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Warfarin Nursing Home Enrolment | 4Cyte Pathology

THS FORM ONLY TO BE USED FOR ENROLLING NURSING HOME PATIENTS.

Simply follow these steps:

Step 1: Fill out the Registration Form below

Step 2: Send through a Request Form marked ‘INR – 4Cyte Lab To Control’ - Rule 3 exemption; and request one-off FBC & E/LFT’s if no test with 4Cyte Pathology in the previous 2 months.

Step 3: Once patients have had their INR blood collected, we will send you the results via your nominated method (fax, download, web portal) within 24-36 hours.

We recommend that the patient continue taking their usual dose of warfarin until you receive their newest results.

NB - Warfarin Care is only offered to patients residing in QLD, VIC and Northern Rivers.

Nursing Home Details

Patient Details

Carer Details

Referring Doctor (Specialist must include patient’s GP)

General Practitioner (GP) Copy from above

History

Hospital Admission if applicable

Warfarin History

including herbal medications, vitamins and dietary supplements. Note start/stop date if recent:
Terms & Conditions

Important notice to referring Doctors/Nurse Practitioners

• This Warfarin Care service provided by 4Cyte Pathology Pty Ltd (4Cyte) is an automated service that communicates INR test results and Warfarin dosing instructions via text message. As a consequence, all patients enrolled into this Warfarin Care service, or their carers, must have access to and the ability to use a mobile telephone.

• This Warfarin Care service is a free service offered by 4Cyte to the patients of 4Cyte’s referring practitioners. In order to provide this service free of charge, 4Cyte requires ongoing cooperation and compliance with 4Cyte’s Warfarin Care testing and dosing process by both enrolled patients and you as referring practitioner.

• You must provide 4Cyte with prompt notice of any change to the management of enrolled patients which you become aware of, including:

(a) changes to medications;

(b) the enrolled patient undergoing medical or dental procedures;

(c) the enrolled patient being admitted or discharged from a hospital; and

(d) the non-compliance by the enrolled patient with testing and dosing instructions.

• The ongoing participation of the enrolled patient in the Warfarin Care service and the Warfarin dosing of the enrolled patient is at all times at 4Cyte’s discretion. 4Cyte reserves the right to, at any time:

(a) refer the enrolled patient back to you for dosing; and/or

(b) discharge the enrolled patient from the Warfarin Care service and transition them back to you as their referring practitioner,

if 4Cyte is not able to safely prescribe a Warfarin dose to the enrolled patient on the basis of the patient’s presentation, information available to 4Cyte or if an enrolled patient persistently, without reasonable excuse, fails to respond to 4Cyte’s text messages or to comply with 4Cyte’s Warfarin dosing instructions or INR testing requirements.

• You, as referring practitioner, remain primarily responsible for the care of the enrolled patient at all times.

• By proceeding with the enrolment of this patient, you acknowledge and agree to these conditions.

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