Surgical medical clearance form 2026

1. Click ‘Get Form’ to open the surgical medical clearance form in the editor.
2. Begin by entering the patient's name, phone number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the pre-op date and surgery date. This helps your primary care physician understand the timeline for clearance.
4. Provide details about the proposed surgery and anesthesia type. This section informs the physician about what they are clearing the patient for.
5. Document any significant past medical history and previous operations. This information is vital for assessing the patient's overall health.
6. List any drug allergies and current medications, including dosages, to ensure safe surgical practices.
7. Complete the vital signs section (blood pressure, pulse) and any relevant physical examination findings.
8. Finally, indicate whether the patient is cleared for surgery by checking 'YES' or 'NO', then have your physician sign and date the form before submission.

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