University Hospitals of Case Medical Center

Department of Emergency Medicine

11100 Euclid Avenue
Cleveland, OH 44106
(216) 844-3836

Page 1 1/20/2015
DISCHARGE INSTRUCTIONS

Your doctor today was: ____Vicken Totten MD____________________

You were treated for:

Treatment in the Emergency Department is offered as emergency care only. Follow

up treatment by your physician is important for your safety. Please follow the
instructions outlined below. If you have no personal physician, please call

the Referral Line to find out which physicians are accepting new patients:
216-844-7553. Womens Health is 844-3896

If you are feeling worse, or are not improved within 24 hours, please call your
physician or return to the Emergency Department.
The above has been explained to me, I understand the instructions, acknowledge receipt of this
written copy of my instructions, and accept responsibility for following these instructions.

Patient Signature___________________________ Date ______________

Staff Signature _______________________________________________