Get Neurology Clearance Request

Filling out the Neurology Clearance Request form online facilitates efficient communication between healthcare providers regarding patient care. This guide provides you with clear, step-by-step instructions to ensure you complete the form accurately and effectively.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to access the Neurology Clearance Request form and open it for editing.
2. Enter the date at the top of the form in the designated fields labeled ‘Date’.
3. In the ‘Dear Dr.’ section, provide the name of the neurologist who will be receiving this request.
4. Next, include the patient’s name and date of birth in the corresponding sections identified as ‘Our mutual patient’ and ‘DOB’.
5. Indicate the date the patient is scheduled for surgery in the section labeled ‘scheduled for surgery on’.
6. Select the type of anesthesia required by checking either the box for ‘MAC’ or ‘General anesthetic’.
7. Specify the length of the procedure by filling in the hours and minutes required in the given fields.
8. Fill out the section requesting Neurology Clearance by describing the procedure in the space provided.
9. Indicate any specific assessments needed prior to risk stratification in the relevant section.
10. Assess the patient’s risk level by marking the appropriate box: low risk, increased risk with recommendations, or prohibitive risk.
11. If the patient is at increased risk, list the recommendations to minimize risk in the provided lines below this section.
12. Capture the neurologist’s signature at the end of the form in the designated area.
13. Input the neurologist's telephone number in the area specified.
14. Fill in the date at the bottom of the form in the corresponding section.
15. Once completed, ensure to save your changes, and consider downloading, printing, or sharing the form as needed.

Prepare and submit your Neurology Clearance Request online for streamlined processing.