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STROKE PREVENTION CLINIC REFERRAL FORM BHS Owen Sound 519376 2121 Ext 2922 Date of Event: ___ Duration of Symptoms: ___ (min/hrs) Signs/Symptoms:Side (R/L)Duration (mins)Unilateral motor deficits
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How to fill out stroke prevention clinic referral
How to fill out stroke prevention clinic referral
01
Obtain the necessary referral form from the stroke prevention clinic.
02
Fill out the patient's personal information including their name, date of birth, address, and contact information.
03
Provide details about the patient's medical history, including any previous strokes or risk factors for stroke.
04
Indicate the reason for the referral and any specific concerns or requests for the clinic to address.
05
Ensure all information is accurate and legible before submitting the referral.
Who needs stroke prevention clinic referral?
01
Patients who have experienced a stroke or transient ischemic attack (TIA).
02
Individuals with risk factors for stroke such as high blood pressure, diabetes, or atrial fibrillation.
03
Those who have a family history of stroke or have been advised by a healthcare provider to seek further evaluation for stroke prevention.
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What is stroke prevention clinic referral?
A stroke prevention clinic referral is a medical referral to a specialized clinic that helps individuals at risk of stroke to prevent future occurrences.
Who is required to file stroke prevention clinic referral?
Healthcare providers such as doctors, specialists, or nurses may be required to file a stroke prevention clinic referral for their patients.
How to fill out stroke prevention clinic referral?
Healthcare providers can fill out a stroke prevention clinic referral by providing detailed information about the patient's medical history, risk factors, and current treatment plan.
What is the purpose of stroke prevention clinic referral?
The purpose of a stroke prevention clinic referral is to ensure that at-risk individuals receive specialized care and treatment to reduce their risk of having a stroke.
What information must be reported on stroke prevention clinic referral?
Information such as the patient's medical history, risk factors for stroke, current medications, and any previous strokes or TIAs must be reported on a stroke prevention clinic referral.
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