Major Hospital                                              

                           Patient Discharge Information

       Deep Vein Thrombosis (DVT)/ Pulmonary Embolism (PE)

Patient/Family Member received written discharge information for Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) covering the following:

1. When to call the Doctor or 911(Chest pain, shortness of breath, coughing up blood)

 2. Adverse drug reactions

 3. Follow-up monitoring of the blood clotting (INR)

 4. Dietary Advice 

 5. Compliance with Coumadin (Warfarin) and regular blood draws for monitoring 

Information given via Krames On Demand written Health Sheets.

Signed: Patient Name________________________________Date__________________

                Other:_________________________ Relationship:_______________________

 Nurse: ___________________________________________Date:__________________

 ***Place this signed copy (of this sheet only)in the chart under CONSENTS***