By DiagnosTEX on 2008-06-10




Consultants in Dysphagia Evaluation and Management
817-514-MBS1 or 1-888-514-MBS1
2921 Brown Trail # 110
Bedford, Texas 76021
Modified Barium Swallow Study Notification for NURSING

                                                             is scheduled for a Modified Barium Swallow Study (MBSS) on________/________/_______
at _____:_____ am/pm

In order for the procedure to run smoothly for our patient, your help is needed:
1.       Please take the VITAL SIGNS prior to the test
2.      Please make sure the patient is sitting UP, in a WHEEL CHAIR, and ready for the test
3.      Have the CHART ready and available for the physician on board to review
4.      Remove any necklaces/earrings as they may interfere with the x-ray
5.      Assist in inserting dentures or other dental items necessary for PO

Thank you very much! 

The MBSS will be performed at this facility, requiring the patient to board a mobile clinic.

BP _______  PULSE _______RESP ______ TEMP ______


Speech Therapy Department_____________________________