Offices: Mission Viejo, Ladera Ranch and Laguna Woods PATIENT INSTRUCTIONS for GLUCOPHAGE ® (METFORMIN) and IODINATED CONTRAST MATERIAL
Name: _______________________________________ DOB: __________________ You are having a procedure today that may include the injection of iodinated contrast material (x-ray dye). Additionally, you have indicated that you are currently taking the medication Glucophage® (Metformin). The following is important information for you to know: Metformin (Glucophage) is an oral antihyperglycemic agent used to treat patients with noninsulin-dependent diabetes. There is an uncommon but serious adverse effect of lactic acidosis, possibly leading to death, in patients who do not discontinue their Metformin medication following injection of contrast material. Metformin (Glucophage) must be discontinued after the contrast injection, and withheld for 48 hours after the injection. It should only be reinstated after you have had a blood test and the results have been reviewed and approved by your personal physician. Trade Names: Gluocophage, Fortamet, Glumetza, Riomet, Glucovance, Metaglip, ActoPlus Met, Acto Plus MET, Prandimet, Avandamet, Janumet If you have any questions regarding this medication interruption or the management of your diabetes during this time period, please contact your personal physician. I have read and understand these instructions. Signature of patient: ___________________________________ Date: __________________ Witness: ____________________________________________ Date: ___________________ REFFERRING PHYSICAN: _______________________________________ FAX NUMBER: _______________________________ FAXED BY: ____________________ DATE: ______________ TIME: ______________ 24301 Paseo De Valencia Suite 100 27725 Santa Margarita Parkway, #101 Offices: Mission Viejo, Ladera Ranch and Laguna Woods “DO NOT COMPLETE THIS FORM UNLESS YOU ARE TAKING ORAL GLUCOPHAGE® (METFORMIN)” Name: _______________________________________ DOB: __________________ You are having a procedure today that may include the injection of iodinated contrast material (x-ray dye). Additionally, you have indicated that you are currently taking the medication Glucophage® (Metformin). I have read and understand these instructions. Signature of patient: ___________________________________ Date: __________________ Witness: ____________________________________________ Date: ___________________ REFFERRING PHYSICAN: _______________________________________ FAX NUMBER: _______________________________ FAXED BY: ____________________ DATE: ______________ TIME: ______________ 24301 Paseo De Valencia Suite 100 27725 Santa Margarita Parkway, #101
Billingshurst Primary School Headteacher : Helen Williamson BSc (Hons) MA Station Road, Billingshurst, West Sussex RH14 9RE Newsletter No. 28 Friday 27th April 2012 Dear Parents and Carers House Points Goodwood won the Noreen Carey House Cup the week before the holidays! Well done. Parent Governor Election Results Thank you to all our parents who stood for ele
Visit our temple website at Purim Jacquie Dyrke and her daughter, Lisa, will be hosting our upcoming Purim dinner (on Friday, March 6). They will be serving a vegetarian pasta dish and would like the rest of us to bring salads. Jacquie already has the desserts assigned. Thanks Jacquie and Lisa! Congregational Meeting & Schedule Changes Refer to the schedule later in this newslett
Offices: Mission Viejo, Ladera Ranch and Laguna Woods
PATIENT INSTRUCTIONS for 
Offices: Mission Viejo, Ladera Ranch and Laguna Woods
“DO NOT COMPLETE THIS FORM UNLESS YOU ARE TAKING ORAL