| 
               Pre-Op Exam 
  
  
  
  
 | 
          
            
               HPI 
  
  
  
  
 | 
          
          
| 
               Clearance 
  
  
  
  
 | 
          
            
               Allergies 
  
  
  
  
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| 
               Medications 
  
  
  
  
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               Past Medical History 
  
  
  
  
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| 
               Social History 
  
  
  
  
 | 
          
            
               Past Surgical History 
  
  
  
  
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| 
               Family History  
  
  
  
  
 | 
          
            
               Vital Signs 
  
  
  
  
 | 
          
          
| 
               Labs 
  
  
  
  
 | 
          
            
               Chest X-Ray 
  
  
  
  
 | 
          
          
| 
               EKG 
  
  
  
  
 | 
          
            
               Review of Systems 
  
  
  
  
 | 
          
          
| 
               Physical Exam 
  
  
  
  
 | 
          
            
               Impression 
  
  
  
  
 | 
          
          
| 
               Plan 
  
  
  
  
 | 
          
            
               | 
          
          
