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Click ‘Get Form’ to open the lumbar puncture referral form in the editor.
Begin by entering the patient information. Fill in the fields for Name, Date of Birth (DOB), and Phone number accurately to ensure proper identification.
Next, provide details about the Primary Care Provider and Referring Provider. This information is crucial for communication regarding the patient's care.
In the 'Reason for Procedure' section, clearly state why the lumbar puncture is being requested. This helps in understanding the context of the procedure.
For 'Tests Requested', select from the list provided. If unsure, you can indicate that additional tests may be ordered based on diagnosis or referral.
Review all entered information for accuracy before finalizing. Ensure that any notes regarding anticoagulation therapy are noted as per guidelines.
Once completed, save your changes and follow instructions to fax this form to our clinic at 203-785-3732 for expedited scheduling.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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Can nurse practitioners perform lumbar punctures?

Who performs a lumbar puncture (spinal tap)? A doctor, nurse practitioner (NP), nurse anesthesiologist, or physician assistant (PA) performs a lumbar puncture.

Can I have someone with me for a lumbar puncture?

Preparing for a lumbar puncture You can also ask if you can bring someone to support you during the procedure, but it may not always be possible.

Does a lumbar puncture require informed consent?

Informed consent procedures are commonly employed prior to lumbar puncture. An understanding of the legal and ethical basis of informed consent is important in developing an acceptable approach to consent and in dealing with problems confronted when consent cannot be obtained.

What are the requirements for lumbar puncture?

Equipment Sterile gloves. Sterile drapes and procedure tray. Skin preparation: 2% chlorhexidine + 70% isopropyl alcohol or povidone iodine solution (Betadine). Local anaesthetic 1% lidocaine, 2 mL syringe and 25-30G needle if local infiltration indicated. Spinal needle of appropriate length. Sterile CSF tubes.

Does lumbar puncture need a consent form?

You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear. Generally, you wont need to fast before a lumbar puncture unless a sedative is prescribed. Follow your healthcare providers instructions.

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