Get the free I-131 MIBG Treatment Work-Up Sheet - radiology emory
Show details
This document serves as a work-up sheet for residents and fellows to gather necessary patient information and medical history related to I-131 MIBG treatment.
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign i-131 mibg treatment work-up
Edit your i-131 mibg treatment work-up form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your i-131 mibg treatment work-up form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit i-131 mibg treatment work-up online
To use the professional PDF editor, follow these steps below:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit i-131 mibg treatment work-up. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
With pdfFiller, dealing with documents is always straightforward. Try it right now!
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out i-131 mibg treatment work-up
How to fill out I-131 MIBG Treatment Work-Up Sheet
01
Gather patient information including full name, date of birth, and medical record number.
02
Fill in the physician's details, including name, contact information, and hospital affiliation.
03
Provide details about the patient's diagnosis and current condition.
04
List prior treatments or procedures related to MIBG therapy.
05
Document any relevant laboratory results or imaging studies.
06
Ensure all sections are completed and reviewed for accuracy.
07
Submit the form to the appropriate medical department for review.
Who needs I-131 MIBG Treatment Work-Up Sheet?
01
Patients diagnosed with neuroendocrine tumors who are being considered for I-131 MIBG therapy.
02
Healthcare professionals involved in the management and treatment planning for these patients.
Fill
form
: Try Risk Free
People Also Ask about
How is MIBG treated for pheochromocytoma?
Metastatic pheochromocytoma is sometimes treated with a radioactive substance called 131I-MIBG. It is given by infusion to deliver radiation directly to tumor cells throughout the body.
How much does MIBG therapy cost?
Specification Test TypeMetaiodobenzylguanidine (MIBG) Scan Includes Metaiodobenzylguanidine (MIBG) Scan Test (Nuclear Medicine) Preparation Reporting Within 4-6 hours* Test Price ₹ 48000 ₹ 60000
What tumor lights up with a MIBG scan?
A procedure used to find neuroendocrine tumors, such as neuroblastomas and pheochromocytomas. A small amount of a substance called radioactive MIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumor cells take up the radioactive MIBG and are detected by a scanner.
What medications interfere with MIBG?
We will also need a list of your medications as you may need to stop any that interfere with the uptake of MIBG. Medications that may need to be stopped include Labetalol, Diltiazem, Nifedapine, Verapamil, Amitriptyline, Imipramine, nasal decongestants, and Phenothiazine.
What are the side effects of a MIBG scan?
There are rarely any side effects from an MIBG scan. The injection of the radioactive MIBG can cause high blood pressure, but this is not common. Your blood pressure might be checked after the injection to make sure it is normal.
How to prepare for a MIBG scan?
Potassium iodate is a thyroid blocking medicine. It is given before a MIBG scan. The potassium iodate protects the thyroid against the isotope given during this scan. To prepare for the MIBG scan, your child will take three doses of potassium iodate in all and it is vital that your child takes all three doses.
What drugs should be stopped before taking MIBG?
Before an MIBG scan, your doctor may ask you to stop taking certain drugs that can interfere with the test, including: ACE inhibitors. Allergy and cold medications. Amiodarone for arrhythmia. Antidepressants. Calcium channel blockers. Opioids.
What is the MIBG-I-131 scan used for?
An MIBG scan may also be called adrenal medullary imaging, I-123 MIBG scan, I-131 MIBG scan, or MIBG scintiscan. An MIBG scan helps locate and diagnose neuroendocrine tumors like neuroblastoma. This scan can show when this type of tumor has spread to the bone and other organs.
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
What is I-131 MIBG Treatment Work-Up Sheet?
The I-131 MIBG Treatment Work-Up Sheet is a document used to collect and organize essential medical information needed prior to administering I-131 MIBG therapy, a targeted treatment for certain types of neuroendocrine tumors.
Who is required to file I-131 MIBG Treatment Work-Up Sheet?
Healthcare providers or medical facilities that intend to administer I-131 MIBG therapy are required to file the I-131 MIBG Treatment Work-Up Sheet for each patient scheduled for the treatment.
How to fill out I-131 MIBG Treatment Work-Up Sheet?
To fill out the I-131 MIBG Treatment Work-Up Sheet, the provider must complete sections that include patient demographics, medical history, prior treatments, contraindications, and any relevant imaging or lab results.
What is the purpose of I-131 MIBG Treatment Work-Up Sheet?
The purpose of the I-131 MIBG Treatment Work-Up Sheet is to ensure that all necessary information is gathered and assessed to determine the patient's eligibility for MIBG treatment and to prepare for safe administration.
What information must be reported on I-131 MIBG Treatment Work-Up Sheet?
The I-131 MIBG Treatment Work-Up Sheet must report information such as patient identification details, diagnosis, treatment history, specific medical conditions, allergies, and results of previous scans or laboratory tests relevant to the therapy.
Fill out your i-131 mibg treatment work-up online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
I-131 Mibg Treatment Work-Up is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
