
Childrens National Hospital Surgical History & Physical - Interdisciplinary Patient Assessment 2009 free printable template
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111 Michigan Avenue, NW, Washington, DC 20010 Surgeon s office to complete the following: Fax completed form to: Date of surgery : Pre-op diagnosis for surgery: ICD-9 code: Proposed procedure: Surgical
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How to fill out Childrens National Hospital Surgical History Physical

How to fill out Childrens National Hospital Surgical History & Physical
01
Begin with patient identification: Write the child's name, date of birth, and medical record number at the top of the form.
02
Fill out the surgical history section: List any surgeries the child has had, including dates and types of procedures.
03
Document relevant medical history: Include any chronic illnesses, allergies, and previous hospitalizations.
04
Complete the physical examination section: Provide details on the child's current health status, including vital signs and any pertinent findings.
05
Ensure consent: If applicable, include signatures from guardians or parents indicating consent for treatment.
06
Review the form for completeness: Double-check all sections to ensure no information is missing.
Who needs Childrens National Hospital Surgical History & Physical?
01
Children who are scheduled for surgery or other medical procedures at Children's National Hospital.
02
Pediatric patients who require a comprehensive evaluation of their surgical history and physical health.
03
Guardians or parents seeking to provide detailed surgical and medical backgrounds for their child.
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What is Childrens National Hospital Surgical History & Physical?
Childrens National Hospital Surgical History & Physical is a comprehensive document that outlines a patient's medical history and physical examination, specifically tailored for surgical procedures. It helps healthcare providers to assess the patient's health status and suitability for surgery.
Who is required to file Childrens National Hospital Surgical History & Physical?
The surgical team, including surgeons, anesthesiologists, and medical staff involved in a child's care, are required to file the Childrens National Hospital Surgical History & Physical. Additionally, the child's primary care physician may also contribute to this documentation.
How to fill out Childrens National Hospital Surgical History & Physical?
To fill out the Childrens National Hospital Surgical History & Physical, healthcare providers should gather comprehensive information about the patient's medical history, current medications, allergies, previous surgeries, and other relevant health details. They should conduct a physical examination and document their findings accurately on the designated form.
What is the purpose of Childrens National Hospital Surgical History & Physical?
The purpose of the Childrens National Hospital Surgical History & Physical is to ensure a thorough understanding of the child's health status prior to surgery. It aids in identifying potential risks, planning appropriate perioperative care, and ensuring the safety of the child during and after the surgical procedure.
What information must be reported on Childrens National Hospital Surgical History & Physical?
The information that must be reported includes the patient's demographic details, medical history, current medical conditions, medication list, allergies, surgical history, family medical history, social history, and results from the physical examination.
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