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Physician’s Release for SCUBA Diving in a MarineLab Program      Please  print  legibly.   
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Document Date: 2014-08-25 16:06:22

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City

Surry / San Antonio / Oxford / Philadelphia / Australia Simon Mitchell / Bethesda / Milwaukee / Ashburton / Durham / Denver / Roseto / New York / Victoria / London / /

Company

W.B. Saunders Company Ltd. / Butterworth & Heineman Ltd. / Diving Medicine Royal Adelaide Hospital Adelaide SA / 2nd Edition / Plennum Press / Medical Seminars Inc. / 4th Ed. / M.D. / /

Continent

North America / /

Country

Australia / United Kingdom / Italy / United States / /

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Facility

Hospital Address Date / Medicine University of Auckland / Luke’s Hospital / Pulmonary Medicine Duke University Medical Center / Anesthesiology Duke University Medical Center / Medical Center Durham / Luke’s Medical Center / M.D. Northridge Hospital / Family Medicine University of Washington Seattle / Hospital Address Phone / Edinburgh Conference Centre / Surgery University of California / Surgical Sciences University of Wisconsin Madison / Dental University / canal History / Prentice Hall / Ph.D. Norwegian University of Science / Ph.D. Duke University / /

IndustryTerm

cerebral gas embolism / prosthedontic devices / gas density / gas trapping / otitis media / subsequent arterial gas embolization / telephone non-emergency line / organ systems / energy cost / /

MedicalCondition

Intracranial Tumor / demyelinating disease / cerebral gas embolism / Hypertrophic cardiomyopathy / decompression illness / seizures / alcohol abuse / pneumothorax / sensorineural hearing impairment Facial nerve paralysis / gastroesophageal reflux / injury / Recurrent otitis / Multiple Sclerosis / pulmonary edema / bullae / blebs / pulmonary overinflation syndrome / Peptic Ulcer Disease / hypoglycemia / Scoliosis / neurologic manifestations / Asthma / neurological decompression illness / Gastric outlet obstruction / recurrent vomiting / Chronic / tension pneumothorax / Allergy / childhood febrile seizures / seizure / reactive airway disease / Active Reactive Airway Disease / coronary artery disease / Aseptic Necrosis / vestibular decompression sickness BIBLIOGRAPHY/REFERENCE / Deficiency / Interstitial lung disease / disorders / pinna Eustachian tube dysfunction Recurrent otitis media / loss of consciousness / neuromuscular disorders / interstitial diseases / significant valvular disease / Inflammatory Bowel Disease / Aneurysm / unconsciousness / decompression sickness / Structural disorders / lung diseases / Complicated Migraine Headaches / Cerebrovascular Accident / personal fears Claustrophobia / Transient Ischemic Attack / Peripheral Neuropathy / pulmonary overinflation / neuromuscular disease / significant cold injury / Obesity / Trigeminal Neuralgia / inner ear surgery Facial nerve paralysis / hemophilia / pulmonary air trapping / head injury / Congestive Heart Failure / Sickle Cell Disease Polycythemia Vera Leukemia Hemophilia/Impaired Coagulation METABOLIC AND ENDOCRINOLOGICAL With the exception of diabetes mellitus / Hypertension / Active Asthma / spontaneous pneumothorax / disease / Exercise Induced Bronchospasm / either structural disorders / spinal cord decompression sickness / Chronic Obstructive Pulmonary Disease / migraine / hernia / pulmonary barotrauma / pain / Renal Insufficiency / Myocardial Infarction / Edema Restrictive Disease / Previous Overinflation Injury / cough / neurological decompression sickness / respiratory disease / /

MedicalTreatment

pleurodesis / surgery / radiation / ear surgery / Thoracic Surgery / embolization / insulin therapy / Amputation / /

Organization

A.F.O.M. Nuffield Department of Anaesthetics Radcliffe Infirmary Oxford / Diving Medicine Royal Adelaide Hospital Adelaide / UCSD / Duke University / Divers Emergency Service / Tulane University School of Medicine New Orleans / Hyperbaric Medical Society / Undersea and Hyperbaric Medical Society / South Pacific Underwater Medicine Society / Norwegian University of Science and Technology / Family Medicine University of Washington Seattle / European Underwater and Baromedical Society / Medical Director Hyperbaric Medical Center St. Luke’s Hospital / Wesley Centre for Hyperbaric Medicine Medical Director Sandford Jackson Bldg. / University of Auckland / Auckland / F.A.A. / University of California at San Diego / Dental University Tokyo / Anesthesiology and Pulmonary Medicine Duke University Medical Center Durham / Surgical Sciences University of Wisconsin Madison / Tokyo Medical and Dental University / Hyperbaric Consultant Division Presbyterian/St. Luke’s Medical Center Denver / Anesthesiology Duke University Medical Center Durham / /

Person

Christopher J. Acott / Karen B.Van Hoesen / Jan Risberg / Injury / Paul A. Thombs / Behavioral / Peter Bennett / Edmond Kay / Keith Van Meter / Vera Leukemia Hemophilia / Tom S. Neuman / Simon Mitchell / Washington Seattle / Wesley Centre / Sandford Jackson Bldg / Christopher W. Dueker / Alessandro Marroni / Des Gorman / Paul G. Linaweaver / /

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Position

family physician Physician / Email PHYSICIAN / Physician / F.A.C.P. Santa Barbara Medical Clinic Undersea Medical Specialist / Director / Emergency Medical Services / asthmatic diver / Professor / Representative / Professor of Medicine / diver / F.A.C.E.P. Assistant / RECREATIONAL SCUBA DIVER / Governor / Pediatric Scuba Diver / Director / Head / /

ProvinceOrState

New York / California / Maryland / Victoria / Pennsylvania / North Carolina / /

Region

Southern Africa / /

Technology

radiation / CAD / /

URL

www.spums.org.au / www.rah.sa.gov.au/hyperbaric / www.diversalertnetwork.org / www.UHMS.org / www.eubs.org / /

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