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Staff member calling?
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Time of call:
|
|
Date of call.
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Procedure(s)
|
|
Medication allergies:
|
Materials allergies (latex, iodine, etc.)
|
|
Name/Number of transport / after care:
|
Anesthesia type:
• • •
|
|
Bathing instructions relayed?
|
Do not drink water after brushing teeth AM of surgery.
|
|
Bring list of medications and dosages.
|
PCP cleared D/C of all blood thinners?
|
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Adult to drive home and stay with them 24 hours.
|
Informed no valuables, jewelry, watches etc?
|
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All preop recommendations of PCP completed?
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No important personal or business decisions postop?
|
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Post op emergencies to ED, not ASC.
|
NPO after midnight reminder?
|
|
Time instructed to arrive:
|
Explain any NO answers above.
|
