Appendix Five - Examples of Default Print Output from  INR RELAY PRINT

Appendix 5a) Example of  Report letter to patient: “Report.tem”
Appendix 5b):  Example of Instructions letter  to patient: “Instructs.tem”
Appendix 5c):  Example of Requests forms (batch of ten) sent to patient: “Requests.tem
Appendix 5d):  Example of “Termination letter”  sent to patient: “term.tem
Appendix 5e):  Example of “High INR >8" sent to patient: “rephigh.tem
Appendix 5f):  Example of “DNA1" sent to patient: “dna1.tem
Appendix 5g):  Example of “DNA2" sent to patient: “dna2.tem
Appendix 5h):  Example of “DNA3" sent to patient: “dna3.tem
Appendix 5a) Example of  Report letter to patient: “Report.tem”
    
INA SUTHERS
17 TYRELL ROAD
20/02/1932

4948445237

01268584279

 

INA SUTHERS
17 TYRELL ROAD
CREST AVENUE BASILDON

ESSEX SS13 2TE

       

 

 MISS TWO DAYS THEN TAKE WARFARIN AS SHOWN BELOW

 

 

 

 

 

DATE

INR

MON

TUES

WED

THURS

FRI

SAT

SUN

FFICE USE ONLY

 

 

16:07:2001

4.5

3 mg

3 mg

3 mg

3 mg

3 mg

3 mg

3 mg

 

 

23:07:2001

 7DATE OF NEXT BLOOD TEST - MONDAY

 

 

 

 

 

 

 

WARFARIN TABLETS    COLOURS AND DOSES

Brown 1mg;    Blue 3 mg;   Pink 5 mg 

 

 

 

 

 

 

OFFICE USE ONLY

Diag: AF     Trans: N  WARFARIN @ 3.00mg/day   Range: 2.0-3.0

 

 

DATE

13/07/2001

04/07/2001

INR

1.70

2.00

DAILY DOSE

3.00

1.97

MISS DAYS

0

0

 

 

 

 

 

 

 

 

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Appendix 5b:  Example of Instructions letter  to patient: “Instructs.tem”

HELEN BAILEY

IMPORTANT ANNOUNCEMENT

In future, we will be sending you your INR results and dosage advice by automatic telephone call.  This service has been used in other hospitals and found to be as good as - if not better than, faster and cheaper than the post. Please read the simple instructions below and keep them in a safe place (inside your anticoagulant record book) for future reference.


HELEN BAILEY     WE CALL YOU  

STEP 1: Answer your phone between 4pm and 9pm the day of your test.  You will hear an automatic announcement and when you are ready to take down your results, start the message by pressing any key on your tone telephone. 

STEP 2: You will hear your date of birth, and if correct, copy into your INR RECORD BOOKLET, your INR result, your dose and date of next blood test.

STEP 3: At the end of the message, you will be asked if you want to hear a repeat of the message (select by pressing the “1" key) and then you may be offered further options.

STEP 4: Hang up the call when requested to do so.  

Note:  We do not dial out to mobile numbers - If you are using a mobile as your main telephone number, then you will have to phone in to get your result - see below:


HELEN BAILEY     YOU CALL US 

STEP 1:DIAL: 01268 524016.

If the system recognises your telephone (if you have your caller identificaton switched on - ask BT or your cable company about this), it will announce your date of birth and your results as above.  If the system failed to recognise your telephone number, it will ask you to enter, starting with your UK national area code, your 11 digit telephone number.

STEP 2: You will hear your date of birth, and if correct, copy into your INR RECORD BOOKLET, your INR result, your dose and date of your next blood test.

STEP 3: At the end of the message, you will be asked if you want to hear a repeat of the message (select by pressing the “1" key) and then you may be offered further options.

STEP 4: Hang up the call when requested to do so.  

SOME NOTES ON USING THE PHONE SYSTEM

*If you do not answer our first call, the computer will continue to try to call you for three of four attempts until about 9pm.  It will try call you the following day if it failed to contact you the same day. 

*The computer may call you to notify you if you did not attend as expected or if your result was unexpectedly high.

*If you are dialling us for your result, you should allow sufficient time (about six hours) for the laboratory to test your blood,  before phoning us. 

*If you phone us too early you will be asked to phone again later, or the next working day.

*You may use dialback (enter “5") if you get an engaged signal. 

*Some older phones are “pulse” phones and will not work with this system. This system requires “tone” phones. Some telephones can be switched from pulse to tone.  If you have a rented pulse phone, ask if your telephone company will change it to a newer tone phone.

*If the system does not recognise your phone, it may be because your caller identification is switched off.  You can have this permanently switched on by contacting your telephone company - but if you prefer not to do this, then you can switch it on for any single call by dialling 1471 before the call.

* If you are hard of hearing, or have another valid reason for not being able to use the phone, please contact us on 01268 593047, or write to us asking us to send you your results by post.

*While every effort is made to keep your information such as your date of birth and your anticoagulant doses confidential, it may be possible for others to secretly obtain this data.  If you are very concerned about this, please let us know by phoning 01268 593047 and we can remove you from the system.

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Appendix 5c:  Example of Requests forms (batch of ten) sent to patient: “Requests.tem

          ***** 01268 593047

 

   

 

 

 

THERESA MARY FORD
67 BOCKINGHAM ROAD
13/12/1955

 4633094274

01268446774

 

THERESA MARY FORD

67 BOCKINGHAM ROAD

BASILDON ESSEX

 SS23 1PF

 

 

 

   KEEP THESE INR REQUEST FORMS IN A SAFE PLACE 

   BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST

lab use only

 

 

 

DATE OF BLOOD TEST: ..../..../200..  

 

 

(Use the above space to tell us about any changes in your health; changes in your medications, or forthcoming events such as: dates of operations, dental extractions or holidays; changes in your address or tel number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Appendix 5d:  Example of “Termination letter”  sent to patient: “term.tem

         ***** 01268 593047

 

 

 

 

 

 

MALCOLM EDWARD

25 ALLWRIGHT ROAD

25/09/1954

 

4768811777

07930816348

 

MALCOLM EDWARD

25 ALLWRIGHT ROAD

TILBURY ESSEX

 RM17 8XL

 

 

 

       *** TREATMENT COMPLETION ***

lab use only

 

 

Our records indicate that you are approaching the end of the course of anticoagulation originally prescribed for you. You are due to stop on 06:08:2001. Continue on your prescribed daily dose of WARFARIN until that time - then simply stop taking any further anticoagulant.

You will not need further INR blood tests. If you have any reason to believe that you should be continuing on anticoagulation, check with your GP or hospital specialist, then contact us on 01268 593047 to discuss.

Signed: Dr John Smith

 

 

 

 

 

 

 

 

 

 

 

 

 

Office use only:  Diag: DVT    Range: 2.0-3.0  

Age: 36    ALERT ? THROMBO SCREEN ??

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Appendix 5e:  Example of “High INR >8" sent to patient: “rephigh.tem

         ***** 01268 593047

 

 

 

MALCOLM EDWARD

25 ALLWRIGHT ROAD

25/09/1954

 

  4768811777

07930816348

 

  MALCOLM EDWARD

25 ALLWRIGHT ROAD

TILBURY ESSEX

 RM17 8XL

 

 

 

       ***  WARNING   ***

lab use only

 

 

YOUR ANTICOAGULANT BLOOD TEST IS QUITE HIGH AT THE MOMENT.  DO NOT TAKE ANY ANTICOAGULANTS UNTIL YOU HAVE HEARD FROM US.  YOUR BLOOD LEVELS OF WARFARIN MAY REMAIN HIGH FOR SEVERAL DAYS SO IF YOU DEVELOP ANY NEW OR WORRYING BLEEDING PROBLEMS SEEK HELP (OR GO TO THE HOSPITAL ACCIDENT AND EMERGENCY DEPARTMENT) STRAIGHT AWAY.

 

Signed: Dr John Smith

 

 

 

DATE OF NEXT TEST: 03 May 2001

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Appendix 5f:  Example of “DNA1" sent to patient: “dna1.tem

           ***** 01268 593047

 

ERIC HARRIS

50 ROKETS

15/11/1966

 

4444771538

07950582892

 ERIC HARRIS

50 ROCKETS

BASILDON ESSEX

 SS14 2BD

 

  BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST

lab use only

 

 

Dear ERIC HARRIS (dob: 15/11/1966)    

Unfortunately, you missed your appointment to have your blood tested for anticoagulant therapy. It is important that you attend for a blood test as soon as possible.  If you have already attended in the last few days, please ignore this letter.   If you are unable to attend, please inform us on 01268 593047.  

Signed: Dr John Smith

 

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Appendix 5g:  Example of “DNA2" sent to patient: “dna2.tem

         ***** 01268 593047

 

 

 

 ERIC HARRIS

50 ROKETS

15/11/1966

 4444771538

07950582892

 ERIC HARRIS
50 ROCKETS
BASILDON
ESSEX
 
SS14 2BD

 

 

 

 

 

 

 

 

 

 

  BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST

lab use only

 

 

Dear ERIC HARRIS (dob: 15/11/1966)  

Unfortunately, you missed your appointment to have your blood tested for anticoagulant therapy. Our records indicate this is the second week that you missed your blood test. It is important that you attend for a blood test as soon as possible.  If you have already attended in the last few days, please ignore this letter. If you are unable to attend, please inform us on 01268 593047.

Signed: Dr John Smith

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Appendix 5h:  Example of “DNA3" sent to patient: “dna3.tem

         ***** 01268 593047

 

 

 

 ERIC HARRIS

50 ROKETS

15/11/1966

4444771538

07950582892

ERIC HARRIS
50 ROCKETS
BASILDON
ESSEX
 
SS14 2BD

 

 

 

 

 

 

 

 

 

 

  BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST

lab use only

 

 

Dear ERIC HARRIS (dob: 15/11/1966)  

Our records indicate this is the third week that you have missed your blood test. It is not safe to continue on anticoagulants without regular blood tests and we may have to stop your treatment for this reason.  Please contact us immediately on  01268 593047 discuss this further.  Ignore this letter if you have attended in the last few days.  

Signed: Dr John Smith

 

 

 

 

 

 

 

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