Get the free Lead Extraction Referral Form - London Cardiac Institute Home

Referral to: LHC ARRHYTHMIA SERVICE. LEAD EXTRACTION REFERRAL BR FORM. 339 Winder mere Road, London ON N6A 5A5. Telephone: 5196633746br ...

How to fill out lead extraction referral form

How to fill out a lead extraction referral form:

1. Start by gathering all necessary information such as patient's personal details (name, date of birth, contact information) and medical history related to lead extraction.
2. Read the instructions provided on the lead extraction referral form carefully to ensure that you understand each section and what information needs to be provided.
3. Begin filling out the lead extraction referral form by entering the patient's personal information accurately.
4. Next, provide details regarding the reason for the lead extraction referral, including any symptoms or concerns that the patient may have.
5. If applicable, provide information about the patient's current implantable device, such as the type of device and its location.
6. Ensure that all relevant medical history related to lead extraction is included. This may include previous surgeries, allergies, and any underlying medical conditions.
7. If the lead extraction is being referred to a specific healthcare provider or facility, provide their contact information and any additional instructions or documents required.
8. Verify that all the information provided on the form is accurate and complete before submitting it.
9. Some lead extraction referral forms may require a signature from the referring healthcare provider. If required, ensure that the form is signed appropriately.
10. Keep a copy of the completed referral form for your records.

Who needs a lead extraction referral form?

1. Patients who have an implanted device, such as a pacemaker or defibrillator, and require the extraction of leads (wires) associated with the device.
2. Healthcare providers who are diagnosing or treating patients with complications related to implanted cardiac devices and need to refer them to specialists for lead extraction.
3. Hospitals and healthcare facilities that specialize in lead extraction procedures and require a referral form to initiate the process and ensure that all necessary information is provided.

Note: It is important to consult with the specific healthcare provider or facility for their guidelines and requirements regarding lead extraction referral forms.

For pdfFiller’s FAQs

How can I edit lead extraction referral form from Google Drive?

Using pdfFiller with Google Docs allows you to create, amend, and sign documents straight from your Google Drive. The add-on turns your lead extraction referral form into a dynamic fillable form that you can manage and eSign from anywhere.

How do I make edits in lead extraction referral form without leaving Chrome?

Install the pdfFiller Google Chrome Extension to edit lead extraction referral form and other documents straight from Google search results. When reading documents in Chrome, you may edit them. Create fillable PDFs and update existing PDFs using pdfFiller.

How do I fill out lead extraction referral form using my mobile device?

On your mobile device, use the pdfFiller mobile app to complete and sign lead extraction referral form. Visit our website (https://edit-pdf-ios-android.pdffiller.com/) to discover more about our mobile applications, the features you'll have access to, and how to get started.

What is lead extraction referral form?

Lead extraction referral form is a document used to refer a patient for a lead extraction procedure to remove pacemaker or defibrillator leads from the heart.

Who is required to file lead extraction referral form?

Medical professionals such as cardiologists, electrophysiologists, and cardiac surgeons are required to file lead extraction referral form for their patients.

How to fill out lead extraction referral form?

The form typically requires information about the patient's medical history, reason for lead extraction, current medications, and any known allergies.

What is the purpose of lead extraction referral form?

The purpose of the form is to provide necessary information for the medical team performing the lead extraction procedure and to ensure proper patient care.

What information must be reported on lead extraction referral form?

Information such as patient's name, date of birth, contact information, medical history, current medications, reason for lead extraction, and any known allergies must be reported on the form.