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_NINETIMH CLINICRequest for Consultation Patient Identification:Name:___ DOB:___ PHN:___ Phone(H):___Cell:___Email:___Address:___ ___ Occupation: ___ Indication for rTMS/MST/ECT: Major Depressive
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How to fill out magnetic seizure formrapy for

01
To fill out a Magnetic Seizure Therapy (MST) form, you need to follow these steps:
02
Start by ensuring that you have the necessary information and documents handy, such as medical history, previous treatment records, and any relevant test results.
03
Begin by providing your personal details, including your full name, date of birth, and contact information.
04
Specify the reason for seeking MST and provide detailed information about your medical condition or symptoms that warrant this therapy.
05
Mention any previous treatments you have undergone and their outcomes, including medications, therapy, or surgeries.
06
Provide information about any existing medical conditions, allergies, or medications you are currently taking.
07
If applicable, provide details about any psychological or psychiatric conditions you may have.
08
Include information about your current health status, such as recent illnesses or hospitalizations.
09
Answer any specific questions related to MST, its risks, benefits, and potential side effects.
10
If required, provide your consent for undergoing MST treatment and any additional procedures that may be necessary.
11
Finally, review the completed form for accuracy and sign it before submitting it to the relevant healthcare provider or facility.

Who needs magnetic seizure formrapy for?

01
Magnetic Seizure Therapy (MST) is a treatment primarily indicated for individuals who meet the following criteria:
02
Patients who have been diagnosed with severe depression that has been unresponsive to conventional treatments like medications and psychotherapy.
03
Individuals who have experienced adverse side effects or limited effectiveness with other forms of brain stimulation therapies, such as electroconvulsive therapy (ECT).
04
Patients with comorbidities or contraindications that make ECT unsuitable or potentially risky.
05
Individuals who prefer a more targeted and focal approach to brain stimulation therapy.
06
It is important to consult with a qualified healthcare professional to determine if you are a suitable candidate for MST and to discuss its potential benefits and risks.
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Magnetic seizure therapy is used for the treatment of certain mental health disorders, particularly treatment-resistant depression.
Healthcare providers who perform magnetic seizure therapy are required to file the necessary documentation.
To fill out the magnetic seizure therapy form, healthcare providers must include patient information, treatment details, and any relevant clinical findings.
The purpose of the magnetic seizure therapy form is to document the treatment provided and ensure compliance with regulations.
Information that must be reported includes patient demographics, treatment history, therapy details, and any adverse effects observed.
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