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Forms

  Consent Forms

Adult Central Venous Catheterization
Arterial Line
CT with Intravenous Contrast
Pediatrics Central Venous Catheterization
Arterial Line

  Case Records/CPC

Morbidity & Mortality Case Submission Form
Please fill-in the form, print out a hardcopy and drop it off in Dr. Desai's or Dr. O'Neill's mailbox
 M&M Form.pdf
Morbidity & Mortality Case Template Form
Use this form to record required information for M&M Case Reviews. There is a downloadable Word file as a zip file if you wish to type the information in directly.
M&M Template.pdf
M&M Template.zip
ICU Case Submission Form
Please fill-in the form, print out a hardcopy and drop it off in Dr. Rios' or Dr. Cirigliano-Thompson's mailbox
 ICU Form.pdf
Tox Case Reporting Form
 Tox Form.pdf
Photography Consent
 Medical Consent.pdf

  Clinical Pathways and Research Forms:

Adult Asthma Guidelines (updated 4/2003)
 Asthma Guildelines.pdf
Pediatric Asthma Guidelines 2002 Asthma Children.pdf
Pulmonary Embolism Clinical Decision Rules PE CDR.pdf
Stroke Code Responsibilities
 Stroke Code.pdf
NYS Dept of Health Reportable Diseases NYS DOH Reportable.pdf
Influenza Guidelines (CDC) CDC Flu Site
ARF Workup Flowchart ARF Workup.pdf
EKG Changes in Hypo/Hyperkalemia Potassium EKG Changes.pdf
C-1 Resuscitation Room Checklist
 C1 Resus Checklist.pdf
C-1 Checklist for Trauma Orders
 C1 Trauma Checklist.pdf
C-1 Area Sign-Out List
 C1 Signout Template.pdf
New ER Area Sign-Out List
 NER Signout Template.pdf
Treatment Room Area Sign Out List
 Treatment Signout Template.pdf
Resuscitation Log Form Resus Log Form.pdf
UHB Sign-Out List UHB Sign Out.pdf
Ultrasound Data Sheet ED US Data Sheet.pdf
Trauma Data Entry Worksheet
 TraumaDataSheet.pdf
Trauma Blank Hit List
 Blank Hit List.xls
SUNY KCHC