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How to get medical clearance for surgery without insurance

Clearance for surgery 2026

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The document outlines the pre-surgical medical clearance requirements for patients undergoing surgery at ColumbiaDoctors Ophthalmology. It specifies the necessary medical history letter and laboratory test results, including a Basic Metabolic Profile, Complete Blood Count, PT/PTT, and an EKG within the past year. These documents must be submitted to the Surgical Scheduling Office via fax at least four days before the surgery date.

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Click ‘Get Form’ to open the clearance for surgery document in the editor.
Begin by entering your name in the 'Patient Name' field. This ensures that all documentation is correctly attributed to you.
Next, input the 'Surgery Date' and specify the procedure along with your doctor's name in the designated fields.
Review the list of required laboratory tests. Ensure that you have completed a Basic Metabolic Profile, Complete Blood Count, PT/PTT, and an Electrocardiogram (EKG) within the past year.
Make sure all lab results are dated within thirty days of your surgery date and prepare to fax them to the Surgical Scheduling Office at least four days prior to your surgery.
Finally, fill in the 'Length of Procedure' and 'Type of Anesthesia' sections as instructed.

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Versions	Form popularity	Fillable & printable
2023	4.8 Satisfied (35 Votes)
2022	4.3 Satisfied (46 Votes)
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2018	4.5 Satisfied (50 Votes)

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