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This form is used for assessing stroke patients within a 0 to 4.5-hour window for thrombolysis treatment. It includes crucial details such as patient information, symptom onset time, NIHSS score, blood pressure, contraindications, decision to thrombolyze, consent status, IV alteplase prescription, body weight/dose chart for alteplase, and NIHSS scoring tool. The form guides healthcare professionals in evaluating and potentially treating stroke patients with thrombolytic therapy.
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