Patient Information Sheets & Forms

Preparing for Your Procedure

At PSFDH, we want to ensure you have the information you need to ensure the best possible outcomes for your care. Below are Patient Information Sheets on a variety of services and procedures offered at the hospital.

If you have additional questions, please speak with your health care provider.

Pocket Health

Requisitions/Forms - Diagnostic Imaging

• Pocket Health - Download details on how you can access your imaging records
• Xray Requisition (June 2019)
•  Cardiac Testing Requisition
•  Pulmonary Requisition
• CT Scan Requisition
• Ultrasound Requisition

Requisitions/Forms - Medical Day Unit

• Consent to Receive Blood Component
  
• Infusion/Transfusion Privileges Short Form
• Intravenous Iron Replacement (Adult Order) Set 
• Laboratory Requisition
• Medical Day Unit Blood Product Order Set
• MOH Immune Globulin Screening Pilot Outcome Questionnaire - Neurology Patients
• MOH IVIG Request Form - Non-Neurology Patients
• Process for Accessing Medical Day Care Unit
  
• Medical Day Unit Referral Form
• Pamphlet - About Blood Transfusions
• Pamphlet - Going Home After A Blood Transfusion

Patient Information Sheets

• Patient Information Sheet – Ultrasound Preparation Instructions
• Patient Information – Abdomen and Pelvis Ultrasound
• Patient Information Sheet – Abdomen Ultrasound
• Patient Information Sheet – Barium Enema

• Patient – Information – Bone Mineral Density
• Patient Info Sheet – Echocardiogram
• Patient Information Sheet – CT Scan
• Patient Information Sheet – Carotid Doppler Ultrasound
• Patient Information Sheet – Mammogram
• Patient Information Sheet - Medical Day Unit Blood Product Order Set
• Patient Information Sheet -Obstetrical Ultrasound
• Patient Information Sheet – X-Rays, Pregnancy and you
• Patient Information – Pelvis Ultrasound

• Patient Information Sheet – Small Bowel – Follow Through
• Patient Information – Upper GI Series or Barium Swallow
• Patient Information Sheet – Radiology IV Contrast – Discharge Instruction