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ATTENDING ANESTHESIOLOGISTS STATEMENT OF SERVICES Jonson Kim, DDS State License: 28856 NPI: 1316019995 Date of Service NOTE TO INSURANCE CARRIERS: The anesthesiologist provided no surgical services.

How to fill out attending anesformsiologist s statement

How to fill out attending anesthesiologist's statement:

1. Start by providing your personal information such as your full name, date of birth, and contact details.
2. Include the details of the medical facility or hospital where the procedure is being performed, including the name, address, and contact information.
3. Fill in the date of the procedure or surgery.
4. Provide a brief description of the procedure or surgery that will be performed. Specify whether it is a general anesthesia or a regional/local anesthesia.
5. Indicate any pre-existing medical conditions or allergies that the anesthesiologist should be aware of.
6. List any medications you are currently taking, including prescription drugs, over-the-counter medications, and herbal supplements. Be sure to include the dosage and frequency of each medication.
7. Mention any previous experiences with anesthesia and if you had any complications or adverse reactions in the past.
8. If you have a specific anesthesiologist that you prefer or if you have any preferences regarding the type of anesthesia to be used, make sure to communicate that in the statement.
9. If you have any concerns or questions about the anesthesia, include them in the statement to discuss with the anesthesiologist.
10. Sign and date the attending anesthesiologist's statement before submitting it to the medical facility or hospital.

Who needs attending anesthesiologist's statement:

1. Patients undergoing any surgical procedure that requires anesthesia will typically need to fill out an attending anesthesiologist's statement.
2. This statement is essential for the anesthesiologist to gather important medical history, evaluate any risks or complications, and determine the appropriate anesthesia plan for the patient.
3. The statement is also crucial for ensuring the patient's safety and well-being during the procedure, as the anesthesiologist needs to be aware of any potential allergies, medical conditions, or medications that may interact with the anesthesia.

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What is attending anesthesiologist's statement?

The attending anesthesiologist's statement is a document that provides details about the anesthetic care administered to a patient.

Who is required to file attending anesthesiologist's statement?

The attending anesthesiologist or their designated representative is required to file the statement.

How to fill out attending anesthesiologist's statement?

The attending anesthesiologist must fill out the statement with accurate information regarding the patient's anesthesia care.

What is the purpose of attending anesthesiologist's statement?

The purpose of the statement is to document the anesthetic care provided to the patient for medical and legal purposes.

What information must be reported on attending anesthesiologist's statement?

The statement should include details about the anesthesia administered, any complications or adverse events, and the patient's response to the anesthesia.