Jag är patient
Problem +
Problem
Synovit
Arthrosamid® +
Arthrosamid®
Vetenskapen
Resultat
Resurser +
Resurser
Klinisk information
Arthrosamid®-akademin
Kontakt
UK
Österreich
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Fill out the information in the form to the right. Required fields are indicated with an asterisk.
Patient Details
Patient Initials *
Sex *
Date of Birth
Indication
Knee Osteoarthritis
Treatment
Date of treatment
LOT No.
Total Volume Injected (mL)
Prophylactic antibiotics
Knee Treated
Details
Description of complication
Onset date of complication
Hospitalisation required
Severity of symptoms
Antibiotics
Other treatment given
Relevant Medical History
Active skin disease or infection present at or near the injection site?
Yes
No
Joint infected or severely inflamed?
Patient has previously received treatment with a different non-absorbable injectable/implant?
Patient has received a knee alloplasty or has any foreign material in the knee?
Patient has undergone knee arthroscopy within the last 6 months?
Hemophilia patient or patient in uncontrolled anticoagulant treatment?
Patient has been treated with corticosteroids within the last 3 months?
Patient has autoimmune disorders?
Patient has uncontrolled diabetes?
Degradable intra-articular injectable such as hyaluronic acid present?
Other relevant medical history
Details of follow-up
Total recovery
Is further medical follow-up required?
Do you need any further medical advice from Contura?
Attach relevant information
Ladda upp en fil
Details of injecting physician
Name of Physician *
Clinic *
Clinic Address
Profession
Telephone number
E-post
Date reported
Physician Signature
Draw your signature in the space below
Skicka meddelande
Medical Device *
Device Returned? *
Malfunction Description *
Date of malfunction
Malfunction occurred *
Were there any risk to patient due to malfunction?
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