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Preop Template

This document contains pre-operative forms for two patients listing their name, surgery, diagnosis, surgeon, attending physician, room number, age, past medical history, past surgical history, current medications, allergies, and pre-operative labs and studies. It also includes sections for patient history, airway exam, anesthetic plan, and other exam notes.

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Joseph D Walch
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2K views1 page

Preop Template

This document contains pre-operative forms for two patients listing their name, surgery, diagnosis, surgeon, attending physician, room number, age, past medical history, past surgical history, current medications, allergies, and pre-operative labs and studies. It also includes sections for patient history, airway exam, anesthetic plan, and other exam notes.

Uploaded by

Joseph D Walch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Name Surgery Diagnosis: Surgeon Room:

Age: Attending: H: W:

PMH: PSH: MEDS: Allergies: Labs/Studies:

PTT CXR:
PT/INR:

h/o Anesthesia: EKG: Other:

Echo:

History: Airway Exam: Anesthetic Plan:

Exam Other:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Name Surgery Diagnosis: Surgeon Room:

Age: Attending: H: W:

PMH: PSH: MEDS: Allergies: Labs/Studies:

PTT CXR:
PT/INR:

h/o Anesthesia: EKG: Other:

Echo:

History: Airway Exam: Anesthetic Plan:

Exam Other:

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