Get Tia Clinic Cuh

Filling out the Tia Clinic Cuh referral form is a crucial step in ensuring that patients receive timely care for transient ischemic attacks (TIAs). This guide will provide you with detailed instructions on how to accurately complete the form online, ensuring a smooth referral process.

Follow the steps to successfully complete the Tia Clinic Cuh form online.

1. Press the ‘Get Form’ button to access the Tia Clinic Cuh referral form and open it in your preferred document editor.
2. Enter the date of symptoms in the designated field in the format of day/month/year.
3. Fill in the date of referral using the same format.
4. In the patient details section, input the patient's full name, date of birth, and CUH MRN if known.
5. Provide the patient's address and age in the respective fields.
6. Enter the patient's mobile telephone number and the mobile number of the next of kin.
7. Input the referring doctor’s name and contact number.
8. Indicate if there are any red flags for urgent same-day admission by selecting yes or no.
9. Describe the symptoms in detail, including the nature of all focal symptoms, duration, and recurrences.
10. Complete the ABCD2 scoring section by providing relevant information, including age, blood pressure, clinical symptoms, duration of symptoms, and diabetes status.
11. Calculate the total ABCD2 score and determine if it is 0-4 or 4+.
12. If the score is 0-4, ensure to fax the completed form to the Rapid Access Stroke Prevention Clinic at 021 4920355. If 4+ or if there are red flags, refer the patient directly to ED.
13. Finalize by triaging as suitable if applicable and reserving the necessary imaging tests, MRI or CT.
14. Ensure all changes are saved and the form is ready for faxing.

Complete the Tia Clinic Cuh referral form online today for timely care.