Get the free PRE-OPERATIVE CO-MANAGEMENT FORM - LVC Canada - lvccanada

PREOPERATIVE COMANAGEMENT FORM NAME OF COMANAGING DOCTOR: DATE: NAME OF PATIENT: PHONE NUMBER: (H) (W) (C) EMAIL ADDRESS: D.O.B (MAY) MAILING ADDRESS: UCLA ACVA REFRACTION MANIFEST CYCLE OD 20× 20×

How to fill out pre-operative co-management form

How to fill out a pre-operative co-management form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand what information is required and how to properly fill it out.
2. Begin by entering your personal information in the designated fields. This may include your full name, date of birth, contact information, and any relevant medical history.
3. Next, provide details about your upcoming surgery. Include the date, time, and location of the procedure, as well as the name of the surgeon who will be performing it.
4. If you have any known allergies or medical conditions, make sure to indicate them on the form. This is crucial information for the healthcare professionals involved in your care.
5. You may be asked to list any medications you are currently taking. Include both prescription and over-the-counter drugs, as well as any vitamins or supplements.
6. Indicate whether you have any pre-existing eye conditions or visual impairments. If applicable, provide details about previous eye surgeries or treatments you have undergone.
7. The form may also require you to state whether you have any specific concerns or questions regarding the surgery. Take this opportunity to communicate your needs and address any uncertainties you may have.
8. Finally, carefully review the completed form before submitting it. Make sure all the information is accurate and legible.

Who needs a pre-operative co-management form?

1. Patients who are scheduled for eye surgery, such as cataract removal or laser vision correction, may be required to fill out a pre-operative co-management form.
2. Optometrists often use these forms to gather relevant patient information before they refer the individual to a ophthalmologist or surgeon.
3. The purpose of the form is to ensure effective communication and collaboration between optometrists and surgeons, as they share the responsibility of managing the patient's care before, during, and after the surgery.

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What is pre-operative co-management form?

The pre-operative co-management form is a document that outlines the agreement between healthcare providers for the management of a patient before surgery.

Who is required to file pre-operative co-management form?

Both the surgeon and the primary care physician are required to file the pre-operative co-management form.

How to fill out pre-operative co-management form?

The pre-operative co-management form must be filled out with the patient's information, medical history, proposed surgery details, and the responsibilities of each healthcare provider involved.

What is the purpose of pre-operative co-management form?

The purpose of the pre-operative co-management form is to ensure that all healthcare providers are aware of their roles in the management of the patient before surgery.

What information must be reported on pre-operative co-management form?

The pre-operative co-management form must include the patient's personal information, medical history, surgical procedure details, post-operative care plan, and signatures of the healthcare providers involved.