Follow Up Instructions


You have been seen in our office/clinic/emergency department for (possible) exposure to a biological or chemical agent. Please follow the instructions as marked below, and take this sheet along with you to your next appointment.

[ ] Immediately call your doctor or go to the nearest Emergency Department (ED) if you develop any unusual symptoms in the next 24 - 48 hours, especially:


•Dizziness, confusion, memory loss, loss of coordination
•Coughing, wheezing, shortness of breath, tightness in the chest
•Nausea, vomiting, diarrhea, abdominal pain
•Muscle weakness or twitching, high fever
•Eye pain or blurred vision


[ ] Call Dr. _______________ on the next business day for a follow-up appointment in ______days.

[ ] Return to our office/department on __________________(date) for a follow up evaluation at ____________________am/pm.

[ ] No follow-up appointment is necessary unless you experience any of the signs or symptoms listed above.

[ ] Do not participate in sports or vigorous activities for ________________days.

[ ] Do not return to work for ____________ days, returning on ____________(date).

[ ] You may return to work on limited duty, see "Additional Instructions" below.

[ ] You may resume your normal activities and schedule including work, school, driving, operating heavy machinery, and/or ___________________________.

[ ] Avoid exposure to tobacco smoke for 72 hours (smoke may worsen lung injury).

[ ] Avoid alcohol consumption for 24-48 hours (may worsen stomach injury).

[ ] Avoid taking these medications: _______________________________________

[ ] You may take these medications as prescribed by your doctor: _______________
__________________________________________________________________

[ ] Additional instructions: ______________________________________________
__________________________________________________________________

 

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