HeartForms- Heart Catherization Form

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Last Name: First Name:
Your clinic/ hospital: Common Cardiac Studies:

Cardiac Catherization with possible intervention (Angioplasty/ Stent)

Right Heart Catherization

Percutaneous Coronary Intervention (PCI)

Physician performing procedure:
Dr. Jaime Lewellyn, DO

Dr. Richard Zelman, MD

Procedure to be performed:
Where is the procedure being done:

Cleveland Clinic Martin North Hospital

Cleveland Clinic Tradition Hospital

On the date of:
Arrive at the location at:
Your facility's phone number:

Medications to ask about:











Click the button to
CONTENT THAT WILL PRINT WILL BE BELOW THIS MESSAGE

Day of Procedure


- Do NOT eat or drink anything after midnight before procedure
- DO take any of your regular medications the morning of procedure unless advised otherwise.
- Your family will be shown to the waiting room and will receive periodic updates.
- The physician will talk with you or your family after the procedure.


Call the office if...

-any questions regarding procedure -you develop an infection that requires antibiotics of any kind
-there is any change in your condition -you develop a fever, cold, or flu symptoms
-are prescribed new medications

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