UC STROKE TEAM TELEMEDICINE NOTE TEMPLATE

/
STroke team telemed image for TTNI _ v2.png

[Copy and Paste text below as needed into EMR]

UC STROKE TEAM TELEMEDICINE NOTE

Time of contact to UC Stroke Team: ***
Time page returned: ***

Pt age: ***
LKW: ***
Time since LKW: ***

HPI (brief): ***

PMH: ***

DOAC or VKA: [y/n]

Known contraindications to tPA: [y/n]

Noncon CT impression: ***
CTA impression (if applicable): ***

NIHSS: *** ; Time NIHSS performed: ***
Exam findings of note: ***

MDM: ***

Additional Recommendations: ***

FOR ANY PATIENTS TREATED WITH tPA, please call UC STROKE TEAM during the first 24 hours of care with any management concerns related to possible or actual neuroworsening or bleeding.

 ***, MD
UC STROKE TEAM