DHS-0470, Assessment for Determination of Care for ...
or diagnosed with the symptoms of TIA (TRANSIENT ISCHEMIC ATTACK). The following information is also documented in the medical record: [include all that apply] Atrial fibrillation / Abnormal Heart Valve(s) / Recent MI. Carotid Doppler / Echocardiogram / or MRA showing: Treatment with: (ASA, Aggrenox, Persantin, Plavix, Coumadin) ................
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