To be translated into
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Ref No.: 31647
During your recent procedure, you were given the medication Steritalc. This drug can be harmful to a developing fetus.
IT IS
RECOMMENDED THAT YOU USE EFFECTIVE CONTRACEPTION FOR 5 MONTHS AFTER DISCHARGE.
______________________________________________
Ref No.: 31650
On the day of surgery you were given the medication aprepitant. This medication interacts with hormonal forms of birth
control (oral contraceptives and injected or implanted birth control) and may make them ineffective. IF YOU USE ANY
HORMONAL FORM OF BIRTH CONTROL, YOU MUST USE AN ADDITIONAL BARRIER BIRTH CONTROL METHOD FOR ONE
MONTH after receiving aprepitant or there is a chance you could become pregnant.
______________________________________________
Ref No.: 16095701
RABIES VACCINE FOLLOW UP
Patient's Name: @NAME@
Original Order Date:@LPPLINK(1601601601)@
Medical Record Number: @MRN@ ED Physician: @ATTPROV@
Primary Diagnosis: Rabies Exposure
PCP: @PCP@
Patient Phone Number: (home) @HMPH@ (cell) @MOB@
(work) @WKPH@
Species of Animal: @FLOW(1600428410::1)@
You have been seen in the Emergency Department for a possible rabies exposure. It's very important
you return for the additional vaccine doses. Please call the clinic listed below for hours of operation.
Clinic that will administer your rabies vaccines:
@FLOW(1600428466::1)@
DAY 0: @LPPLINK(1601601601)@
DAY 3: @LPPLINK(1601601602)@
DAY 7: @LPPLINK(1601601603)@
DAY 14: @LPPLINK(1601601604)@
The 5th vaccine injection is considered for immune compromised patients only.
DAY 28: @LPPLINK(1601601605)@
______________________________________________
Ref No.: 24887
CONE HEALTH PEDIATRIC ASTHMA ACTION PLAN
CONE HEALTH PEDIATRIC TEACHING SERVICE
(PEDIATRICS)
336-832-6100
@NAME@ @DOB@
@FOLLOWUP2@
Provider/clinic/office name:***
Telephone number :***
Followup Appointment date & time: ***
Remember! Always use a spacer with your metered dose inhaler!
GREEN = GO!
Use these medications every day!
- Breathing is good
{CHL IP Asthma Action Plan Controller Meds:20468}
- No cough or wheeze day or night Use 15 minutes before exercise or trigger exposure
- Can work, sleep, exercise
{CHL IP Asthma Action Plan Reliever Meds:20469}
Rinse your mouth after inhalers as
directed
YELLOW = asthma out of control
- Cough or wheeze
- Tight chest
- Short of breath
- Difficulty breathing
- First sign of a cold (be aware of
your symptoms)
Call for advice as you need to.
RED = DANGER
- Albuterol not helping or not lasting
4 hours
- Frequent, severe cough
- Getting worse instead of better
- Ribs or neck muscles show when
breathing in
- Hard to walk and talk
- Lips or fingernails turn blue
Continue to use Green Zone medicines & add:
Quick Relief Medicine:{CHL IP Asthma Action Plan
Reliever Meds:20469}
If you improve within 20 minutes, continue to use
every 4 hours as needed until completely well. Call
if you are not better in 2 days or you want more
advice.
If no improvement in 15-20 minutes, repeat quick
relief medicine {CHL IP Asthma Yellow
Zone:20470}. If improved continue to use every 4
hours and CALL for advice.
If not improved or you are getting worse, follow Red
Zone plan.
Special Instructions:
Get help from a doctor now!
TAKE: {CHL IP Asthma Emergency Meds:20474}
{CHL IP Red Zone Action:20477}
STOP! MEDICAL ALERT!
If still in Red (Danger) zone after 15 minutes this
could be a life-threatening emergency. Take
second dose of quick relief medicine
AND
Go to the Emergency Room or call 911
If you have trouble walking or talking, are
gasping for air, or have blue lips or fingernails,
CALL 911!I
“Continue albuterol treatments every 4 hours for the next {CHL IP PEDS HOURS:20790}
Environmental Control and Control of other Triggers
Allergens
Animal Dander
Some people are allergic to the flakes of skin or dried saliva from animals
with fur or feathers.
The best thing to do:
• Keep furred or feathered pets out of your home.
If you can’t keep the pet outdoors, then:
• Keep the pet out of your bedroom and other sleeping areas at all times,
and keep the door closed.
SCHEDULE FOLLOW-UP APPOINTMENT WITHIN 3-5 DAYS OR FOLLOWUP ON DATE PROVIDED IN
YOUR DISCHARGE INSTRUCTIONS *Do not delete this statement*
• Remove carpets and furniture covered with cloth from your home.
If that is not possible, keep the pet away from fabric-covered furniture
and carpets.
Dust Mites
Many people with asthma are allergic to dust mites. Dust mites are tiny bugs
that are found in every home—in mattresses, pillows, carpets, upholstered
furniture, bedcovers, clothes, stuffed toys, and fabric or other fabric-covered
items.
Things that can help:
• Encase your mattress in a special dust-proof cover.
• Encase your pillow in a special dust-proof cover or wash the pillow each
week in hot water. Water must be hotter than 130º F to kill the mites.
Cold or warm water used with detergent and bleach can also be effective.
• Wash the sheets and blankets on your bed each week in hot water.
• Reduce indoor humidity to below 60 percent (ideally between 30—50
percent). Dehumidifiers or central air conditioners can do this.
• Try not to sleep or lie on cloth-covered cushions.
• Remove carpets from your bedroom and those laid on concrete, if you can.
• Keep stuffed toys out of the bed or wash the toys weekly in hot water or
cooler water with detergent and bleach.
Cockroaches
Many people with asthma are allergic to the dried droppings and remains
of cockroaches.
The best thing to do:
• Keep food and garbage in closed containers. Never leave food out.
• Use poison baits, powders, gels, or paste (for example, boric acid).
You can also use traps.
• If a spray is used to kill roaches, stay out of the room until the odor
goes away.
Indoor Mold
• Fix leaky faucets, pipes, or other sources of water that have mold
around them.
• Clean moldy surfaces with a cleaner that has bleach in it.
Pollen and Outdoor Mold
What to do during your allergy season (when pollen or mold spore counts are high)
• Try to keep your windows closed.
• Stay indoors with windows closed from late morning to afternoon,
if you can. Pollen and some mold spore counts are highest at that time.
• Ask your doctor whether you need to take or increase anti-inflammatory
medicine before your allergy season starts.
Irritants
Tobacco Smoke
• If you smoke, ask your doctor for ways to help you quit. Ask family
members to quit smoking, too.
• Do not allow smoking in your home or car.
Smoke, Strong Odors, and Sprays
• If possible, do not use a wood-burning stove, kerosene heater, or fireplace.
• Try to stay away from strong odors and sprays, such as perfume, talcum
powder, hair spray, and paints.
Other things that bring on asthma symptoms in some people include:
Vacuum Cleaning
• Try to get someone else to vacuum for you once or twice a week,
if you can. Stay out of rooms while they are being vacuumed and for
a short while afterward.
• If you vacuum, use a dust mask (from a hardware store), a double-layered
or microfilter vacuum cleaner bag, or a vacuum cleaner with a HEPA filter.
Other Things That Can Make Asthma Worse
• Sulfites in foods and beverages: Do not drink beer or wine or eat dried
fruit, processed potatoes, or shrimp if they cause asthma symptoms.
• Cold air: Cover your nose and mouth with a scarf on cold or windy days.
• Other medicines: Tell your doctor about all the medicines you take.
Include cold medicines, aspirin, vitamins and other supplements, and
nonselective beta-blockers (including those in eye drops).
I have reviewed the asthma action plan with the patient and caregiver(s) and provided them with a copy.
@ME@
Guilford County
Department of Public Health
School Health Follow-Up Information for Asthma – Hospital Admission
@NAME@
Date of Birth: @DOB@
Age: @AGE@
Parent/Guardian: ***
School: ***
Date of Hospital Admission: @ADMITDT@
Discharge Date: ***
Reason for Pediatric Admission: ***
Recommendations for school (include Asthma Action Plan): ***
Primary Care Physician: @PCP@
Parent/Guardian authorizes the release of this form to the Guilford County Department of Public Health School
Health Unit.
Parent/Guardian Signature
Date
Physician: Please print this form, have the parent sign above, and then fax the form and asthma action plan to
the attention of School Health Program at 336-641-6050
Faxed by @ME@ @TD@ @NOW@
Pediatric Ward Contact Number 336-832-6100