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OUTPATIENT SURGERY PREOPERATIVE CONSULTATION FORM Please fax back to (717)7356894(PRE anesthesia office) and (surgeon). Consultation to be completed within 30 days of surgery and received by anesthesia

How to fill out out-patient surgery pre-operative consultation

How to fill out out-patient surgery pre-operative consultation:

1. Start by providing your personal information: Fill in your full name, date of birth, and contact information. This will ensure that the healthcare provider can reach you if needed.
2. Next, provide your medical history: Include information about any previous surgeries, medical conditions, allergies, and medications you are currently taking. It is important for the healthcare team to be aware of your medical background to ensure your safety during the procedure.
3. List any specific concerns or questions you may have: If you have any worries or doubts about the surgery, make sure to jot them down on the form. This will allow the healthcare provider to address them and provide you with the necessary information or reassurance.
4. Fill out the surgical consent form: This document confirms that you understand the risks and benefits of the surgery and that you give your informed consent to proceed. Read it carefully and ask any questions if needed before signing.
5. Provide emergency contact information: In case of any unforeseen complications or emergencies during the surgery, it is crucial to have a designated person who can be contacted. Fill in their full name, relationship to you, and contact details.

Who needs out-patient surgery pre-operative consultation:

1. Individuals scheduled for out-patient surgery: Those who are scheduled for surgery that does not require an overnight stay in the hospital will typically have a pre-operative consultation. This consultation allows the healthcare team to gather necessary information and ensure that the patient is prepared for the procedure.
2. Patients with underlying medical conditions: If you have any pre-existing medical conditions, such as diabetes, heart disease, or high blood pressure, it is vital to undergo a pre-operative consultation. This additional step helps the healthcare team assess the potential risks and develop a specialized plan for your surgery.
3. Patients taking certain medications: If you are taking medications that may interact with anesthesia or affect the surgical procedure, a pre-operative consultation becomes necessary. This allows the healthcare provider to evaluate the medications' impact and make any necessary adjustments or recommendations.

Remember, the purpose of a pre-operative consultation is to ensure your safety and optimize the surgical outcome. It is a valuable opportunity to communicate with your healthcare team, ask questions, and address any concerns you may have before undergoing surgery.

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