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PT - INR Flowsheet

This document contains a patient's anticoagulation therapy record. It includes the patient's name, date of birth, contact information, the indication for anticoagulation such as atrial fibrillation or deep vein thrombosis, the start date and planned duration of therapy. The record tracks the date, current dose, PT/INR results, any complications, new dose if adjusted, next check date, and physician signature for each visit over the course of anticoagulation therapy.

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brendacoon
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© Attribution Non-Commercial (BY-NC)
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2K views2 pages

PT - INR Flowsheet

This document contains a patient's anticoagulation therapy record. It includes the patient's name, date of birth, contact information, the indication for anticoagulation such as atrial fibrillation or deep vein thrombosis, the start date and planned duration of therapy. The record tracks the date, current dose, PT/INR results, any complications, new dose if adjusted, next check date, and physician signature for each visit over the course of anticoagulation therapy.

Uploaded by

brendacoon
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Patient’s Name: _____________________________________ DOB: _____________________


Contact Person: ________________________________ Contact #:
______________________
Indication for anticoagulation therapy:
Atrial fibrillation Deep Vein Thrombosis Mechanical valve
Cerebrovascular accident Pulmonary embolism Other: _________________________
Start date: _____/_____/_____ Therapy Duration: 3 months 6 months 1 year Indefinite Other: _______________

Next INR
Date Current Dose PT/INR Complications Initials New Dose Due MD Signature

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

None Noted/Reported
Lab Performed In-office

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