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Ns assessment tool r3:layout 1.qxd

Antidepressant Treatment Record (ATR)
An eligible patient for NeuroStar TMS Therapy has shown resistance, during the current episode of
Major Depressive Disorder, to one treatment. The treatment must have been administered for at least
four weeks, at or above the minimum effective dose as defined by the attached Approved Treatment
List. The ATR will clarify and capture for your records a patient’s eligibility for NeuroStar TMS Therapy.

Does the patient meet the criteria for MDD as defined in the DSM-IV? Create a treatment record chart on the next page to use in answering Questions 2 - 3 below. List all treatments administered in the current episode. For NeuroStar eligibility decisions, a treatment is:
1. An antidepressant medication . NOTE: Write each medication, whether administered alone or in combination, on a separate line. For your own records, indicate combinations by circling medications administered together.
2. A medication plus an augmenting agent. NOTE: If, after starting a medication, an augmenting agent was added, count that date as ending one treatment and starting another. Re-write the name of the medication and the agent on the next line.
Answer all questions for each line independently. Refer to the Approved Treatment List on the back of this page for treatment names and minimum dose. When you have completed the treatment record chart, return to this page to answer Questions 2-3. Is there at least one treatment on the chart for which all the answers are YES?
2 If not, please create a treatment record chart for the most recent episode in which treatment
occurred. Return to this question when the chart is complete.
Is there only one treatment on the chart for which all the answers are YES?
If the answer to all three questionson this page is YES, the patient iseligible for NeuroStar TMS Therapy. reatment List
etracyclic
Other Antidepressants
AUGMENTING AGENT
Approved T
All trademarks are the property of their respective manufacturers Antidepressant Treatment Record(ATR), CONTINUED
unsatisfactory?
Use both sides of the page when needed. For additional space, copy the chart. Antidepressant Treatment Record(ATR), CONTINUED
unsatisfactory?
Use both sides of the page when needed. For additional space, copy the chart.

Source: http://www.suffolktmsandbehavioraltreatmentcenter.com/pdf/ATR-%20Antidepressant%20Record%20Form.PDF

Electronic components part numbers available at iiic.cc

OPA637KM OPA637KM OPA650A OPA650AOPA656UB OPA656UB -OPA656UB OPA656UB OPA656UB. OPA656UB OPA666AU OPA666AU OPA671SG OPA671SGOPF1412 OPF1412OPI110B OPI110B OPT101PR OPT101PR OSC 4.194MHZ KSS OSC4194MHZ OSC 43.29MHZ NDK FULL OSC4329MHZOSC. 4.608 MHZ OSC4608MHZ OSC48.000 HALF KTS KDN-4 OSC48000HALFOXTW911-TQ-A OXTW911TQA OZ168T OZ168T OZ711E1B OZ711E1B OZ961S OZ961S OZ962R OZ962R P059002T22KP059002T2

Microsoft word - anthonygrassocv 2008.doc

Anthony R. Grasso, Jr., M.D. EDUCATION University of Connecticut School of Medicine Farmington, CT Medical Doctor College of the Holy Cross POSTGRADUATE EDUCATION National Rehabilitation Hospital Washington, DC Residency, Physical Medicine & Rehabilitation Georgia Baptist Medical Center Atlanta, GA Internship, Transitional Year PROFESSIONAL EXPERIENC

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