Boston Scientific Cardiology Order Form

Boston Scientific Cardiology Order Form - Boston Scientific Cardiac Diagnostics Inc is a wholly owned subsidiary of Boston Scientific Corporation Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world For patients and caregivers

PATIENT NAME D O B 1 MODEL s ICD CRT D ATRIAL LEAD RV LEAD LV LEAD Use the following checklists to ensure that patients who have a Boston Scientific Transvenous Defibrillation System labeled MR Conditional can receive an MR Conditional scan

Boston Scientific Cardiology Order Form

Boston Scientific Cardiology Order Form

Boston Scientific Cardiac Diagnostics Forms. Patient Support IFrame. Patient Survey IFrame. Healthcare Professional Survey IFrame. Request Sales Rep IFrame. Having Difficulties with my Monitor IFrame. Billing and Insurance Inquiry IFrame.

According to Boston Scientific s device labeling the following Conditions of Use MUST BE MET for a patient with an ImageReadyTM Transvenous Defibrillation System to undergo an MR Conditional scan

Span Class Result Type

Cardiology Order Form Off Label MRI Scan PATIENT NAME An MRI scan has been requested for this patient Because D O B NOT ALL CONDITIONS OF USE HAVE BEEN MET the scan is off label Boston Scientific labeling warns of potential risks for off label MRI scans and does not promote nor encourage this use RESOURCES

Form 8 K BOSTON SCIENTIFIC CORP For May 01

Cardiology Order Form Boston Scientific Cardiology Order Form MRI Non conditional System 1 DATE PHYSICIAN SIGNATURE PHYSICIAN NAME This form may contain patient confidential information If you receive this form in error contact Boston Scientific Technical Services 800 227 3422 DO NOT FORWARD

Patient Support Patients

Cardiology Order Ordering Physician Signature Date and Time Phone Number Fax Patient Information Patient Name Phone Number DOB Cardiology orders for device programming 1 The patient was reviewed for the following A ProMRI pacemaker or ICD system has been implanted pectorally Leads have been implanted for at least six weeks

Cardiologists

Cardiology Order Form Patient name Pacemaker Model Boston Scientific Advancing science for Date of Birth Atrial Lead Model RV Lead Model his form mav contain patient confidentga information If you reccrv e this form in error please do not orward and contact Boston Scientific Techngca Services at 800 227 3422

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Boston Scientific Cardiac Diagnostics Forms

Boston Scientific Cardiac Diagnostics Inc is a wholly owned subsidiary of Boston Scientific Corporation Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world For healthcare professionals

Boston Scientific Cardiology Order Form

Cardiology Order Form Patient name Pacemaker Model Boston Scientific Advancing science for Date of Birth Atrial Lead Model RV Lead Model his form mav contain patient confidentga information If you reccrv e this form in error please do not orward and contact Boston Scientific Techngca Services at 800 227 3422

PATIENT NAME D O B 1 MODEL s ICD CRT D ATRIAL LEAD RV LEAD LV LEAD Use the following checklists to ensure that patients who have a Boston Scientific Transvenous Defibrillation System labeled MR Conditional can receive an MR Conditional scan

Boston Scientific Holds Workshops To Promote Innovation In Interventional Cardiology Business