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Cardiac Clearance Form 2013-2023
The following Patient is at prohibitive risk from a cardiac standpoint for the above procedure. Patient May May Not stop Plavix/ASA days before procedure. Patient may restart Coumadin/Plavix/ASA days post procedure. Telephone Number Date PLEASE FAX COMPLETED FORM ASAP TO COMMUNITY SURGERY CENTER NORTHWEST 317 621-3016. Patient May May Not stop Plavix/ASA days before procedure. Patient may restart Coumadin/Plavix/ASA days post procedure. Telephone Number Date PLEASE FAX COMPLETED FORM ASAP...
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