Houma Outpatient Surgery Center Medical Clearance free printable template

Houma Outpatient Surgery Center AAAHC ACCREDITED 3717 Houma Blvd 3rd Floor P 504 456 1515 Metairie La. 70006 F 504 454 3810 Medical Clearance for Surgery/Anesthesia Patient Date of Surgery/Anesthesia Surgeon recommending patient for medical clearance Proposed surgical procedure anesthesia Indications for Medical Clearance Labs/Tests/Diagnostics needed Patient is cleared for proposed surgical procedure anesthesia Yes No Recommendations for surgery/anesthesia Comments Examining Physician...

How to fill out medical clearance form

How to fill out Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia

1. Obtain the Houma Outpatient Surgery Center Medical Clearance form from the facility or download it from their website.
2. Fill out your personal information at the top of the form, including your name, date of birth, and contact information.
3. Provide information about your medical history, including any pre-existing conditions, past surgeries, and current medications.
4. Indicate if you have any allergies, particularly to anesthesia or medication.
5. Answer any specific questions regarding surgical history and current health status as prompted in the form.
6. Sign and date the form to certify that the information provided is accurate.
7. Submit the completed form to your physician or the surgery center as instructed.

Who needs Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

1. Patients scheduled for surgery at the Houma Outpatient Surgery Center require medical clearance to ensure that they are fit for the procedure and anesthesia.
2. Individuals with significant past medical histories or currently taking medications that may affect surgery or anesthesia need this clearance.

Instructions and Help about medical clearance form

Music welcome to Florida hospitals patient education video the purpose of this video is to prepare you or your loved one for abdominal surgery as your safety and well-being our priority the information in this video will guide you from the planning of your surgery through your recovery in addition to this video your surgeon will provide information regarding the preparing for your surgery class please remember any questions related to your surgeries should be directed to your surgeon preparing for surgeries start to your surgeon's office you can expect to get the following details type and name of surgery you'll be having dates time and location of surgery possible risks or complications anticipated time in the hospital after surgery alternative treatment options any changes to your blood thinners or anticoagulants any medical clearance you may need readmission testing dates and location dates and times for preparing for your surgery class in addition you'll be signing your surgery consent form Music pre-admission testing involves completing the hospital registration process having tests and blood work drawn completing a personal health history review of any medication or supplements that you're taking verification of existing advance directives or living wills receiving preoperative instructions such as diet and bathing guidelines verifying the date and time of surgery and review of parking and surgery location you'll also receive a folder of information and chlorhexidine gluconate soap also known as CH g we'll go over the CH G bathing process later in the video Music here are some suggestions on things to bring to the hospital paperwork received at the readmission testing appointment ID and insurance card a list of your current medications and a toothbrush comb or brush and non-skid slippers we would suggest leaving the following at home your wallet or purse cash and credit cards jewelry and medications unless your surgeon told you otherwise if you have any additional questions about what to bring please contact your surgeon's office we suggest keeping all valuables at home unless you have someone that can keep them secured during your surgery diet prior to surgery is important especially the week leading up to surgery we recommend you follow a healthy diet rich and fruits and vegetables we suggest that you avoid alcohol completely and limit your red meat intake you'll need to stop eating solid foods after midnight the night before surgery your surgeon will advise you on consuming liquids and if there are any routine medicines you can take on the morning of your surgery if you're taking aspirin ibuprofen or are on any blood thinners please follow the instructions given by your surgeon as these may be stopped prior to your surgery Music one of the items that you'll receive in readmission testing is a bottle of chlorhexidine gluconate or CH G soap this soap helps lower the number of germs on your skin and will help prevent infections during and...

People Also Ask about

How do I document surgical clearance?

The procedures involved are as follows: Document the requesting provider's name and the reason for the preoperative medical evaluation. Forward a copy of the findings of the evaluation and management service and recommendations to the surgeon clearing the patient for surgery. Assign diagnosis code Z01.

What is surgical clearance?

Surgical Clearance is an examination that determines whether a patient is an appropriate candidate for surgery. By performing an examination and running the necessary tests, doctors can ensure that a patient will be able to tolerate the surgery safely and obtain successful results.

What is needed for surgery clearance?

Tests Before Surgery Common tests that your surgeon may ask you to have if you have not had them recently are: Blood tests such as a complete blood count (CBC) and kidney, liver, and blood sugar tests. Chest x-ray to check your lungs. ECG (electrocardiogram) to check your heart.

What does a cardiologist do to clear you for surgery?

Our Cardiology Team reviews your most recent EKG, along with any other recent heart tests. The main test involved in preoperative cardiac clearance is an EKG, which evaluates your heart's electrical activity. If you're having cardiac surgery, or if your EKG results aren't clear, you may need further testing.

What is a clearance for surgery letter?

What is a clearance letter for surgery? In the context of surgery, a medical clearance is, essentially, considered to be an authorization from an evaluating doctor that a patient is cleared, or deemed healthy enough, for a proposed surgery.

What tests are done for cardiac clearance for surgery?

Cardiac Testing for Surgical Clearance Chest Radiography. Also called a chest X-ray, chest radiography takes images of the heart and lungs. Electrocardiography. Also called an ECG or an EKG, this test records the electrical signals produced by the heart. Cardiac Stress Test. Cardiac Testing for Surgery in Irmo, SC.

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What is Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia is a formal evaluation to ensure that a patient is medically fit to undergo surgery or anesthesia. It involves a review of the patient's medical history, current health status, and any potential risks related to the procedure.

Who is required to file Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

Patients scheduled for outpatient surgeries or procedures that involve anesthesia are required to file the Houma Outpatient Surgery Center Medical Clearance. This is typically done when patients have pre-existing medical conditions or are of a certain age that may necessitate additional evaluation.

How to fill out Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

To fill out the Houma Outpatient Surgery Center Medical Clearance, patients must provide their personal information, detailed medical history, current medications, allergies, and any previous surgeries. It is advisable to consult with a healthcare provider for accurate completion.

What is the purpose of Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

The purpose of the medical clearance is to assess the patient's overall health and readiness for surgery, identify any risks, and ensure that the surgical team has all necessary information to provide safe and effective care.

What information must be reported on Houma Outpatient Surgery Center Medical Clearance for Surgery/Anesthesia?

The information that must be reported includes the patient's name, date of birth, medical history, current medications, any allergies, previous surgeries, and results of any recent medical tests or evaluations relevant to the surgery.