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PHOENIX NEUROLOGICAL AND SLEEP INSTITUTE New Patient Form Name: Age: Sex: Date of Birth: Reason for visit today? (List in order of importance to you) 1. For how long? 2. For how long? 3. For how long?
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To fill out stroke symptoms, follow these steps:
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Feeling numbness or weakness in the face, arm, or leg, especially on one side of the body.
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Sudden confusion, trouble speaking, or difficulty understanding speech.
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Trouble seeing in one or both eyes.
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Severe headache with no known cause.
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Loss of balance or coordination, dizziness, or trouble walking.
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Sudden severe unexplained headache with no known cause.

Who needs stroke - symptoms and?

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Anyone who suspects they or someone else may be experiencing stroke symptoms should fill out stroke symptoms form.
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A stroke is a medical emergency that occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting essential nutrients and oxygen. Symptoms may include sudden numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion, trouble speaking, or difficulty understanding speech; vision problems in one or both eyes; difficulty walking, dizziness, or loss of balance and coordination.
Individuals experiencing symptoms of a stroke, or healthcare providers assessing or providing treatment for stroke, are required to report stroke symptoms to ensure timely medical intervention and record-keeping.
To fill out the stroke symptoms report, document the time symptoms began, describe the symptoms observed, note any relevant medical history or medications, and provide details about the patient's vital signs and level of consciousness.
The purpose of documenting stroke symptoms is to facilitate prompt diagnosis and treatment, track patient progress, inform healthcare providers, and contribute to research and education on stroke care and prevention.
The report must include the time of symptom onset, specific symptoms observed, patient demographics, medical history, current medications, and additional relevant observations that may assist in treatment.
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