DCI Template

Read the following information and attached handout about your diagnosis, treatment and/or prevention of symptoms, and indications for return.
** Take any medications prescribed as directed.
[comment memo="Special Instructions"][text name="variable_1" default=""]
** Follow up with your doctor [checkbox value="tomorrow|as needed|in 1-2 days for a recheck|in 2-3 days for a recheck|in 3-5 days for a recheck|within a week for a recheck|You will need a referral to see a specialist:"][text]
[checkbox value="** If you do not have a primary physician follow-up at the county hospital or one of the clinics listed. (Phone and/or address for referrals can be found above)"]
** Bring your exam results to your follow up appointments. Keep a copy  for your records as well.
** ALWAYS have a list of your current medications with you.
** Return to the ER for: [checkbox value="worsened or uncontrolled pain, particularly if the pain localizes to the right lower part of your abdomen, for fever, vomiting|worsened or uncontrolled pain, fever, excessive vomiting, bloody diarrhea|signs of dehydration - decreased tears, decreased urination, lethargy|fever lasting longer than 5 days|vaginal bleeding (more than 1 pad an hour for 2-3 consecutive hours),lightheadedness, fainting|Worsened chest pain, shortness of breath, dizziness, fainting, swelling|bleeding that does not stop with simple pressure within 10 minutes|worsened headache, vomiting, mental status changes|recurrent symptoms, facial droop, slurred speech, focal weakness|worsened symptoms, failure to improve, or for any other concerns.|or for any other concerns."]