard ECG paper allows an approximate estimation of the heart rate (HR) from an ECG recording. Each second of time is represented by 250 mm (5 large squares) along the horizontal axis. So if the number of large squares between each QRS complex is: 5 - the HR is 60 beats per minute.

An ECG (electrocardiogram) records the electrical activity of your heart at rest. It provides information about your heart rate and rhythm, and shows if there is enlargement of the heart due to high blood pressure (hypertension) or evidence of a previous heart attack (myocardial infarction).

An ECG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart.

Heart rate can be easily calculated from the ECG strip: When the rhythm is regular, the heart rate is 300 divided by the number of large squares between the QRS complexes. For example, if there are 4 large squares between regular QRS complexes, the heart rate is 75 (300/4=75).

Normal range 120 200 ms (3 5 small squares on ECG paper). QRS duration (measured from first deflection of QRS complex to end of QRS complex at isoelectric line). Normal range up to 120 ms (3 small squares on ECG paper).

Full name. Date of birth. Unique patient identifier. Home address.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232