Get the free 070 Anesthesia Periop Evaluation 022916

PELOSI MEDICAL CENTER Patient Name: ANESTHESIA PERIOPERATIVE EVALUATION Date Time NPO Since Birthdate: / / 070 MR #: ALLERGIES MEDICAL HISTORY MEDICATION RECONCILIATION FORM REVIEWED AIRWAY SURGICAL

How to fill out 070 anesformsia periop evaluation

How to fill out 070 anesthesia periop evaluation:

1. Start by entering the patient's personal information, including their name, date of birth, and medical record number, in the designated fields.
2. Provide the date and time of the evaluation, ensuring it is accurate and matches the actual evaluation appointment.
3. Assess the patient's medical history by reviewing any previous surgeries, anesthesia experiences, and medical conditions. Fill out all relevant information in the appropriate sections.
4. Evaluate the patient's current medications, both prescribed and over-the-counter. Include any allergies or adverse reactions they may have had in the past.
5. Assess the patient's physical status by obtaining vital signs such as blood pressure, heart rate, and oxygen saturation. Document these values accurately.
6. Evaluate the patient's airway, breathing, and circulation to determine if there are any concerns or risks associated with anesthesia administration. Note any potential issues or abnormalities.
7. Assess the patient's mental status by evaluating their level of consciousness and cognitive function. Document any abnormalities or concerns.
8. Consider the patient's ASA physical status classification, which categorizes their overall health and helps determine the level of risk associated with anesthesia.
9. Review any additional tests or consultations required before the surgery, such as laboratory work or specialist evaluations. Document the necessary actions.
10. Provide a brief summary and recommendation based on the evaluation, including whether the patient is fit for surgery, any concerns or precautions to consider, and any specific interventions recommended.

Who needs 070 anesthesia periop evaluation:

1. Patients scheduled to undergo surgery that requires anesthesia.
2. Individuals with a history of previous anesthesia complications or adverse reactions.
3. Patients with significant medical conditions or complex medical histories that could impact the administration of anesthesia.
4. Those who may require specialized or high-risk anesthesia techniques.
5. Individuals with certain risk factors or comorbidities that may affect their response to anesthesia, such as obesity, cardiovascular disease, or compromised respiratory function.
6. Patients scheduled for procedures involving major organ systems, extensive surgical interventions, or prolonged anesthesia duration.
7. Individuals participating in clinical research or certain study protocols that necessitate anesthesia evaluation.
8. Patients who have been referred for anesthesia consultation by their primary care physician or surgeon.

Note: The specific criteria for who needs a 070 anesthesia periop evaluation may vary based on institutional policies, the nature of the surgery, and the anesthesiologist's or surgeon's discretion. Consultation with a healthcare professional is essential to determine individual needs.

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