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FROM : ST. JOE GAS & BAIT FAX NO. : 12185687272 Jun. 04 2006 08:06PM P9 <br /> WATT,130NNIE J <br /> M E E)f CA L CENTER EMERGENCY DEPARTMENI MM-. 21.,63_72 OR: <br /> - knedictim; I-(eatth sysUenl . DISCHARGE INSTRUCTIONS roe: ao AM IIMWM <br /> 218-828-755 ooa osr3v,sas seY SmmmmEIIII�t.7051681 <br /> It <br /> BgA1NERD,MN 56401 <br /> ���-E--•d-C..-L9-��..,�1 � j II111111NN��t� ` <br /> Discharge Diagnosis: <br /> [] Care of Stitches/Wound Care <br /> Medications Prescribed., <br /> Take your medication as directed and take all medication prescribed unless your follow-up njury <br /> physician instructs you to do otherwise. Notify your health care provider immediately if you ❑ Fever in Children <br /> experience an allergic reaction or other unexpected effects from medication prescribed. ❑ Cast Care <br /> El Earl Pre nanc Loss <br /> F1 You have been prescribed a medication which may cause drowsiness or decreased ❑ <br /> coordination. You should not drive or use alcohol when you take this medication. ❑ <br /> Special Instructions/Return Concerns: <br /> . ........................0...................... <br /> a'1 f C�. b `7 1 t �` Family Violence-. <br /> . w:j.trT-:• l.d.. <br /> Vll6 tit•St'Joseph's Medical Center are concerned• <br /> / r �lgti�;tlie violence.that is•affecting the.tiealth•oP�:•:t <br /> / �' many'of`our'pallents:af: .':: <br /> C'�" •• ���'�'� *.You have been hit kicked,pushed or otherw6e; <br /> 'hurt or mistreated by someone.•.:. .. . <br /> r� VL ��� /��l �`, , ,,-Soottiervi►Ise tryieng y ening;you;br:rnepn8 o yll . t <br /> 41 <br /> to control you�:lifel,, , <br /> •Call the CRISIS..IME at 218-f12f-1M or. <br /> 86046 525 r <br /> A <br /> Follow-up Instructions: ~ <br /> Make sure that you obtain follow-up care as directed. Take this information with you when you go for follow-up care. If your symptoms <br /> increase or persist,return to the Emergency Department or call your regular physician. <br /> (] Your follow-up appointment's <br /> 'You need to call a aw r1 to schedule a follow-up appointment within -r`' <br /> Central Scheduling will can you <br /> X-Rays: <br /> Your ED physician reviews Xrays. A Radiologist will verify all x-ray tests within 24 hrs. If significant discrepancy or abnormality arises, <br /> you will be notified. It you will need copies of your x-rays for a follow-up appointment,please call 218-828-7660 to arrange for pick up. <br /> Lab work: <br /> Some lab results may not be available for several days. We will attempt to contact you with abnormal results. You may also call <br /> 218-828-7555 for results. <br /> You may return to work/school: <br /> ❑ Without restrictions ❑With the following restrictions <br /> ❑ Do not return to work/school until return approved at follow-up visit as noted above. <br /> Follow-up Contact# <br /> I understand the treatment and evaluation I received today was rendered on an emergency basis. i have read and understand the abov <br /> instructions,received a copy of this form and applicable instruction sheets,and will arrange for follow-up care. <br /> Instructions received by:X I '1 _ Relationship to patient❑ Parent Cl Spouse ❑Caregiver <br /> • '�� � w <br /> Instructions provided 7b : ❑Other <br /> Physician Signature', Vr <br /> • PA7IFNT t;nl' <br />