Patient History

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                            Patient History Questions for Urinary Catheterization

1) Have you ever had a urinary catheter placed?                                              YES         NO

 If YES, answer the following:

 Was there any difficulty in placing the catheter?                                      YES         NO

 If YES, what issues were encountered?

 2) Have you had any of the following surgeries?

  Prostate surgery                                                                                            YES         NO

  Bladder surgery                                                                                             YES         NO

 Lower urinary tract surgery                                                                          YES         NO

3) Do you have any of the following conditions?

Stricture disease                                                                                              YES         NO

Acute urinary retention                                                                                 YES         NO

Enlarged prostate                                                                                           YES         NO

4) Are you on an anticoagulation therapy (blood thinners)?                          YES         NO

                                If the patient answers “YES” to any of these questions,

                                            use DirectVision® for the initial insertion


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