Pre-admission screening pre-operative order sheet - UPMC 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's information in the 'PATIENT LABEL' section, including their name, date of birth, and surgical date.
3. Fill in the 'ORDERING PHYSICIAN' details, including their name, phone number, and fax number for communication purposes.
4. Specify the 'INDICATION / DIAGNOSIS CODE' relevant to the patient's condition to ensure accurate processing.
5. In the 'PROCEDURE / TEST' section, list any required diagnostic tests along with their locations and scheduled dates/times.
6. Complete any necessary laboratory tests by checking appropriate boxes under HEMATOLOGY, COAGULATION, CHEMISTRY, URINE, and other relevant sections.
7. Ensure all fields are filled accurately before signing off on the document at the bottom where indicated.

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