Get Pre Admission Assessment Form

Completing the Pre Admission Assessment Form online is a crucial step in preparing for your upcoming procedure. This guide provides a clear and supportive approach to ensure that you can fill out the form accurately and efficiently.

Follow the steps to complete the Pre Admission Assessment Form online

1. Press the ‘Get Form’ button to retrieve the form and open it in your editor.
2. Begin by entering the patient's name in the designated field, followed by the Date of Procedure (DOP) and the surgeon's name.
3. Indicate the source from which the interview is being conducted by checking the appropriate box: Patient, Spouse, Parent, or Other.
4. Specify the type of anesthesia that will be used for the procedure.
5. Input the procedure that the patient will undergo.
6. Fill in the home phone, cell phone, business phone, age, height, weight, and Body Mass Index (BMI).
7. List any known allergies along with their reactions, referring to the medication/allergy sheet if necessary.
8. Provide a summary of past surgical history by checking 'No' or 'Yes' as applicable.
9. Document any personal history of anesthetic problems and if the patient has any metal implants, hearing aids, or other pertinent items.
10. Detail family history related to anesthetic problems.
11. Complete the medical history section by checking all that apply, indicating any previous issues or conditions.
12. Complete the system review by marking each applicable area, detailing conditions present.
13. Document smoking history, drug, and alcohol consumption, along with the PPD results.
14. Complete the STOP-BANG screening tool for obstructive sleep apnea.
15. Answer questions related to primary language, religious beliefs, racial background, and any need for translation services.
16. Fill out the emergency contact information, ensuring to include their name and telephone number.
17. Acknowledge understanding the advance directives, patient rights, and responsibilities.
18. Review pre-operative instructions and confirm the completion of all necessary lab work and pre-operative testing.
19. Once everything is completed, save the changes, download, print, or share the form as needed.

Complete your Pre Admission Assessment Form online today to ensure a smooth preparation for your procedure.