Get University Of Virginia Form 060163 2015-2025

This guide provides clear and supportive instructions for completing the University Of Virginia Form 060163 online. Follow the steps outlined below to ensure accurate and efficient submission of the necessary information.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate the type of exam by selecting one of the options: inpatient, outpatient, or emergency room.
3. Complete the contrast questionnaire section by noting whether the questionnaire was filled out prior to the exam, and include the date.
4. If applicable, document any known history of contrast reactions, including the type of reaction experienced and the approximate time between exposure and occurrence. Input any premedication taken, along with the time and dosage.
5. If there is an unexpected contrast reaction, fill out the section regarding the type of reaction, the time of occurrence, and the time between exposure and occurrence. Note the name and time the radiologist was notified.
6. Fill in the details about the contrast type and amount used, including the lot number.
7. Document the patient’s disposition and indicate whether the patient received written post-contrast instructions and understands them.
8. Provide a phone number where the patient can be reached, and indicate if the form was sent to Radiology Nursing for follow-up.
9. Ensure to record additional comments if necessary, including any relevant history of contrast reaction, and whether this information has been documented in the electronic medical record.
10. Finalize the form by signing it, dating it, and ensuring that copies are sent to the relevant departments as required.
11. After completing the form, you can save changes, download, print, or share the document as needed.

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