|
Lab:
|
Coagulation Instruments:
|
|
Pad Placement:
|
Setting Cut:
|
|
Coag:
|
Serial #
|
|
Padsite Pre-Procedure:
|
Padsite Post-Procedure:
|
|
Technician:
|
Time out done by :
|
|
Safety Check List Complete:
|
Hemorrhoid Banding
|
|
2% Lidocaine Applied PR by Dr.
|
Varices Banding
|
|
Bravo pH
|
EG Junction:
|
|
above SCJ
|
Capsule ID
|
|
Starting pH
|
Recording Verified
|
|
Esophageal Dilation
|
Abdominal pressure or pillow used
|
|
Respiratory Complication:
|
I.C. notified:
|
|
Additional Notes:
|
|
|
New Short Text Field
|
|
