4Cyte Pathology - Warfarin Dosing Hospital Discharge Form

Warfarin Dosing Hospital Discharge Form

Please complete details below prior to patient discharge to ensure safe management.

(For patients who are already enrolled on the Warfarin Dosing programme only)

Patient Details

Patient Name

Patient Surname

Patient DOB

Patient State

Hospital

Hospital Ward

Admission Date

Discharge Date

Admitting Consultant

Patients reason for admission to hospital

Did the Patient Cease Warfarin?

Yes

Did the Patient Have Vitamin K in Hospital?

Yes

What Date did the Patient Recommence Warfarin

Was the patient given Clexane in hospital?

Yes

Does the Patient Have Any New Medication / Antibiotics?

Target Range?

INR Test Dates and Warfarin Doses

INR

Dose

Discharge Dose Given?

Yes

Please ensure the patient tests within the next three (3) days.

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