Le tadalafil possède une affinité marquée pour la PDE5, mais épargne en grande partie les isoformes PDE1, PDE2 et PDE11, réduisant ainsi le risque d’effets extra-caverneux. L’action se traduit par une augmentation contrôlée de la circulation sanguine locale, indépendante des variations alimentaires. Sa pharmacocinétique repose sur une absorption digestive rapide, un métabolisme hépatique par CYP3A4 et une distribution tissulaire large. La biodisponibilité reste stable, et l’équilibre plasmatique est atteint en quelques jours lors d’administrations répétées. Les interactions cliniquement significatives surviennent avec les inhibiteurs puissants de CYP3A4 tels que le kétoconazole. Dans la littérature pharmacologique, acheter cialis 20 mg est souvent associé à des schémas d’utilisation basés sur la durée prolongée de son action.
Microsoft word - 491c8287-6d5d-0823b4.doc
Patient Data Sheet Patient Information
MR. MS. MRS. MISS (circle one) First Name _______________________ Last Name __________________________ M_____
Address__________________________________________________
City ______________________________ State ______ Zip_________
Sex M F Age ______ DOB____________ SS#_____________________
Hm Ph.#_____________________ Bus Ph.#____________________ Cell# __________________
Employer _______________________________ Occupation ______________________________ E-Mail Address _________________________________________________________________ Whom may we thank for referring you?_______________________________________________ Who is your current eye doctor?___________________________________Phone#____________ Has your current eye doctor ever suggested LASIK eye surgery to you? Y N
Name _____________________ Relationship ________________ Phone#____________________
• How long have you been considering LASIK or another vision correction option?
__________________________________________________________________________
• Have you been told in the past that you were a candidate for LASIK and if so, how long ago
__________________________________________________________________________
• What prompted you to schedule your consultation with our practice?
___________________________________________________________________________
___________________________________________________________________________
• What activities will you be able to more fully participate in after your vision is corrected?
___________________________________________________________________________
___________________________________________________________________________
• What is most important to you in making a decision to have your vision surgically corrected?
___________________________________________________________________________
___________________________________________________________________________
• What is your desired outcome from today’s visit?
____________________________________________________________________________
____________________________________________________________________________
Patient Data Sheet Assignment and Release
¾ Refractive procedures are elective and not generally covered by insurance. I understand that
unless there is a contractual obligation or prior agreement if you should file my insurance or agree
to any alternative form of payment including payment from any third party I am still ultimately responsible for and guarantee the payment of all fees owed.
¾ During a refractive consultation it may be necessary to dilate my eyes to confirm my candidacy.
Dilating drops may blur vision for a length of time that varies from person to person. I authorize Dr. Updegraff and/or his associates to administer dilation drops during any of my consultation
¾ Should I choose to schedule surgery, I understand that I am responsible for a scheduling deposit
¾ In the event that I must cancel my surgical date, I understand that my scheduling deposit is
refundable up to 48 hours prior to the scheduled procedure.
¾ I acknowledge that I have received your Patient Information Privacy Notice.
¾ I understand this is an initial consultation only to determine my candidacy for a refractive
procedure. Unless I follow up with surgery or regular office visits no doctor patient relationship has been established and no information from this consult will be released to anyone.
___________________________________ _________________________
HEALTH HISTORY FORM NAME: ______________________________________ DATE: _____________________
YES NO HEART ATTACKS/ ANGINA WITHIN LAST 2 YEARS
NO PERMANENT DEFECT FROM ILLNESS, DISEASE OR INJURY
NO DO YOU SMOKE_____PKS PER DAY_____ WK_____ MO _____
YES NO ARE YOU TAKING OR HAVE YOU TAKEN SABRIL?YES NO ARE YOU USING LATISSE?
NO DO YOU DRINK _____# PER DAY_____WK _____ MO _____
HEIGHT____ WEIGHT ____ PLEASE LIST ALL MEDICATIONS YOU ARE TAKING AND THE DOSAGE: ALLERGIES: ________________________________________________________________________________________ SURGICAL HISTORY (Please include Date and Type) PROBLEMS WITH ANESTHESIA YES _____ NO _____ OCULAR HISTORY (HAVE YOU BEEN DIAGNOSED WITH ANY OF THE FOLLOWING IN THE PAST?)
NO CORNEA DISEASE _______________________________
NO GLAUCOMA ____________________________________
NO INJURY ________________________________________
YES NO IRITIS ___________________________
NO OTHER EYE DISORDERS _________________________
CATARACT SURGERY (date of surgery) RIGHT _________
RETINA SURGERY (Date of surgery) RIGHT ____________
FAMILY HISTORY (has anyone in your family (blood relative) has any of the following?)
(NOTE RELATION TO PATIENT: F- Father M- Mother P-Paternal M- Maternal S- Sister B- Brother
GF- Grandfather GM-Grandmother U- Uncle A- Aunt)
YES NO GLAUCOMA ________________________YES NO CATARACTS ____________________
NO HEART PROBLEMS ____________________________________
NO DIABETIC RETINOPATHY ______________________
NO RETINAL DETACHMENT _______________________
YES NO RETINITIS PIGMENTOSA _______________
NO STROKE ______________________________________
NO OTHER GENERAL HEALTH PROBLEMS __________
PRIMARY CARE PHYSICIAN: PATIENT SIGNATURE: ______________________________ CONTACT PHONE NUMBER: ____________________________ TECH/ DR. NAME: DATE UPDATED/REVIEWED: _______________________
CHANGES IN MEDICAL HISTORY OR MEDICATIONS SINCE LAST VISIT: YES _______ NO ______
CHANGES THAT HAVE OCCURRED: ___________________________________________________________________________________ _______
___________________________________________________________________________________________________
Impact of the proposed legislation on alternative dispute resolution (ADR) and online dispute resolution (ODR) on legal protection insurance RIAD evaluated whether the proposed legislation on alternative dispute resolution (ADR)1 and online dispute resolution (ODR)2 will have an impact on legal protection insurance and whether it will necessitate changes of national provisions regulating l
Catechesi e Liturgia Animazione TRASMETTERE LA FEDE CELEBRANDO LA FESTA IN FAMIGLIA . Voglio riferirmi ancora qui all'esperienza del popolo ebraico, quella che quoti-dianamente vado facendo in Israele, dove per trasmettere la fede non ci sono catechi-smi, catechisti e nemmeno ore di religione. Come viene allora trasmessa la fede? In famiglia, non attraverso definizioni astratte,