NST INSTRUCTIONS REVISED – Southeast Cardiologist

Southeast Cardiovascular Associates
Board Certified, Interventional Cardiology, Cardiovascular Disease & Nuclear Cardiology
Rajan Kadakia MD Nisheeth Goel MD Manu Pillai MD Marlos Fernandes MD Arvin Bansal MD
PATIENT INSTRUCTIONS FOR NUCLEAR STRESS TEST
Patient Name:*
Date of Procedure:*
MM slash DD slash YYYY
Time:*
: Hours
Minutes
AM/PM
Primary Contact #:*
Secondary Contact #:
Please note: Failure to provide 24 hour cancellation notice will result in you being billed $250.00 for the cost of the nuclear isotope purchased for your test, which is not covered by insurance.*
- 11920 Astoria Blvd. Suite 340 Houston, TX 77089
- 10905 Memorial Hermann Dr. Suite 209 Pearland, TX 77584
1. The test usually takes approximately 4 hours, although your test time will vary.
2. Nothing to eat or drink 4 hours prior to the test. You may have water at any time. (Bring a water bottle with you).
3. DO NOT take any of your medication(s) the morning of the test, but bring all morning medication(s) with you as you will take them after the stress portion of the test is completed.
4. Patients who have diabetes MUST consult their physician before taking insulin or diabetic medication the morning of the test.
5. Bring a list of medications you are taking with the dosing information.
6. Wear comfortable clothing and walking shoes. Wear a short sleeve, button down, or loose fitting t‐shirt that contains no metal; no underwire bras or necklaces. Bring a light jacket / sweater without any metal zippers or buttons; the rooms must be kept cold.
7. Bring something to occupy your time (book, knitting, etc.) As there are waiting periods during the test.
8. Please call if you need to cancel or reschedule. If the appointment is not cancelled at least 24 hours in advance, I understand that I will be charged $250.00 for the isotope that was ordered on my behalf; as the isotope cannot be used for another patient and expires within (3) hours.
9. - Monday – Friday (8:00am‐5:00pm) Call (281) 506‐8720
  - After hours or Saturday – Sunday Call (281) 460‐6869; Ask to speak to DP
10. We will attempt to contact you 3 times the day before the test in order to confirm your appointment; however if we are unable to confirm the appointment with you or your representative, WE WILL CANCEL THE TEST ON YOUR BEHALF.
11. I understand that if the treadmill is unavailable for any reason, that I will be given a chemical stress test in its place.
My signature below acknowledges that I have read and understand these instructions:
Signature:*
Date:*
MM slash DD slash YYYY
Patient Name: (please print)*
Date of Birth:*
MM slash DD slash YYYY
Person other than patient:
Relationship: