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Pre-Operative Anesthesia Health Form - Delaware Surgery Center

Pre-Operative Anesthesia Health Form - Delaware Surgery Center 2025

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The document is a pre-operative evaluation form for patients at the Delaware Surgery Center. It collects essential patient information, including personal details, medical history, current medications, allergies, and previous surgeries. The form also includes sections for assessing various health conditions such as cardiac, pulmonary, and neurological issues. Additionally, it outlines pre-operative instructions and requirements for anesthesia evaluation on the day of surgery.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name, date of birth, and scheduled procedure date at the top of the form. Ensure accuracy as this information is crucial for your medical records.
Fill in your contact details including home, work, and cell phone numbers. This allows the surgery center to reach you if necessary.
Complete the 'PRE-OPERATIVE DEPARTMENT' section by indicating any verbalizations or other relevant notes.
In the 'TESTING' section, check off any tests that have been completed or are required prior to your procedure.
List all allergies and current medications in their respective sections. Be thorough to ensure your safety during anesthesia.
Answer questions regarding previous operations, pain levels, and any recent hospitalizations to provide a comprehensive health overview.
Finally, review all entries for accuracy before saving or submitting the form through our platform.

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How do you prepare for anesthesia before surgery?

Pre-Operative Instructions: Anesthesia DO NOT EAT OR DRINK ANYTHING (INCLUDING WATER) FOR 6 HOURS BEFORE YOUR SURGERY. DO NOT SMOKE OR DRINK ALCOHOL 24 HOURS PRIOR TO SURGERY. DO NOT DRIVE OR OPERATE HAZARDOUS MACHINERY THE SAME DAY AFTER SURGERY. DO NOT WEAR LONG-SLEEVE SHIRTS OR JEANS.

When to schedule a pre-op appointment?

Pre-op Checkup This checkup usually needs to be done within the month before surgery. This gives your providers time to treat any medical problems you may have before your surgery. During this visit, you will be asked about your health over the years.

How many days before surgery is a pre-op appointment?

Which Surgical Procedures Are the Most Dangerous? Brain surgery. One of the most dangerous procedures is any type of surgery on the brain or skull. Heart surgery. Cancer surgery. Transplants. Spinal cord surgery. What if my doctor made a mistake during my surgery?

What is a preop clinic?

Preoperative Clinic Patients are thoroughly evaluated to ensure their health is optimized prior to surgery. The Preoperative Clinic provider works with the patient and the surgeon to develop an evidence-based pre- and post-surgery plan of care tailored to the individual.

What are the top 3 riskiest surgeries?

Depending on your insurance, procedure, and physician, it typically takes anywhere from 2 weeks to 2 months from your initial consultation to your surgery.

What is an anesthesia pre-op appointment?

A thorough anaesthetic pre-assessment should be performed on all patients prior to surgery. The aim of pre-assessment is to: establish a good rapport with the patient. make sure the patient is fit and optimally prepared for surgery.

Pre-Operative Anesthesia Health Form - Delaware Surgery Center 2025

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