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Request form-cast.xls

ALLERGY CAST REQUEST FORM
ALLERGOLOGY, DIAGNOSTIC & CLINICAL RESEARCH UNIT (ADCRU)
Tel: (021) 406-6889
UCT LUNG INSTITUTE
Fax: (021) 406-6888
Age/D.O.B: .….…/….…./….…….
Account To
Relevant Clinical Data:
Work Tel.No.:Home Tel.No.: Employer's Name: Time lapse since last adverse reaction:
Other: (specify) ……………………………………………………………………………………………………………………….………………….
PLEASE TICK AND INDICATE ALLERGENS REQUESTED :
ANTIBIOTICS:
ANALGESICS & ANTI-INFLAMMATORIES: FOOD ADDITIVES & COLOURANTS: ANAESTHETICS:
C5 1 Lys-aspirin
C1 0 3 Tartrazine
C AT R Atracurium
C5 2 Diclofenac
C1 1 1 Na benzoate
C MI V Mivacurium
C1 1 Benzylpenicil oyl
C5 3 Ibuprofen
C1 1 2 Na nitrite
C P AN Pancuronium
C2 0 3 Ampicil in
C5 4 Indomethacin
C1 1 3 Na-Metabisulphite C S UX Suxamethonium
C2 0 4 Amoxycil in
1C5 785 Acetaminophen
C1 1 4 Na salicylate
C R O C Rocuronium
C3 Cephalosporin C
1C5 8796 Mefenamic acid
C E1 0 4 Quinoline Yel ow
C VE C Vecuronium
C3 1 Cefamandole
12C5 9807 Phenylbutazone
C E1 1 0 Sunset Yel ow FCF CL I D Lidocaine
C3 2 Cefazolin
21C5 0918 Propylphenazone
C E1 2 2 Chromotrope B
CT H I Propofol
C6 1 Sulphamethoxazole 2C5 109 Dipyrone / Metamizole C E1 2 3 Amaranth
C6 2 Trimethoprin
C E1 2 4 New Coccine
C7 5 Tetracycline
C E1 2 7 Erythrosine
OCCUPATIONALS:
C8 1 Ciprofloxacin
C E1 3 1 Patent Blue V
2K8 102 Latex
4C3 63 Cefuroxime
C E1 3 2 Indigo carmine
C1 2 Minor 1 Determinant Mix
C E1 5 1 Bril iant Black
C1 0 1 Food Colourant Mix I (CE104, CE110, CE122, CE123, CE124)
C1 0 2 Food Colourant Mix II (CE127, CE131, CE132, CE151)
C E6 2 1 Glutamate
Patient to be taken off al al ergy medication 24 hours prior to blood col ection.
Please take 2 EDTA tubes (purple top).
Please take blood after 3pm and send to UCT Lung Institute via Pathcare N1 City to arrive the next morning.
Please send on ice and wrap specimens in paper towel or bubble wrap to prevent damage to blood cel s.

Source: http://lunginstitute.co.za/downloads/cast_request.pdf

Microsoft word - nb_harvardcv_mcleanweb_14aug093pm.doc

General Information: Office Address: Email: nbuttner@gmail.com FAX: 617-876-5148 Education: 1984 B.A. Williams College 1992 Ph.D. Department of Physiology & Cellular Biophysics Columbia University – Presbyterian Medical Center, 1993 M.D. Columbia University – Presbyterian Medical Center Postdoctoral Training: PGY 1 medical intern Department of Internal Medicine

Microsoft word - norway meeting proceedings final

Proceedings of a Joint Meeting held between The Norwegian Society of Infectious Diseases and the Royal Society of Tropical Medicine and Hygiene, Oslo, 20th June 2008 1Department of Medicine, Brighton and Sussex Medical School, Falmer, Sussex, BN1 9PS, UK (m.j.newport@bsms.ac.uk) 2Centre for Imported and Tropical Diseases Ullevål University Hospital,0407 * Address for correspondence

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