Get Instructions To Patient Patient Representative Please Complete Section I And Return To Radiology

Filling out the Instructions To Patient Patient Representative form is an important step in ensuring that your medical history is accurately captured. This guide provides a step-by-step approach to complete Section I of the form online, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to obtain the form and open it in your browser's document editor.
2. Enter the date in the designated space at the top of Section I.
3. Indicate your weight in pounds and kilograms, and your height in feet and inches.
4. Select your pregnancy status by marking 'Yes' or 'No' for the question about being pregnant.
5. Select your breastfeeding status by marking 'Yes' or 'No' for the question about breastfeeding.
6. List any allergies you have, including food allergies, and describe your allergic responses, particularly any reactions to x-ray contrast.
7. For medications, fill in the name and dosage of each medication you are currently taking. Make sure to include both prescription and over-the-counter medications.
8. Specify the route of administration for each medication (e.g., By Mouth, other).
9. Indicate how often you take each medication, including the number of times a day or hours between doses.
10. Provide information on your last dose taken prior to arriving at the hospital, including the date and time.
11. Indicate who provided the information by selecting 'Patient' or specifying 'Other' and listing the name and relationship.
12. Once you have completed Section I, save your changes and prepare to return the form to radiology staff.

Complete your documentation promptly by filling out the form online today.