Radiation Safety Discharge Instructions (Therapeutic Radiopharmaceutical)

(Do not finalize this document unless the Radiopharmaceutical name is confirmed. Use plain language. Keep sentences short. Include only rows and items that apply to this patient. If a duration cannot be individualized now, write: "Call [phone] before resuming this activity.")

Patient Name: [Patient full name]

DOB: [Date of birth]

MRN: [Medical record number]

Date/Time of Administration: [Date and time]

Treating Location: [Clinic or hospital name]

Treating Clinician: [Clinician name and title]

Radiopharmaceutical: [Generic name, radionuclide, route] (Required; hold document if unknown)

These instructions apply until: [End date/time]

Purpose

You received a radioactive medicine today. You may give off small amounts of radiation for a short time. These steps help protect family, friends, and others.

Your instructions are tailored to you. If two instructions seem to conflict, follow the more restrictive one.

Your Radiation Precautions

(Include only rows that apply. For each row, provide a clear action, a relative duration, and an absolute end date/time.)

Precaution Area	What to Do	Until When
Distance from adults	Stay at least [distance] away from other adults. Avoid sitting side-by-side for long periods.	[For X days] (until [date/time])
Distance from pregnant people	Stay at least [distance] away from anyone who is pregnant. Avoid prolonged close contact.	[For X days] (until [date/time])
Contact with children	Avoid holding children in your lap or close hugging. Keep at least [distance] apart when possible.	[For X days] (until [date/time])
Sleeping arrangements	Sleep alone in a separate bed. Keep at least [distance] from others while sleeping.	[For X nights] (through the night of [date])
Intimacy and kissing	No sexual activity or deep kissing. Do not share utensils, cups, or toothbrushes.	[For X days] (until [date/time])
Work or school	[May return on [date] with distancing / Stay home until [date] / Call [phone] before returning]	[For X days] (until [date/time])
Public places and transportation	[Avoid crowded places and long rides on public transit / Short trips are okay if you can maintain distance]	[For X days] (until [date/time])
Bathroom and hygiene	Use your own bathroom if possible. If sharing, wipe surfaces after use. Flush twice with the lid down.	[For X days] (until [date/time])
Travel or security screening	You may set off radiation detectors. Carry your letter and wallet card. If stopped, say: "I received medical radioactive treatment on [date]."	[For X weeks] (until [date/time])
Pregnancy and conception (if of reproductive potential)	Avoid pregnancy during this time. Use reliable birth control. If you think you may be pregnant, call [phone] right away.	[For X weeks/months] (until [date])
Breastfeeding (if lactating or may lactate)	[Do not breastfeed until [date]; pump and discard milk until then / Call [phone] for guidance before resuming]	[For X days/weeks] (until [date/time])

Key Principles

• More distance means less exposure. Keep space when you can.
• Less time close to others means less exposure. Keep close contact brief.
• The medicine leaves your body mainly through urine and body fluids. Good hygiene prevents spread.

Hygiene at Home

• Bathroom: Close the lid and flush twice. Wash hands well with soap and water. Keep surfaces clean and dry.
• Spills or vomit: Wear gloves if available. Blot with paper towels. Place towels and gloves in a plastic bag. Clean the area with household cleaner. Wash hands well.
• Laundry and linens: If clothing or linens contact body fluids, handle with gloves if available. Wash promptly. Wash separately only if instructed for this therapy.
• (Include only if indicated for this therapy) Hydration: Drink extra fluids as advised. Urinate often. This helps the medicine leave your body faster.

When to Get Help

Call our team:

• Persistent vomiting or cannot keep fluids down
• Unable to stay hydrated
• Uncontrolled pain or fever
• A large spill you cannot safely clean

Call 911 or go to the Emergency Department:

• Trouble breathing
• Chest pain
• Severe allergic reaction (swelling of face or throat, hives, wheezing)
• Fainting or loss of consciousness
• Uncontrolled bleeding

In an emergency, get care right away. Tell staff you received radioactive medicine, but never delay emergency care because of radiation concerns.

Contact Information

Clinical questions about your treatment:

• Phone: [Clinic phone]
• Hours: [Hours]
• After-hours: [Instructions and on-call number]

Radiation safety questions:

• Phone: [Radiation safety phone]
• Hours: [Hours]
• After-hours: [Instructions and on-call number]

Tell any healthcare provider: "I received [radiopharmaceutical] on [date]. For radiation safety questions, call [radiation safety phone]."

(If applicable) A travel/security letter and wallet card are included. Carry them if traveling or entering places with security screening.