Surgical Reservation Form - Rush University Medical Center - rush 2026

1. Click ‘Get Form’ to open the Surgical Reservation Form in the editor.
2. Begin by entering the patient's name, including last name, first name, and middle initial. Ensure accuracy as this information is crucial for identification.
3. Fill in the patient’s date of birth and sex. This data helps in verifying the patient's identity and medical history.
4. Provide contact details such as work phone, home phone, and mobile phone numbers to facilitate communication regarding the surgery.
5. Specify the requested surgery date and time. This section is vital for scheduling purposes.
6. Complete the case order and surgeon's details, including their office phone number for any necessary follow-ups.
7. Indicate the patient class (in-house/ED, inpatient/admit after surgery, observation, outpatient) to clarify the patient's status.
8. Fill out additional sections like pre-op diagnosis, anticipated length of stay (LOS), and any required procedures or implants needed.

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