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Patient Education - Prohibited Item Reminder

Patient Education - Prohibited Item Reminder

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Patient Education - Prohibited Item Reminder

Thank you for choosing the Hyperbaric & Wound Care Center at XXXXX for your Hyperbaric Oxygen Therapy (HBOT).

Your first HBOT has been scheduled for ____________________ at _______________.

As a reminder, the following items are PROHIBITED in the Hyperbaric Chamber:

  • Reading material (newspaper, magazines, books, etc.)
  • Drinks, snacks, candy, gum or food of any kind (water will be available for you to take in the chamber)
  • Please do not wear any of the following:
    • Makeup, lipstick, lip balm, or base, deodorant (we will have you remove them)
    • Hairspray, Gel, Mousse, fresh Coloring, fresh Perms, wigs, hair extensions, hair rubber bands
    • Vaseline, Oils, Lotions of any kind, any Petroleum based products, any Alcohol based products.
    • Thermal Wrap or patches, Hand Warmers, or any Heat producing products.
    • Dentures or removable dental appliances
    • No nail polish or nail extensions
    • Velcro
    • Prosthetics
  • Electronic Devices such as: (may be placed in a locker at the clinic)
    • Watches, cell phones, pagers, PDA’s.
    • External pace makers, internal pace makers prior to 1980
    • Hearing aids
    • Insulin pumps
    • Handheld video games, computers, cameras
    • Lasers, pen lights
  • Matches or lighters
  • Medication patches – Please inform the staff prior to entering the hyperbaric chamber
  • Tobacco products of any kind (cigarettes, cigars, chew, snuff, pipes)
  • Jewelry of any kind (please leave them at home or with a spouse)
  • Anything deemed unsafe by this Center.

PLEASE GIVE US A COURTESY CALL AT XXXXXX IF YOU WILL BE LATE OR IF YOU ARE NOT GOING TO BE IN FOR YOUR APPOINTMENT.

Thank you again for choosing the Hyperbaric & Wound Care Center at XXXXX. If there is anything that you need, please do not be afraid to ask any of the staff members for help.

The Hyperbaric Team

Patient Signature: ______________________________________________________ Date: _____________________

CHRN/CHT Signature: __________________________________________________ Date: _____________________

Safety Director Signature: ________________________________________ Date: ________________________

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
Topic 1597 Version 1.0

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