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Procedure
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Phone Number:
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Pre-Procedure Phone Call Documentation
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Date & Time:
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Caller's Initials:
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Left Message with information
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Have you had your labs drawn?
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Do you have transportation home?
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Do you have medical conditions?
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Are you on any anti-coagulant therapy?
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Do you have any drug allergies?
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Do you have Asthma, COPD, or any breathing problems?
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Are you diabetic?
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Do you have a pacemaker or internal defibrillator?
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Do you take blood pressure medication?
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Explain:
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Have you been hospitalized (for any reason) in the past 6 months:
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Do you have another language in which it is easier for you to communicate?
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Do you have any problems with your vision or hearing that might affect how we teach you?
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How would you prefer to receive information regarding your case?
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Were you given information about Advance Directive including CEC's policy?
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Did you receive printed information regarding preparation for your procedure?
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Do you have any questions regarding the information, procedure/bowel prep?
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What time were you told to arrive for your procedure?
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Did you complete the patient medication form?
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Remember, nothing by mouth after:
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Please remember to leave your valuables at home and do not wear any perfume or jewelry.
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Wear comfortable clothing and women can wear sports bra.
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Post-Procedure Phone call Documentation
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Phone Number:
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Leave Message:
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Date & Time:
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Caller's Initials:
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Call Status:
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Do/did you have any problems with elevated temperature?
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Do/did you have any problems with severe pain?
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Do/did you have any problems with excessive cramping?
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Do/did you have any problems with bleeding?
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Do/did you have any problems with vomiting/vomiting blood?
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Do/did you have any problems with your IV site?
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If yes to any of the above, what did you do?
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Were you satisfied with your care at CEC?
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Were you satisfied with you care at CEC?
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Follow up
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Notes:
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