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PreProcedure (Intake) Advanced Directives on File ___ Smoking Status ___ Tobacco Use ___ Diabetes No Yes, ___ Hypertension No Yes; PVD No Yes; Pt History CAD No ; Family He of CAD No Yes; Dyslipidemia
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01
Begin by providing personal information such as name, date of birth, and contact information.
02
Fill out any medical history forms accurately, including past surgeries, medications, and allergies.
03
List any current health conditions or symptoms you may be experiencing.
04
Provide information about any current medications you are taking, including dosage and frequency.
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Disclose any known drug allergies or sensitivities.
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Answer any specific questions related to the procedure you will be undergoing.
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Review all information for accuracy before submitting the intake form.

Who needs pre-procedure intake?

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Anyone who is scheduled to undergo a medical procedure or treatment may need to fill out a pre-procedure intake form.
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Pre-procedure intake is the process of collecting information from patients before a medical procedure.
Patients scheduled for a medical procedure are required to file pre-procedure intake.
Patients can fill out pre-procedure intake forms provided by the healthcare facility or online portal.
The purpose of pre-procedure intake is to gather necessary information about the patient's health history, medications, and allergies to ensure a safe and successful medical procedure.
Information such as medical history, current medications, allergies, and contact details must be reported on pre-procedure intake forms.
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