Resources for Providers

The BMC Stroke and Cerebrovascular Center is pleased to serve as the tertiary affiliate for many area hospitals, medical centers, and private practices. We provide emergency patient care, quality assurance, education, and transfer services as needed to support the neuroscience programs at these facilities.

• Anesthesia Request Form (PDF)
• Authorization to Obtain Protected Health Information (PHI) from a Non-BMC Healthcare Provider (PDF)
• Consent to Special Procedure Form
  • Consent to Special Procedure Form (PDF, English)
  • Consentimiento para Procedimiento Especial (PDF, Español)
• CT Myelogram Request (Online Form)
• Fluoroscopy Data Form (PDF)
• Interventional Neuroradiology Consult Form (PDF)
• Lumbar Puncture Form (MS Word)
• Pre-Procedural Neuro-IR Planning Meeting Form (PDF)
• Stroke Dysphagia Screening Criteria (PDF)
• NIH-BMC Stroke Scale (PDF)
• MA Office of Emergency Medical Services Comfort Care/DNR Order Verification Form (PDF)