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This form has been created to assist you in the referral process and to ensure that your referral is routed to the correct personnel. PATIENT NAME DIAGNOSIS DATE Referring MD Print Phone Fax If you are referring a patient already implanted with a DBS system we will require the following LEGIBLE PATIENT DEMOGRAPHIC SHEET WITH BEST TO CONTACT PT. You are hereby notified that any disclosure copying distribution or the taking of any action in reliance on the contents of this information is...
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How to fill out dbs deep brain stimulation

01
Start by gathering all the necessary documents and information needed for the application process.
02
Ensure that you have a referral from your primary care physician or neurologist to undergo a deep brain stimulation procedure.
03
Contact the specific medical center or hospital where you want to have the surgery and schedule an initial consultation.
04
During the consultation, discuss your medical history, symptoms, and any previous treatments you have undergone.
05
Undergo a series of tests and evaluations to determine if you are a suitable candidate for deep brain stimulation.
06
Once approved, schedule the surgery and follow any pre-operative instructions provided by the medical center.
07
On the day of the surgery, arrive at the hospital or medical center on time and follow the instructions given by the medical staff.
08
After the surgery, follow the post-operative care instructions provided by your medical team, including taking any prescribed medications and attending follow-up appointments.
09
Attend regular programming sessions to customize the settings of the deep brain stimulation device and optimize its effectiveness.
10
Continue regular follow-up appointments with your neurologist to monitor your progress and make any necessary adjustments to the treatment.

Who needs dbs deep brain stimulation?

01
Patients with Parkinson's disease who have experienced inadequate control of their symptoms with medication alone may benefit from deep brain stimulation.
02
Individuals with essential tremor that cannot be effectively managed with medication may be suitable candidates for deep brain stimulation.
03
People with dystonia, a movement disorder characterized by muscle contractions, may benefit from deep brain stimulation if other treatments have been unsuccessful.
04
Patients with obsessive-compulsive disorder (OCD) that has not responded to other treatment options may be considered for deep brain stimulation.
05
In some cases, deep brain stimulation is used for the treatment of epilepsy, specifically for those who have not responded to other forms of therapy.
06
It is important to consult with a neurologist or medical professional specializing in deep brain stimulation to determine if it is a suitable treatment option for your specific condition.
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DBS deep brain stimulation is a surgical procedure used to treat a variety of neurological disorders, such as Parkinson's disease, essential tremor, and dystonia. It involves implanting a device that delivers electrical stimulation to specific areas of the brain.
DBS deep brain stimulation is typically performed by neurosurgeons and neurologists who specialize in movement disorders.
Filling out a DBS deep brain stimulation procedure involves a series of pre-operative evaluations, surgical implantation of the device, and post-operative programming and follow-up appointments.
The purpose of DBS deep brain stimulation is to help manage symptoms of neurological disorders by modulating abnormal brain activity through electrical stimulation.
Information that must be reported on a DBS deep brain stimulation procedure includes patient demographics, medical history, surgical details, post-operative outcomes, and any adverse events.
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