Follow the steps to complete the clearance request form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the current date in the space provided at the top of the form, ensuring the format is month/day/year.
3. Begin filling out the doctor’s information. In the designated area, write the name of the physician the request is addressed to.
4. Complete the section regarding the mutual patient’s name and date of birth (DOB). Fill in the patient’s full name and the DOB using the same month/day/year format.
5. Indicate the scheduled surgery date by entering the date in the provided space, using the month/day/year format.
6. Choose the type of anesthesia required for the procedure by marking either ‘MAC’ or ‘General’ anesthetic.
7. Fill in the length of the procedure by specifying hours and minutes in the corresponding fields.
8. In the section requesting nephrology clearance, specify the procedure for which the clearance is being requested in a clear and comprehensive manner.
9. List any required tasks prior to risk stratification under the appropriate section, ensuring that each item is clearly detailed.
10. Evaluate the patient's risk status from a nephrology standpoint by marking the appropriate checkbox: low risk, increased risk with recommendations, or prohibitive risk.
11. If the patient is at increased risk, provide detailed recommendations in the listed fields.
12. Sign and date the form in the designated areas at the bottom, ensuring to include your contact number.
13. Once all fields are completed, save your changes, then choose to download, print, or share the completed form as necessary.

Complete your IN Achilles Podiatry Nephrology Clearance Request online for timely processing.