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WRHA SURGERY PROGRAM PREoperative Assessment Patient Questionnaire DATE COMPLETED (DD/MMM/YYYY): PHIN: Please fill out this form (questions 1 - 33) to help our Health Care Team meet your medical needs.

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How to fill out the PREoperative Assessment online

The PREoperative Assessment form is an essential document designed to gather necessary information about patients before their surgical procedures. Completing this form accurately is crucial for ensuring that your health care team can address your medical needs effectively.

Follow the steps to successfully complete the PREoperative Assessment online:

  1. Use the ‘Get Form’ button to access the PREoperative Assessment document and open it in your chosen editor.
  2. Begin by entering your legal name in the designated fields. Make sure to fill in your surname, first name, and middle name as required.
  3. Provide your date of birth and contact information, including home and cell phone numbers, as well as your email address and any alternate phone numbers.
  4. Indicate your scheduled date of surgery along with your surgeon’s name and type of surgery intended.
  5. Answer whether you have a Health Care Directive and specify the primary language you speak or understand. If necessary, note if you require an interpreter.
  6. List the contact person who will be your representative and relate their connection to you. Additionally, include who will be responsible for picking you up after discharge.
  7. Complete the medical history section by answering questions related to recent hospitalizations, allergies, and any medications you are currently taking. Be thorough and list all relevant info.
  8. If you wear a Medic Alert® Bracelet, provide the details regarding its contents to ensure your safety.
  9. Review your filled form carefully to ensure all fields are completed.
  10. Once satisfied with your entries, you can save changes, download a copy of the form, print it, or share it as necessary.

Complete your documents online today for a smooth surgical experience.

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The Preoperative Evaluation Identifying Statement. Past Medical History: Review of Systems: Remember to be systematic and complete, with particular focus on the following: Past Surgical History. Past Anesthetic History. Family History. Social History. Medications.

An Overview of Preoperative Nursing Identification of the patient with two identifiers, such as name and date of birth. Mental and physiological status of the patient. Functional status (patient's ability to perform ADLs, activities of daily living) Cardiovascular and respiratory status. Skin condition.

What Are the Significant Components of Pre-Operative Assessment? Cardiovascular diseases including hypertension. ... Respiratory diseases since adequate oxygen and ventilation prevent acute ischemic events during the surgery. Renal diseases since they can increase the risk of complications during surgery.

Documentation of the condition(s) for which surgery is needed. Assessment of the patient's overall health status. Uncovering of hidden conditions that could cause problems both during and after surgery. Perioperative risk determination.

The aims of preoperative assessment are to reduce the risks associated with surgery and anaesthesia, to increase the quality (thus decreasing the cost) of peroperative care, to restore the patient to the desired level of function, and to obtain the patients' informed consent for the anaesthetic procedure.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232