Combined medical device and form

• US 6,007,104 A
• Filed: 06/04/1998
• Issued: 12/28/1999
• Est. Priority Date: 06/04/1998
• Status: Expired due to Fees

• Current Assignee: Brad E. Draper
• Original Assignee: Brad E. Draper
• Inventors: Draper, Brad E.
• Primary Examiner(s): Fridie, Jr., Willmon
• Application Number:
  US09/090,371
• Time in Patent Office: 572 Days
• Field of Search: 283/900, 283/105, 283/101, 283/61, 283/62, 283/74, 283/75, 462/22, 462/24, 462/28
• US Class Current: 283/74
• CPC Class Codes: B42D 15/00 Printed matter of special format or style not otherwise provided for
• CPC Class Codes: B42D 15/0053 Forms specially designed for commercial use, e.g. bills, receipts, offer or order sheets, coupons
• CPC Class Codes: Y10S 283/90 Medical record

Abstract

A combined medical device and form (20) having a unitary substrate (22) which is divided into a medical device portion (24) and a form portion (26). The form portion (24) of the substrate includes an informational section (30, 32, 34), and form identification material (36). The medical device portion (26) is illustrated as a DBS packet for collecting blood samples. The medical device portion (26) also has medical device identification material (68) that is preferably identical to the form identification material (36). With identical identification materials, which are preferably machine readable, the occurrences of patient misidentifications are substantially reduced if not eliminated.

Claims

1. A combined medical device and form comprising:

a unitary substrate having a form portion and a medical device portion;

a biographical data section on the form portion of the substrate;

form identification material on the form portion of the substrate;

medical device identification material on the medical device portion, and the medical device identification material corresponding to the form identification material for matching the form with the medical device; and

a separation line dividing the form portion from the medical device portion, and the separation line being positioned between the form identification material and the medical device identification material.

2. The combined medical device and form according to claim 1 wherein the substrate comprises a paper board substrate.

3. The combined medical device and form according to claim 1 wherein the biographical data section comprises a data update section.

4. The combined medical device and form according to claim 3 further comprising a plurality of carbon copy sheets operatively disposed relative to the data update section to create multiple copies of updated biographical data.

5. The combined medical device and form according to claim 4 wherein each carbon copy includes carbon copy identification material substantially identical to the form identification material.

6. The combined medical device and form according to claim 1 wherein the form identification material comprises machine readable bar code, and the medical device identification material comprises a substantially identical machine readable bar code.

7. The combined medical device and form according to claim 1 wherein the separation line comprises a line of weakness for separating the medical device from the form.

8. The combined medical device and form according to claim 1 wherein the medical device is secured to the medical device portion of the substrate.

9. The combined medical device and form according to claim 1 further comprising an informational section including test instructions.

10. A medical testing apparatus comprising:

a unitary substrate having a form portion and a medical device portion;

a biographical data section located on the form portion of the substrate;

form identification material on the form portion of the substrate;

medical device identification material on the medical device portion, and the medical device identification material corresponding to the form identification material for matching the form with the medical device;

a separation line dividing the form portion from the medical device portion, and the separation line being positioned between the form identification material and the medical device identification material; and

a medical device secured to the medical device portion of the substrate.

11. The testing apparatus according to claim 10 wherein the medical device comprises a DBS packet.

12. The testing apparatus according to claim 10 wherein the line of separation comprises a perforated line of weakness.

13. The testing apparatus according to claim 10 further comprising a securement sheet having pressure sensitive adhesive securing the medical device to the medical device portion of the substrate.

14. The testing apparatus according to claim 13 wherein the securement sheet comprises a perimeter margin extending beyond the medical device and adhering to the medical device portion of the substrate.

15. The testing apparatus according to claim 10 wherein the biographical data section comprises a data entry section.

17. The testing apparatus according to claim 15 further comprising a securement sheet adhering to the substrate and the blood application sheet.

20. The testing apparatus according to claim 15 wherein the substrate includes a form portion and medical device portion separated by a separation line.

16. A dry blood spot testing apparatus comprising:

a substrate having at least one blood application opening; and

a blood application sheet secured to the substrate, and the blood application sheet covering the at least one blood application opening.

18. The testing apparatus according to claim 16 wherein the securement sheet comprises a plurality of blood application openings, and the substrate comprises a plurality of blood application openings aligned with the blood application openings in the securement sheet.

19. The testing apparatus according to claim 16 wherein the securement sheet includes a pressure sensitive adhesive and a perimeter surrounding the blood application sheet.