Saint Louis University Orthopaedic Sports Medicine Patient Surgical Clearance Form 2016-2024 free printable template

Saint Louis University Department of Orthopaedic Surgery Orthopaedic Sports Medicine Patient Surgical Clearance Form Scott Kaar MD Adnan Cutuk MD Patient Name Today s Date Diagnosis Planned Surgical Date / Please fax recent CMP CBC PT INR PTT UA CXR EKG Patient is medically cleared for surgery on Peri-operative comments/recommendations Clearing Physician s Name Signature Please fax this form to 314 268-5121 and any other relevant documentation to...

How to fill out surgical clearance form

How to fill out pre op dental clearance:

1. Contact your dentist or oral surgeon to schedule a preoperative dental exam.
2. Provide your dental and medical history, including any previous dental treatments or surgeries, as well as any underlying medical conditions or allergies.
3. Inform your dentist/surgeon about any medications you are currently taking, including over-the-counter drugs, supplements, or herbal remedies.
4. Undergo a thorough dental examination, which may include X-rays, to assess your oral health and identify any potential dental issues that may affect your surgery.
5. Follow any preoperative instructions given by your dentist/surgeon, such as avoiding certain foods and drinks, fasting, or discontinuing certain medications before the procedure.

Who needs pre op dental clearance:

1. Patients undergoing any type of oral or dental surgery, such as tooth extraction, dental implant placement, or jaw reconstruction.
2. Individuals with a history of dental or gum infections, as these can increase the risk of complications during surgery.
3. Patients with certain medical conditions, such as heart disease, diabetes, or autoimmune disorders, which may require special precautions or modifications during dental procedures.
4. Patients who are taking medications that may affect dental care or increase the risk of bleeding or infection, such as blood thinners or immunosuppressants.

People Also Ask about surgical clearance form

Why do you need dental clearance for hip surgery?

Request Dental Clearance Before Surgery More and more surgeons are requiring that their patients get clearance from their dentist before hip and knee replacements to help decrease the risk of pre-existing infection traveling to the surgical site.

What is a full dental clearance?

Full dental clearance This is the procedure of removing and replacing all of a person's teeth, perhaps as a result of periodontal disease or abscessed teeth. This can make a big improvement to a person's oral health and general health.

What do you need for dental clearance?

Prior to surgery, it is important to verify that the patient has had a dental exam within the past 6 months, has no current dental infection, no active cavities, gum disease, abscessed teeth, fractured teeth or fillings, loose teeth or other oral pathology and no anticipation of dental care within the next 6 months.

What is a dental clearance?

What is dental clearance? Dental clearance is communication between a medical provider and a patient's dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment prior to the medical/surgical treatment.

Why do you need a dental clearance for surgery?

ANSWER: A dental exam before surgery helps to rule out dental abscesses, dental infection or gum (periodontal) disease. This is important because dental infections may lead to bacteria entering the bloodstream that could settle into surgical areas and cause complications.

Why do I need dental clearance before surgery?

ANSWER: A dental exam before surgery helps to rule out dental abscesses, dental infection or gum (periodontal) disease. This is important because dental infections may lead to bacteria entering the bloodstream that could settle into surgical areas and cause complications.

What is dental clearance for surgery?

What is dental clearance? Dental clearance is communication between a medical provider and a patient's dentist to validate that planned medical/surgical treatment is safe for the patient and to review the potential need for dental treatment prior to the medical/surgical treatment.

How do I get a dental clearance?

A: There are 2 possible avenues to the submission of a dental clearance. First, if the patient's evaluation and salivary analysis are unobjectionable, the dentist should provide the physician with a written letter of explicit clearance along with copies of the salivary analysis and periodontal charts.

For pdfFiller’s FAQs

What is pre op dental clearance?

Pre-op dental clearance refers to the evaluation and assessment of a patient's oral health status prior to undergoing a surgical procedure. It involves a dental examination to identify and address any dental issues that can potentially lead to complications during or after the surgery. This clearance ensures that the patient's oral health is optimal and reduces the risk of infection or other problems that may arise from compromised dental health.

Who is required to file pre op dental clearance?

Typically, individuals who are planning to undergo certain medical procedures or surgeries—including dental surgeries—are required to obtain pre-operative dental clearance. This requirement may vary depending on the specific procedure, the medical condition of the patient, and the policies of the healthcare provider. In general, patients with certain medical conditions or risk factors such as heart disease, diabetes, respiratory conditions, compromised immune systems, or a history of complications during dental treatments may be required to obtain dental clearance before undergoing dental surgery. The decision to require pre-operative dental clearance is usually made by the healthcare provider or dental surgeon in consultation with the patient's primary care physician or relevant specialists.

What is the purpose of pre op dental clearance?

The purpose of pre-operative dental clearance is to evaluate a patient's oral health status before a surgical procedure. It helps to identify any potential dental issues that may interfere with the procedure or the patient's overall health and well-being. Dental clearance ensures that the patient is in good oral health, minimizing the risk of complications during surgery, such as infections or bleeding. Additionally, it allows the dental team to provide any necessary treatments or dental emergency care before proceeding with the surgical procedure.

What is the penalty for the late filing of pre op dental clearance?

Penalties for the late filing of a pre-op dental clearance can vary depending on the specific policies and regulations of the dentist or healthcare provider. In some cases, there may be no direct penalty, but the scheduled surgery could be delayed or canceled if the necessary clearance is not received in time. Additionally, some providers may charge a fee for late submissions or rescheduling appointments. It is best to check with your specific dentist or healthcare provider to understand their policies regarding late filing of pre-op dental clearances.

How to fill out pre op dental clearance?

When filling out a pre-op dental clearance form, follow these steps: 1. Personal information: Provide your full name, date of birth, contact information, and any other relevant personal details. 2. Medical history: Fill in your medical history, including any ongoing medical conditions, previous surgeries, allergies, and current medications you are taking. Mention any heart problems, respiratory conditions, bleeding disorders, diabetes, high blood pressure, or any other medical issues that your dentist needs to be aware of. 3. Dental history: Describe any dental procedures you have had in the past, including extractions, root canals, implants, or any ongoing dental treatment you are receiving. 4. Current dental issues: Indicate any current dental problems, such as tooth pain, gum inflammation, loose teeth, or any other concerns you have. 5. Medications and allergies: Provide a comprehensive list of all medications you are currently taking, including any over-the-counter drugs, supplements, or herbal remedies. Additionally, mention any known allergies to medications, latex, or other substances. 6. Previous dental clearance: If you have had a dental clearance in the past, mention the date and details. 7. General health information: Answer any questions regarding your general health, such as your smoking status, alcohol consumption, recent illnesses, and immunization history. 8. Emergency contact information: Provide the name and contact details of a person to be notified in case of an emergency during your dental procedure. 9. Signature and date: Sign and date the form to verify that the information provided is accurate to the best of your knowledge. Remember, it is important to answer all the questions truthfully and in detail, as it ensures the dentist can appropriately assess any potential risks during your dental procedure.

What information must be reported on pre op dental clearance?

The information that must be reported on preoperative dental clearance includes: 1. Medical history: This includes any pre-existing medical conditions, current medications, previous surgeries, allergies, and any other relevant medical information. 2. Previous dental history: This includes any previous dental treatments, surgeries, or dental conditions that may impact the procedure or anesthesia. 3. Oral health status: The current oral health condition, including the presence of cavities, gum disease, infections, or any other oral health issues, should be reported. 4. Radiographs: Any recent dental X-rays or radiographs should be included in the report to provide a comprehensive understanding of the oral health status. 5. Current treatment plan: The planned dental procedure, including the type of treatment, extent of surgery, and any additional procedures, should be clearly outlined in the preoperative clearance. 6. Anesthesia considerations: If the procedure requires anesthesia, the report should include the type of anesthesia planned, any specific requirements for sedation, and any known risks or complications associated with anesthesia. 7. Recommendations: Based on the patient's oral health status and medical history, any recommendations or precautions for the dental procedure should be included. It is important to note that the specific requirements for preoperative dental clearance may vary depending on the dental practice, the complexity of the procedure, and the patient's medical condition. Therefore, it is always recommended to consult with the dentist or oral surgeon for any specific instructions or requirements.

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