Spectrum Printable Forms  NEW

updated12/28/2012

Central Lines
Central Line Infection (pdf)  handout for patients on infection risks
Ocular Surface Injury (aka Corneal Injury) 
Ocular Surface Injury
(Corneal Injury)
(pdf)

epic logo For Maine Medical Center (EPIC): EPIC generates a printed form as well as documenting the event in the patient record. Here's How

For all other Spectrum Practice Sites, 2011:
OSI Management Guidelines & Patient Instruction Sheet (pdf)
 
Print one copy and complete: then photocopy X 2 and give one to Patient, one for Medical Record, one for Spectrum Q/A.

Difficult Airway / Difficult Intubation
Difficult Airway
Maine Med (Sunrise)

 

Difficult Airway 
Maine Med Printed Form

how to tag a patient in Sunrise as having a Difficult Airway in Sunrise Clinical Manager. You can also generate a patient handout with instructions and advice.

If Sunrise is not available, you can download a printed form, complete it,  photocopy X 2 and give one to Patient, one for Medical Record, one for Spectrum Q/A.

Difficult Airway
Mercy Hospital
(pdf)
Print one copy and complete: then photocopy X 2 and give one to Patient, one for Medical Record, one for Spectrum Q/A.
Difficult Airway  
(Off-Campus Sites)
for use at off-campus sites like P&H, OA, CMO. 
Print one copy and complete: then photocopy X 2 and give one to Patient, one for Medical Record, one for Spectrum Q/A.
Epidurals
Epidural Blood Patch (pdf)

handout for patients in whom we have performed an Epidural Blood Patch for post-dural puncture headache.  Robyn Dixon, 2011

Epidural Catheter Site Infection (pdf)

handout for patients in whom we have a concern for potential epidural catheter site infection.  I send this home with patients who are discharged with an insertion site that is of any concern.  
Robyn Dixon 2010

Obstetrics Consult (All Sites)
Obstetrics Consult  (pdf)

Complete form, PhotoCopy x2. One copy for Patient Record, One Copy for OB Notebook (Sutherland), One Copy for Spectrum Anesthesia Billing

Anesthesia Consult (MMC)
Anesthesia Consult (pdf)

Complete form, PhotoCopy x2. One copy for Patient Record, One Copy for Consult Book in Anesthesia Office, One Copy for Spectrum Anesthesia Billing (see Consultation Guidelines). Also smart to let Floorwalker and Secretary know for appropriate case assignment.

 
   

12/28/2012epic logo

  • Instructions for finding the smart text for the documention of an Ocular Surface Injury (and the patient information sheet).
  •  
  • Select your patient from Anesthesia S/B (or from Patient Lists)
  •  
  • Open "NOTES" on left
  • NEW NOTE  In the "Insert Smart Text" box type AN->Enter
  • List of smart text selections will appear.  You are able to save these to your favorites. 
  • Highlight (or click) the "MH AN Ocular Surface Injury Documentation" and complete note by "F2" through note.
  •  
  • Highlight (or click) the " MH AN Ocular Surface Injury Patient Instructions" to add to the patients chart.

  Any questions/problems come see me.
  Paula