Follow the steps to complete the worksheet with ease.

1. Click ‘Get Form’ button to access the InterStim Therapy Patient Worksheet and open it for editing.
2. In the first section, enter the patient's name and phone number. Make sure to input accurate contact information for effective communication.
3. Provide the physician's name in the designated field. This section is crucial for identifying the healthcare provider involved in the patient's care.
4. Mark the lead location checkbox as either left or right, indicating where the lead is positioned.
5. Check the INS location checkbox to specify whether the device is placed on the left or right side.
6. Fill in the active electrodes section by ticking 'Y' for yes if the electrode is active or 'N' for no. This allows for tracking the functionality of electroded used during therapy.
7. Complete the pre-implant evaluation section, entering baseline numbers as instructed.
8. Input the patient programmer program number, ensuring all personalized settings are documented.
9. Assign names to the clinician programmer configuration fields (C1, C2, etc.) to organize the therapy settings effectively.
10. Record the pulse width, rate, and amplitude settings pertinent to the patient's individualized therapy plan.
11. Document bladder symptom diary information, including voids per day and night, urgency levels, leaks, and other relevant metrics.
12. Similarly, complete the bowel symptom diary section with pertinent information, such as episodes per day and level of urgency.
13. Finally, review all the entered information for accuracy. Once confirmed, users can save changes, download, print, or share the completed form as needed.

Complete the InterStim Therapy Patient Worksheet online to facilitate your therapy journey.