Get Patient Monitoring Form

Filling out the Patient Monitoring Form is essential for documenting the administration and monitoring of patients treated with SPRAVATO™. This guide provides clear, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the Patient Monitoring Form. This action will allow you to open the form in an online editor.
2. Begin filling out the patient information section. Ensure to print the patient’s first name, middle initial, last name, and birthdate in the specified format (MM/DD/YYYY). All fields marked with an asterisk (*) are required.
3. In the concomitant medication section, indicate whether the patient is currently taking any of the listed medications that may impact sedation or blood pressure changes by selecting 'Yes' or 'No' for each item.
4. Fill in the healthcare setting and provider information. Include the healthcare provider's first name, last name, phone number, email, and the details of the healthcare setting, including name and address, ensuring all required fields are completed.
5. Document the treatment session details such as the date and time of administration, the dose administered (28 mg, 56 mg, or 84 mg), and the time of discharge. Make sure to confirm that vital signs were within an acceptable range before and after the treatment.
6. In the sedation and dissociation section, indicate whether the patient experienced these symptoms during or after treatment. Note the onset time and resolution time as applicable, completing each field accurately.
7. Document any serious adverse events by indicating if the patient experienced any significant issues during this treatment session or since the last session. Fill in all relevant details clearly and check all applicable outcomes.
8. Once all sections are completed, review the form for accuracy. You can then save any changes made, download, print, or share the form as needed.

Complete the Patient Monitoring Form online today for accurate patient documentation.