For Contrast Only – MRI (gadolinium), Gastrograffin, and Barium studies are excluded
Initial History –
* If changes in history – document change, date and initial.
History of DiabetesPresently taking: (Circle)Glucophage/Metformin Other Drug controlling Diabetes: ________________________________ NOTE: If the patient is taking another oral diabetic drug other than the above medications, call Pharmacy for instructions.
History of Kidney ProblemsCurrently or ever been on dialysisHistory of cancer – Type – Reaction to Contrast given by a radiology procedure or cardiac catheterizationPregnantPatient has had an out-patient study/procedure with contrast in the last 72 hours, notify physician.
Are there any previous contrast studies within 72 hours in the chart (Radiology or Cath Lab)? If yes, notify performing physician.
Initial History Date:
Lab Findings & Review of History
Most recent BUN & Creatinine results:
Notify physician, if lab pending.
History with
Creatinine (normal range = 0.5-1.3 mg/dl) procedure
Contrast Procedure (to be performed):
Cumulative Contrast Use
Notification to
Amount of
performing MD
Given for
of total contrast
within 72 hours -
within 72
(within the
For Intravenous Contrast - Insertion and Administration
IV inserted by
Infusing Site During
& Post-Procedure
Dry & Intact, no Sign of swellingSee comment Dry & Intact, no Sign of swellingSee comment Dry & Intact, no Sign of swellingSee comment Dry & Intact, no Sign of swellingSee comment Dry & Intact, no Sign of swellingSee comment Methodist Le Bonheur Healthcare
Patient Name:_____________________________ Ht:____ Wt:____ No Home Medications (including over the counter drugs & herbal preparations) Unable to Obtain Medication History – Reason ____________________________________ Current Home Medications (Including Over the Counter Drugs & Herbal Preparations)
Above is a list of medications this patient or his/her representative told us he/she was taking before coming to the
hospital. The physician has reviewed these medications to see if there is any conflict with new medications the
patient is being prescribed and will be taking after discharge. Unless marked “STOP TAKING” the patient wil
be instructed to continue taking these medications as described in SPECIAL INSTRUCTIONS. The patient
will be encouraged to review these medications with his/her personal physician on a regular basis.
List of Additional Medications Prescribed in Patient Friendly Terms
(To Be Completed by Physician or Clinical Staff Member)
Name of next physician patient is scheduled to visit___________________

Source: http://www.methodisthealth.org/dotAsset/2e390d72-4343-4a35-8d15-e74f858d35c4.pdf


Joan RafelUniversitat de Gironajoan.rafel@udg.es The Syntax of Small Clause Predication Abstract In this paper I put forward and justify a syntactic configuration that I call Complex SmallClause -structure. I show that this single syntactic structure can explain both the semantic valueand the syntactic behavior of a range of constructions that up to now have been exploredseparately and, h

North carolina rheumatology association

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