Pain Level: {FLD:0-10 BOX}

Procedure to Be Performed: Arthrocentesis

iMed Consent (preferred) or VA Form 10-0431a, Consent for Clinical

Treatment or Procedure and/or VA Form 10-0431b, Consent for Transfusion

of Blood Products completed: Yes

Procedure site(s) marked by MD: Yes

Patient Position Confirmed as: Sitting

Pre Invasive Procedure Imaging Confirmed: Yes

Special Equipment or Implants Confirmed: N/A

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PREPROCEDURE BLEEDING RISK ASSESSMENT:

1. The patient has not recently received fondaparinux, enoxaparin, or

dalteparin.

Anticoagulant: none

2. The patient has not recently received heparin, argatroban, or lepirudin.

Anticoagulant: none

3. I have reviewed the most recent INR.

4. I have reviewed the most recent platelet count.

5. I have considered risks for platelet dysfunction.