UVA Downtime IV Contrast (DYE) Screening Form 2008 free printable template

UVA Imaging Scheduled Exam Time Ready PATIENT NAME Outpatient Diagnostic Imaging Centers 415 Ray C. Hunt Dr., Fontaine pH 434.243.9198 Fax 434.243.0243 MR # CONTRAST (DYE) SCREENING FORM ADDRESSOGRAPH

How to fill out UVA Downtime IV Contrast DYE Screening

How to fill out UVA Downtime IV Contrast (DYE) Screening Form

1. Gather patient information, including name, age, and medical history.
2. Check the contrast material allergy history of the patient.
3. Ensure the patient hasn't had prior reactions to IV contrasts.
4. Review kidney function by requesting recent lab results (e.g., creatinine levels).
5. Complete the sections for patient demographics and medical history.
6. Sign and date the form to confirm that all information is accurate.
7. Submit the completed form to the appropriate department or personnel.

Who needs UVA Downtime IV Contrast (DYE) Screening Form?

1. Patients undergoing imaging procedures that require IV contrast.
2. Healthcare providers assessing the risk of contrast-induced nephropathy.
3. Radiology departments to ensure patient safety during contrast administration.

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What is UVA Downtime IV Contrast (DYE) Screening Form?

The UVA Downtime IV Contrast (DYE) Screening Form is a document used to assess patients' eligibility for receiving intravenous contrast agents during imaging procedures, particularly during periods when normal operational protocols are interrupted.

Who is required to file UVA Downtime IV Contrast (DYE) Screening Form?

Healthcare providers involved in the administration of intravenous contrast during imaging procedures are required to file the UVA Downtime IV Contrast (DYE) Screening Form for patients who are to receive such agents.

How to fill out UVA Downtime IV Contrast (DYE) Screening Form?

To fill out the UVA Downtime IV Contrast (DYE) Screening Form, providers should gather relevant patient information, assess the patient's medical history, and complete the specified sections of the form, ensuring all necessary data is accurate and thorough.

What is the purpose of UVA Downtime IV Contrast (DYE) Screening Form?

The purpose of the UVA Downtime IV Contrast (DYE) Screening Form is to ensure patient safety by evaluating potential risks associated with the use of contrast agents during imaging, especially when standard safety protocols might be affected due to downtime situations.

What information must be reported on UVA Downtime IV Contrast (DYE) Screening Form?

The information that must be reported on the UVA Downtime IV Contrast (DYE) Screening Form includes patient demographics, medical history, previous reactions to contrast agents, renal function status, and any other relevant clinical information that may impact the use of IV contrast.