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Site No:Screening No:PARTUM Eligibility Checklist Toronto ONE or more: Mild inherited thrombophilia, one of: Heterozygous factor V Leiden Heterozygous prothrombin gene mutation Protein C deficiency
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How to fill out venous thromboembolism in form

01
Obtain the form for venous thromboembolism (VTE).
02
Enter the patient's personal information in the designated fields, including name, age, and contact details.
03
Fill in the medical history section, noting any previous episodes of VTE or relevant health conditions.
04
Complete the risk factors section, listing any factors such as surgery history, immobility, or family history of VTE.
05
Provide details on the current medical condition that warrants assessment for VTE.
06
Include any relevant medications the patient is taking that may impact VTE risk.
07
Sign and date the form, ensuring all information is accurate before submission.

Who needs venous thromboembolism in form?

01
Patients with a history of venous thromboembolism.
02
Individuals who have recently undergone surgery, especially orthopedic or major abdominal procedures.
03
Patients with prolonged immobility due to illness, injury, or long travel.
04
Individuals with risk factors such as obesity, smoking, or a family history of clotting disorders.
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People using hormonal therapies, such as contraceptives or hormone replacement therapy.
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Venous thromboembolism refers to the formation of blood clots in the veins, which can lead to serious health complications such as pulmonary embolism. In form, it typically pertains to a required report or documentation regarding cases of VTE.
Healthcare providers, hospitals, or facilities involved in the treatment or reporting of cases of venous thromboembolism are typically required to file this form.
To fill out the venous thromboembolism in form, individuals must provide patient information, details regarding the diagnosis, treatment provided, and any complications encountered, ensuring all fields are completed accurately.
The purpose of this form is to track, monitor, and report incidents of venous thromboembolism to enhance patient safety and improve healthcare quality through data collection and analysis.
The information reported typically includes patient demographics, clinical details of the VTE event, treatment provided, and outcomes associated with the case.
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