Priate including ward) Inpatient Outpatient Date of Birth GP/Consultant Name Address GP/Consultant contact details Postcode Contact Telephone If already on enter recent INR and dose record Current Medication (please specify Anti-platelet drugs and other interacting medication) To continue when INR is therapeutic Y/N Date INR dose (Five most recent results & dose) Aspirin …..…….. mg daily ……….mg daily please fax recent prescription with the for.
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How to fill out the PSD/HOF001/GB/DC online
This guide provides a comprehensive overview of filling out the PSD/HOF001/GB/DC online, focusing on critical components and step-by-step instructions to ensure accurate submission for anticoagulant management. Whether you are new to this process or need a refresher, this guide aims to assist you in navigating the form effectively.
Follow the steps to successfully complete your PSD/HOF001/GB/DC online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Complete the patient details section. Include the patient's full name, date of birth, unit number, and current medication information. Ensure all specified fields are filled out carefully.
- Provide your details in the referrer details section. This includes surname, forename(s), position, and contact telephone number.
- Indicate if the patient is an inpatient or outpatient by ticking the appropriate box.
- If the patient is currently on , enter the recent INR and dose record, including details of any anti-platelet drugs.
- Specify the therapeutic INR range and the duration for which management is requested.
- Select the appropriate initiation algorithm (Rapid or Slow) by ticking the designated box.
- Complete any necessary sections for monitoring and advising the patient on dose changes as per the algorithm.
- Cross one of the options regarding authorisation of Vitamin K in case of over-anticoagulation.
- Sign and print your name, confirming you are legally responsible for the information provided.
- Finally, save your changes, and if required, download, print, or share the completed form.
Complete your PSD/HOF001/GB/DC online today to ensure efficient anticoagulant management.
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