Follow the steps to fill out the form online successfully.

1. Press the 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the patient's name and date of birth in the designated fields at the top of the form.
3. Provide the surgeon's name, along with their phone and fax numbers, ensuring all contact details are accurate.
4. Fill in the surgery confirmation number, if available.
5. Indicate any required spinal pre-surgery testing that needs to be performed within 30 days by checking off the appropriate boxes and providing any additional notes as necessary.
6. For anesthesia details, complete the relevant sections regarding general, MAC, or local anesthesia, following the prompts regarding specific conditions (like age or current health status) that may require additional testing.
7. Complete the health and physical examination (H&P) portion by listing the required labs and any X-ray or EKG tests with the reasons noted.
8. Record any allergies the patient may have in the allergies section.
9. Specify the admission status, whether inpatient or outpatient, and indicate the intravenous fluid requirements and any necessary antibiotics per the protocol outlined.
10. Ensure that the physician's signature is provided along with the date and time, signifying authorization for the order.
11. Once all fields are completed, review the form for accuracy. You can save changes, download the document, print it for physical copies, or share it as needed.

Complete your documents online today to ensure efficient surgical preparation.