Patient or Caregiver Counseling for DVT Yes No Medical condition information 1. Understands what a DVT is 2. Can recognize the symptoms of a DVT 3. Understands the purpose of Lovenox® (low-molecular-weight heparin) injections? 4. Understands the purpose of warfarin therapy 5. Can recognize the signs of disease recurrence Lovenox counseling points 1. Method and location of administration 2. Dose and schedule 3. Duration of therapy 4. Signs of over anticoagulation 5. What to do in case of bleeding 6. Missed dose instructions 7. Storage instructions 8. Risks involved with treatment Warfarin counseling points 1. Food and drug interactions 2. Dose and schedule 3. Duration of therapy 4. Signs of over anticoagulation 5. What to do in case of bleeding 6. Missed dose instructions 7. Risks involved with treatment Signature/Date
Signature/Date