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FORM 21 DISCHARGE HOLDER FORM 21. DISCHARGE 24HOUR HOLDER RECORDING Form 21 should be led out for all patients who enroll and are randomized in the main CABG Patch Trial. Use this form to enter data
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How to fill out form 21 pre-discharge holter
How to fill out form 21 pre-discharge holter:
01
Begin by providing your personal information, such as your full name, date of birth, and address.
02
Next, indicate the reason for the holter monitoring and provide details about your medical history that may be relevant to the test.
03
Specify the duration of the holter monitoring and any specific instructions given by your healthcare provider.
04
Fill in the date and time of starting and ending the holter monitoring.
05
Record any symptoms or activities that you should note during the monitoring period.
06
Follow the instructions for attaching the holter monitor to your body and ensure it is worn correctly.
07
Keep a record of any time you remove the monitor, such as during bathing or swimming, and note the duration of such removal.
08
During the monitoring period, keep a log of any symptoms you experience, including their duration and severity.
09
Finally, sign and date the form to attest that the information provided is accurate to the best of your knowledge.
Who needs form 21 pre-discharge holter?
01
Patients who have undergone cardiac procedures or surgeries may need to have a pre-discharge holter monitor.
02
Individuals with a suspected or diagnosed heart condition may require a pre-discharge holter monitor to monitor their heart activity before leaving the hospital.
03
Patients who are being evaluated for potential arrhythmias or abnormal heart rhythms may be instructed to undergo a pre-discharge holter monitoring.
04
It may also be necessary for individuals who have experienced unexplained fainting episodes or other similar symptoms.
05
Healthcare providers will determine the need for form 21 pre-discharge holter based on the individual's medical condition and the goals of their treatment.
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