Urology Pre Surgery 1283 Order Form Physician Signature-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's Date of Birth and Surgery confirmation number at the top of the form. This information is crucial for identifying the patient and their procedure.
3. Fill in the Patient Name and contact details, including Fax number, ensuring all information is accurate for communication purposes.
4. In the Procedure Order section, clearly specify the surgical procedure being requested. This helps streamline pre-operative preparations.
5. Complete the Weight (kg) field and list any known Allergies to ensure patient safety during anesthesia and surgery.
6. Review and check off any required tests or procedures listed under Pre Admission Testing/Same Day Surgery RN criteria, ensuring compliance with medical guidelines.
7. Finally, have the physician sign and date at the bottom of the form to validate it before submission.

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