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CONSULTANTS IN PAIN MEDICINE, INC.
Please call us at 395-6450 at least 24 hours in advance if you cannot make your appointment or this will result in a missed appointment charge. If the directions are unclear in any way, please do not hesitate to call us or visit our website at www.beachpain.com. Thank you. Consultants in Pain Medicine, Inc.
**MEDICATION GUIDELINES PRIOR TO PROCEDURES

Please continue to take all your regular medications on the day of your appointment EXCEPT:
Insulin- For morning appointments, DO NOT take insulin.
For afternoon appointments take HALF your insulin.

Oral diabetic agents (i.e.: Glucotrol, Amaryl, Diabeta, Micronase, Prandin, Diabinese, Glynase, Actos,
Avandia, Rezulin) – do not take.
Anticoagulants

Arixtra- stop 3 days prior to your procedure.
Coumadin - stop 5 days prior to your procedure.
Effient- stop 7 days prior to your procedure.
Heparin - contact the office for specific directions.
Plavix – stop for 7 days prior to your procedure.
Pradaxa- stop 3 days prior to your procedure.
Ticlid (Ticlopidine)- stop for 14 days prior to your procedure.
Xarelto (Rivaroxaban)- stop 24 hours prior to your procedure.
***Please note***
___
Nothing to eat or drink ____ hours prior to your procedure. A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.
Please contact our office or visit our website at www.beachpain.com if you have questions. DIRECTIONS TO 1080 MEDICAL OFFICE BUILDING
From Interstates 64 and 664: Take 264E to exit 21B (2nd of two First Colonial Rd exits). Once on First Colonial Rd, go about 1.5 miles to 1080 First Colonial Rd, located just past Virginia Beach General Hospital. Turn Right on Old Donation Parkway to access the parking lot. Use the second building entrance that is closest to the hospital. We are located on the 2nd floor in Suite 201. From Chesapeake Bay Bridge Tunnel: After exiting bridge stay in right lane and follow sign towards Beaches/ Shore Dr. Turn left at light onto Shore Dr. Cross the Lesner Bridge. At the 4th traffic light turn right on N. Great Neck Rd. Travel approx. 5 miles and then turn left on First Colonial Rd (Exxon Station on corner). At 2nd traffic light make a left onto Old Donation Parkway. Make the first right into the parking lot for the 1080 Medical Office Building. Use the second building entrance that is closest to the hospital. We are located on the 2nd floor in Suite 201. A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.
CONSULTANTS IN PAIN MEDICINE, INC.

Welcome to Consultants in Pain Medicine.
Our physician, nurses and office staff hope to provide the best care possible with regard
to your particular pain condition.
Please fill out the enclosed questionnaire and answer all questions as completely as
possible. Bring the completed forms to your appointment. (Please do not mail forms
back to our office.) Your information is very important for proper treatment.
Thank you.
Consultants in Pain Medicine

A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.
Consultants in Pain Medicine, Inc.
Please remember your fasting instructions, medication instructions, and to bring a driver. If you have
not received this information, please call the office at 395-6450 or visit www.beachpain.com.

M.D. Signature______________________________
Name: ______________________________ Age______ Height ______ Weight___________ Vitals: BP__________ HR_________ RR___________ T_________ SaO2____________ (will be completed at consultation) Please mark exactly where your pain is located: When did you first notice your pain:______________________________________________________________________ Did you injure yourself, if so, what was the nature of your injury: _________________________________________ _________________________________________________________________________________________________________ Please describe what your pain feels like: _________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Please mark any of the following that help describe your pain:

PLEASE RATE YOUR PAIN BELOW
What makes your pain WORSE: __________________________________________________________ What makes your pain BETTER (mark ALL that apply): A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.

Please remember your fasting instructions, medication instructions, and to bring a driver. If you have
not received this information, please call the office at 395-6450 or visit www.beachpain.com.

Do you have numbness in your arms or legs:
Do you get tingling in your arms or legs: Do you have weakness in your arms or legs: Since your pain began, have you lost TOTAL control of your bowel or bladder? _____________ What medications have you taken BEFORE and stopped:________________________________ ______________________________________________________________________________ Please indicate if you have had the following treatments for your pain: Which has helped your pain:_______________________________________________________ Please indicate if you have had the following tests for your pain:
Which other doctors do you see:____________________________________________________
Please mark all illnesses and disorders for which you are being treated or followed by a doctor:
OTHER:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
___________________________________________________
Please indicate all SURGERIES you have had:
OTHER:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________ A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.
Please remember your fasting instructions, medication instructions, and to bring a driver. If you have
not received this information, please call the office at 395-6450 or visit www.beachpain.com.
Please list all your MEDICATIONS and doses:
DRUG

Please list all drug ALLERGIES:___________________________________________________
Are you taking any BLOOD THINNING MEDICATIONS:
A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.
.CONSULTANTS IN PAIN MEDICINE, INC.
PATIENT:
________________________
______________________
I hereby give Consultants in Pain Medicine my permission to request and receive any and all medical information from any previous or referring doctors. A SUBSIDIARY OF ATLANTIC ANESTHESIA, INC.

Source: http://www.beachpain.com/yahoo_site_admin/assets/docs/NP_PACKET.68145429.pdf

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