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CardiothoracicandVascularICU
Auckland City Hospital0800 ADULT ECHO
CV ICU ECHO Referral Form
REFERRING HOSPITAL DETAILS
DateTimeReferring DoctorCellphoneReferring Hospital
PATIENT DETAILS
First Name
Surname
Do
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How to fill out ecmo referral formdoc
How to fill out ecmo referral formdoc
01
To fill out the ECMO referral formdoc, follow these steps:
02
Open the ECMO referral formdoc on your computer.
03
Enter the patient's demographic information such as name, age, and gender.
04
Provide the patient's medical history, including any relevant diagnoses or conditions.
05
Specify the reason for referral to ECMO, providing details about the patient's current medical condition.
06
Include any additional information or documentation that supports the need for ECMO.
07
Ensure that all sections of the referral formdoc are completed accurately and legibly.
08
Double-check the formdoc for any errors or missing information.
09
Submit the completed formdoc to the appropriate healthcare provider or ECMO specialist for review and processing.
Who needs ecmo referral formdoc?
01
The ECMO referral formdoc is required for patients who need to be referred for ECMO (Extracorporeal Membrane Oxygenation) therapy. ECMO is a life-saving treatment for patients with severe respiratory or cardiac failure who are unable to obtain adequate oxygenation or circulation through conventional means. The referral formdoc is typically used by healthcare providers, physicians, or ECMO specialists to initiate the evaluation and transfer process for eligible patients in need of ECMO support.
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What is ecmo referral formdoc?
The ecmo referral formdoc is a document used for referring a patient for ECMO (Extracorporeal Membrane Oxygenation) treatment.
Who is required to file ecmo referral formdoc?
Medical professionals such as physicians, surgeons, or intensivists are required to file the ecmo referral formdoc.
How to fill out ecmo referral formdoc?
The ecmo referral formdoc can be filled out by providing the patient's information, medical history, reason for referral, and contact information of the referring medical professional.
What is the purpose of ecmo referral formdoc?
The purpose of the ecmo referral formdoc is to facilitate the referral process for patients in need of ECMO treatment.
What information must be reported on ecmo referral formdoc?
The ecmo referral formdoc must include the patient's name, age, medical history, current condition, reason for referral, and contact information of the referring medical professional.
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