Get MD Pre-Anesthesia Assessment 2012
_ BMI__________Date of Surgery_________________________________ List of all previous surgeries: Medications (prescribed medications, Food and drug allergies/reactions: over the counter medications): Premed:___________ Taking Beta blockers Time:____________ Taking Blood thinners Check Do you now have or have you ever had a history of: Cardiovascular Disease Chest Pain/Tightness/Pressure/ Heart Attack Irregular Heart Beat Pacemaker/Defibrillator Brand: Pr.
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