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Click ‘Get Form’ to open the preoperative history and physical examination form in the editor.
Begin by entering the patient's last name, first name, middle initial, age, gender, surgery date, surgeon's name, and procedure details in the designated fields.
In the medical history section, list any relevant medical conditions or past surgeries. Use bullet points for clarity.
Document current medications along with their dosages and note any drug sensitivities and reactions in the provided fields.
Indicate immunization status and check 'Yes' or 'No' for latex sensitivity as applicable.
Fill in vital signs including pulse, blood pressure, temperature, height, and weight accurately.
Complete the general assessment and specific examinations (HEENT, heart, lungs, abdomen) by providing detailed observations.
Finally, based on your evaluation, indicate whether the patient is stable for surgery or not ready for surgery. Ensure to sign and date the form before submission.

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What is the difference between a pre-op physical and a regular physical?

A pre-op exam assesses your overall health prior to undergoing a surgical procedure, to determine if there are any potential risks for complications that need to be addressed in advance. It also helps determine if youll need any special care during or after your surgery.

What does a pre-op physical exam consist of?

The medical staff will carefully explain the surgery to you before you have it. This includes why you are having it, any risks of the surgery, and what you can expect afterward. You will also be asked to sign an informed consent form. It explains the procedure and its risks and benefits.

What are forms that are given before surgery?

Most surgery centres and hospitals also have a before-surgery form for you to fill out. This form usually includes questions about your past and current health. This information helps the surgical team prepare for your surgery. You most likely will complete the form 1 to 3 days before your surgery.

What to expect at a pre-op physical?

Common tests that your surgeon may ask you to have if you have not had them recently are: Blood tests such as a complete blood count (CBC) and kidney, liver, and blood sugar tests. Chest x-ray to check your lungs. Electrocardiogram (ECG) to check your heart.

pre op physical exam template

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