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A surgical clearance form is used to determine a patients eligibility for surgery. It is used to assess the patients overall medical condition, to document any existing medical conditions that may affect the outcome of the surgery, and to verify that the patient is healthy enough for the procedure.
If it is determined that the patient can proceed with surgery, the evaluating practitioner should communicate the findings to the surgeon verbally and in writing. Document the patients record with the evaluation and findings and when and how the information was communicated to the surgeon.
Answer: Primary physician Your surgeon should be able to give you a referral for a primary doctor you can see for medical clearance. Another option is to contact your insurance carrier for primary care physicians in your area who are accepting new patients.
History and Physical Examination: Your surgeon will completely document your medical history and physical examination. Most often it is done before the day of surgery but may be done on the day of surgery too.
Pre-op consists of chest and X-rays (to check your lungs), an EKG (to check your heart), and blood tests consisting of a complete blood count (CBC) and liver and kidney blood sugar levels.
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A Medical Clearance Letter typically includes the patients name, a statement of their health condition, the healthcare professionals assessment of the patients ability to undergo the procedure or activity safely, and any recommendations for care or restrictions needed.
PREOP CLEARANCE LETTER. Please give this to the provider who will be clearing you for surgery. examined this patient, checked all appropriate lab work and tests and certify, that to the best of my knowledge, there is not a medical contraindication for undergoing elective surgery with a general and/or regional anesthesia.

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