Emergency Department Discharge Instructions
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1 Emergency Department Discharge Instructions Abdominal Pain Adult Abdominal Pain Child Abrasions (Scrapes) Abscess Alcohol Use and Abuse Allergic Reaction Adult Allergic Reaction Child Allergic Rhinitis (Hay Fever) Anaphylactic Reaction (Severe Allergic Reaction) Ankle Fracture (Broken Ankle) Ankle Sprain Arm Fracture Humeral Shaft (Broken Upper Arm) Arm Fracture Radius or Ulna (Broken Forearm) Arthritis Asthma Adult Asthma Child Avulsed Tooth (Knocked Out Tooth) Adult Avulsed Tooth (Knocked Out Tooth) Child Back Herniated Disk Lumbar (Slipped Disk) Back Lumbar Pain (Lower) Bacterial Vaginosis (Vaginal Infection) Bell s Palsy Bite Animal Bite by Human Bite or Sting Bee or Wasp Bite or Sting Fire Ant Bite or Sting Insect Bite or Sting Marine Animal Bite Snake Non poisonous Bite Snake Poisonous Bite Spider Non poisonous Bite Spider Poisonous Bite Tick Blood and Body Fluid Exposure Boils and Carbuncles Bronchiolitis Child Bronchitis Acute Adult Bronchitis Acute Child Bursitis (Joint Inflammation) Candidiasis (Thrush) Candidiasis (Yeast Infection) 2008 RelayHealth and/or its affiliates. All rights reserved Page 1 of 6
2 Carbon Monoxide Poisoning Cast Care Adult Cast Care Child Cellulitis Chemical Pneumonitis (Inhaled Chemicals) Chest Pain Adult Chest Pain Child Chest Wall or Rib Injury Cholelithiasis (Gallstones) Chronic Obstructive Pulmonary Disease (Lung Disease) Clavicle Fracture (Broken Collarbone) Coccyx Injury (Tailbone Injury) Colic Child Constipation Adult Constipation Child Costochondritis (Chest Wall Pain) Cough Crutches Dehydration Adult Dehydration Child Dental Pain (Toothache) Diarrhea Acute Child Diarrhea Adult Diarrhea Diet BRAT Dietary Approaches to Stop Hypertension (The DASH Diet) Dizziness Drug Use and Abuse Ear Cerumen Impaction (Earwax Blockage) Adult Ear Cerumen Impaction (Earwax Blockage) Child Ear Foreign Body Adult Ear Foreign Body Child Ear Otitis Externa (Swimmer s Ear) Adult Ear Otitis Externa (Swimmer s Ear) Child Ear Otitis Media (Middle Ear Infection) Adult Ear Otitis Media (Middle Ear Infection) Child Earache Adult Earache Child Edema (Swelling or Fluid Retention) Elastic Bandage Use Elbow Fracture (Broken Elbow) Elbow Radial Head Subluxation (Nursemaid s Elbow) Elbow Sprain Electrical Injury 2008 RelayHealth and/or its affiliates. All rights reserved Page 2 of 6
3 Epididymitis (Testicle Inflammation) Epistaxis (Nosebleed) Epstein Barr Virus (Infectious Mononucleosis) Essential Hypertension (High Blood Pressure) Eye Burn from Welding or UV Light Eye Chemical Burn Eye Conjunctivitis (Pinkeye) Eye Conjunctivitis Allergic (Allergic Pinkeye) Eye Corneal Abrasion (Scratch) Eye Foreign Body Eye Orbit Fracture (Broken Eye Socket) Eye Soft Tissue Injury (Black Eye) Facial Laceration (Cut) Facial Puncture Wound Facial Trauma Adult Facial Trauma Child Facial Trigeminal Neuralgia (Nerve Pain) Fever Adult Fever Child Finger Dislocation Finger Fifth Metacarpal Fracture (Boxer s Fracture) Finger Fracture (Broken Finger) Finger Sprain Foot Laceration (Cut) Foot Plantar Fasciitis (Heel Pain) Foot Puncture Wound Foot Sprain Frostbite Gastroesophageal Reflux Disease (Heartburn) Gout Groin Strain Hand Fracture Metacarpal (Broken Hand) Hand Laceration (Cut) Hand Puncture Wound Hand Sprain Head Injury (Concussion) Adult Head Injury Child Headache Migraine Headache Tension Adult Headache Tension Child Heart Failure (HF) Heat Illness Hematuria (Blood in Urine) Hemorrhoids Hyperglycemia (High Blood Sugar) 2008 RelayHealth and/or its affiliates. All rights reserved Page 3 of 6
4 Hyperventilation Syndrome (Rapid Deep Breathing) Hypoglycemia (Low Blood Sugar) Inguinal Hernia (Groin Hernia) Inguinal Hernia Indirect (Scrotal Hernia) Knee Dislocation Patella (Knee Dislocation) Knee Fracture Patella (Broken Kneecap) Knee Sprain Laceration (Cut) General Laryngitis (Hoarse Voice) Laryngotracheitis (Croup) Child Lice Child Lice Overview Mastitis (Breast Infection) Meningitis Exposure Motor Vehicle Accident Adult Motor Vehicle Accident Child Nausea and Vomiting Adult Nausea and Vomiting Child Neck Herniated Cervical Disk (Slipped Disk) Neck Strain Neck Torticollis (Wry Neck) Nose Foreign Body Child Nose Fracture or Injury (Hurt or Broken Nose) Overdose of Drug or Substance Palpitations (Rapid Heartbeat) Adult Palpitations (Rapid Heartbeat) Child Panic Attack Paresthesia (Numbness) Pelvic Inflammatory Disease Penile Discharge Penile Lesion Pharyngitis (Sore Throat) Adult Pharyngitis (Sore Throat) Child Pharyngitis Strep (Strep Throat) Adult Pharyngitis Strep (Strep Throat) Child Phlebitis and Superficial Thrombophlebitis (Blood Clot) Pleurisy Pneumonia Pregnancy Ectopic Pregnancy Normal Pregnancy Spontaneous Abortion (Miscarriage) Radiculopathy (Arm or Leg Pain) 2008 RelayHealth and/or its affiliates. All rights reserved Page 4 of 6
5 Renal Calculi (Kidney Stones) Rib Fracture (Broken Rib) Safety in the Home Adult Safety in the Home Child Scalp Laceration (Cut) Seizures (Convulsions) Adult Seizures (Convulsions) Child Seizures Febrile (Convulsions from High Fever) Sexual Assault Chlamydia Genital Herpes Gonorrhea Trichomoniasis Shoulder Dislocation Shoulder Fracture Proximal Humerus (Broken Shoulder) Shoulder Sprain Sinusitis (Sinus Infection) Skin Atopic Dermatitis (Eczema) Adult Skin Atopic Dermatitis (Eczema) Child Rectal Bleeding Skin Contact Dermatitis (Skin Irritation) Skin Contusion (Bruise) Skin Decubitus Ulcer (Bedsore or Pressure Sore) Skin Dermatitis (Rash) Adult Skin Dermatitis (Rash) Child Skin Foreign Body Skin Impetigo (Bacterial Infection) Skin Infection Methicillin resistant Staphylococcus Aureus Skin Lesion Mole Skin Lesion Wart Skin Needlestick Injury Skin Partial thickness (2 nd Degree) Burn Skin Pruritis (Itchy Skin) Skin Rhus Dermatitis (Poison Ivy, Sumac, and Oak) Skin Sunburn Skin Superficial (1 st Degree) and Partial Thickness (2 nd Degree) Burns Child Skin Superficial (1 st Degree) Burn Skin Urticaria (Hives) Skin Varicella (Chicken Pox) Skin Varicella Zoster (Shingles) 2008 RelayHealth and/or its affiliates. All rights reserved Page 5 of 6
6 Skin Chemical Exposure Syncope (Fainting) Child Toe Dislocation Toe Fracture (Broken Toe) Toe Ingrown Toenail Toe Sprain Transcient Ischemic Attack (Stroke) Tremor (Shake) Upper Respiratory Infection (Common Cold) Adult Upper Respiratory Infection (Common Cold) Child Urinary Tract Infection (UTI) Adult Urinary Tract Infection (UTI) Child Vaginal Bleeding Vasculitis (Inflammation of Blood Vessels) Vertigo Subungual Hematoma (Blood Under Nail) Syncope (Fainting) Adult Viral Illness Adult Viral Illness Child Vomiting and Diarrhea Adult Vomiting and Diarrhea Child One Year and Older Vomiting and Diarrhea Child Under 1 Year West Nile Virus Wheezing Adult Wheezing Child Wound Care Wound Dressing Change Wound Puncture Wrist Fracture Radius or Ulna (Broken Wrist) Wrist Sprain 2008 RelayHealth and/or its affiliates. All rights reserved Page 6 of 6
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Mayflower Acupuncture LLC
Welcome to Mayflower Acupuncture. To help us provide you with the best possible care, please fill out this form as completely as you can. All information provided here will be held in strictest confidence.
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ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION. Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security #: - -
ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security : - - Home Address: City, State, Zip: Home Phone: ( ) Work Phone:
DNA CENTER New Patient Information
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Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in.
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Medical History Intake Form
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My Certification I certify that the above information is correct and I request services. X Signature of patient or person acting on patient's behalf
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Review of STAGE presentation framework (from umass.macy.edu, revised Alicia Monroe, MD from 2005 STFM) S- style organization, sequencing adequate to build a case for your diagnosis or a story T- Timing-
Avery Acupuncture & Natural Medicine New Patient Registration
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This week we saw a total of 85 patients, 25 of whom were unable to pay because of limited financial resources.
February 2014 Honduras New Hope Clinic Weekly Reports Weekly Report Feb. 3-7, 2014 This week we saw a total of 85 patients, 25 of whom were unable to pay because of limited This week the clinic donated