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AS2C014 ASC Anesthesia Flow Sheet Stony Brook Medicine Production Examination & Evaluation Lungs Heart Airway Date Time ALLERGIES: Resident/CRNA SIG. ID# MD SIG. ID# ASA: Anesthesia Tourniquet Pressure:
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How to fill out Stony Brook Medicine ASC:

01
Obtain the ASC form: Visit the Stony Brook Medicine website or the ASC office to download or obtain a hard copy of the ASC form.
02
Personal information: Begin by filling out your personal information such as your name, date of birth, address, and contact details in the designated sections.
03
Medical history: Provide details about your medical history, including any pre-existing conditions, previous surgeries, current medications, allergies, and family medical history if required.
04
Insurance information: If you have health insurance, include your insurance provider's name, policy number, and any other requested information. If you do not have insurance, make sure to provide necessary information as instructed.
05
Emergency contact: Fill in the name, relationship, and contact information for someone who should be contacted in case of an emergency during your visit to the ASC.
06
Authorized representative: If you would like to designate someone as your authorized representative, include their information in this section.
07
Consent and acknowledgments: Read through the consent and acknowledgment sections carefully, and sign where required to indicate that you understand and agree to the stated terms.
08
Date and signature: Sign and date the form to complete the process.

Who needs Stony Brook Medicine ASC:

01
Patients visiting Stony Brook Medicine for an outpatient procedure or surgery will likely need to fill out the ASC form.
02
Individuals seeking medical care and treatment at the Stony Brook Medicine Ambulatory Surgery Center will be required to complete the ASC form.
03
Anyone undergoing a medical procedure or surgery at Stony Brook Medicine's ASC will need to provide their personal and medical information through the ASC form.
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Stony Brook Medicine ASC is a Ambulatory Surgery Center affiliated with Stony Brook Medicine.
Physicians and healthcare providers operating within the Stony Brook Medicine ASC are required to file.
To fill out Stony Brook Medicine ASC, healthcare providers must provide required patient and procedural information.
The purpose of Stony Brook Medicine ASC is to accurately report surgeries and procedures conducted at the facility.
Information such as patient demographics, procedure details, and outcomes must be reported on Stony Brook Medicine ASC.
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