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Pre-op screening patient form (pdf) - Le Bonheur Children 's Hospital - lebonheur 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the date of surgery and the surgeon’s name at the top of the form. Ensure these details are accurate as they are crucial for your child's procedure.
- In the Patient Information section, fill in your child’s name, date of birth, age, and contact numbers. Be sure to include all relevant phone numbers for easy communication.
- Answer all medical history questions thoroughly. If a question does not apply, write 'N.A.' to indicate that it is not relevant.
- For anesthesia information, provide details about any previous surgeries or complications. This section is vital for ensuring your child's safety during anesthesia.
- Complete the medication and allergy sections carefully. List all medications your child is currently taking and any known allergies to ensure proper care.
- Once completed, review the form for accuracy before submitting it as instructed. The surgeon's office will fax this completed form after you finish.
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