Childrens National Hospital Surgical History & Physical - Interdisciplinary Patient Assessment 2019-2025 free printable template

111 Michigan Avenue NW Washington DC 20010 Surgeon s office to complete the following Fax completed form to ______________________ Date of surgery _____________ Pre-op diagnosis for surgery _________________ ICD-9 code _________________ Proposed procedure _____________________________________________________ Surgical History Physical - Interdisciplinary Patient Assessment Chief Complaint __________________________________________________________ History of Present Illness/Injury...

How to fill out

How to fill out Childrens National Hospital Surgical History & Physical

1. Obtain a copy of the Childrens National Hospital Surgical History & Physical form.
2. Begin by filling out the patient's personal information at the top of the form, including name, date of birth, and medical record number.
3. Provide a detailed account of the patient’s surgical history, including any previous surgeries, dates, and outcomes.
4. List any current medical conditions or diagnoses that the patient has.
5. Include a comprehensive medication list, detailing prescription and over-the-counter medications the patient is taking.
6. Document any known allergies, particularly to medications, anesthetics, or other substances.
7. Complete the family medical history section, noting any hereditary diseases or conditions.
8. Fill out the patient’s immunization records, ensuring that all vaccinations are up to date.
9. Sign and date the form to confirm that the information provided is accurate and complete.

Who needs Childrens National Hospital Surgical History & Physical?

1. Parents or guardians of children who are scheduled for a surgical procedure at Childrens National Hospital.
2. Healthcare providers who require a detailed surgical history and physical examination for pre-operative assessments.
3. Pediatric patients undergoing evaluations for surgery or needing consultations related to surgical procedures.

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What is Childrens National Hospital Surgical History & Physical?

Childrens National Hospital Surgical History & Physical is a comprehensive document that outlines a patient's medical history, current health status, and relevant surgical information prior to undergoing a procedure.

Who is required to file Childrens National Hospital Surgical History & Physical?

The surgical history and physical must be filed by the attending physician or surgeon responsible for the patient's care and procedure.

How to fill out Childrens National Hospital Surgical History & Physical?

To fill out the Surgical History & Physical, a healthcare provider should gather detailed medical history, perform a physical examination, document findings, and ensure all sections are completed accurately according to the guidelines provided by Childrens National Hospital.

What is the purpose of Childrens National Hospital Surgical History & Physical?

The purpose of the Surgical History & Physical is to ensure that all relevant medical information is reviewed and documented in order to assess the patient's fitness for surgery and to plan for their perioperative care.

What information must be reported on Childrens National Hospital Surgical History & Physical?

The information that must be reported includes the patient's medical history, current medications, allergies, previous surgeries, family medical history, physical examination findings, and any other pertinent health information.