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Dialysis History and Physical Patient: Date: Sex: M F DOB: Age: EDW: Ht: Doctor: Date first dialysis DX: Hypertension Y N yrs. Diabetes I II Y N yrs. HP: Past History: FH: SH: ROS: Modality interests:
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How to fill out dialysis history and physical
How to fill out dialysis history and physical:
01
Start by gathering all necessary information about the patient's medical history, including any previous dialysis treatments, medications, and current symptoms.
02
Begin with the patient's personal information, such as name, age, contact information, and insurance details.
03
Document the reason for the current dialysis history and physical, whether it is an initial evaluation, routine assessment, or pre-surgery requirement.
04
In the medical history section, record any underlying conditions or diseases that may affect the patient's kidney function, such as diabetes or hypertension.
05
Include details about any previous kidney surgeries, transplantation, or other relevant procedures.
06
Note the patient's current dialysis treatment modality, frequency, and duration, along with any complications or side effects experienced.
07
Record the patient's vital signs, including blood pressure, heart rate, and temperature.
08
Document any physical examination findings, such as edema, skin changes, or signs of infection.
09
Include laboratory test results, such as blood urea nitrogen (BUN), creatinine, electrolyte levels, and complete blood count (CBC).
10
Describe the patient's overall functional status, including any limitations or disabilities.
11
Discuss the patient's psychosocial well-being and support system, addressing any emotional or mental health concerns.
12
Finally, sign and date the dialysis history and physical form, ensuring all information is accurate and complete.
Who needs dialysis history and physical?
01
Patients who require dialysis treatment for their kidney disease need to provide a dialysis history and physical to their healthcare providers.
02
Nephrologists or kidney specialists who are overseeing the patient's dialysis care would require this information for continued management and treatment planning.
03
Surgeons may also request a dialysis history and physical before performing kidney-related surgeries to assess the patient's overall health and suitability for the procedure.
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What is dialysis history and physical?
Dialysis history and physical is a document that provides information about a patient's medical history related to kidney dialysis treatment and their current physical condition.
Who is required to file dialysis history and physical?
Patients receiving dialysis treatment are required to file dialysis history and physical with their healthcare provider.
How to fill out dialysis history and physical?
Patients must provide accurate information about their medical history, current medications, dialysis treatment details, and any symptoms or concerns they may have.
What is the purpose of dialysis history and physical?
The purpose of dialysis history and physical is to help healthcare providers monitor the progress of the patient's treatment, assess their overall health, and make informed decisions about their care.
What information must be reported on dialysis history and physical?
Information such as medical history, current medications, dialysis treatment schedule, blood pressure readings, laboratory test results, and any symptoms or concerns must be reported on the dialysis history and physical form.
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