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Pre op physical exam template

Preoperative history and physical form 2026

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The document is a Preoperative History & Physical Form for the WRHA Surgery Program, which must be submitted at least 14 days before surgery. It includes sections for patient alerts, medical history, physical examination details, optimization strategies to reduce postoperative complications, and laboratory screening requirements. The form emphasizes the importance of accurate contact information and outlines necessary preoperative tests based on the type of surgery.

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Click ‘Get Form’ to open the preoperative history and physical form in our editor.
Begin by filling out your personal information, including your name, proposed surgery date, and contact details. Ensure all information is accurate to avoid any delays.
In Part A, address alerts such as previous adverse reactions or the need for an interpreter. Provide detailed descriptions where necessary.
Move to Part B to document your medical history. Indicate tobacco use, alcohol consumption, and any medications you are currently taking. Attach additional notes if required.
Complete Part C by entering your physical measurements like height and weight. Note any abnormal findings in the review of systems section in Part D.
Finally, ensure that all sections are filled out completely before submitting the form at least 14 days prior to your surgery date.

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What does a history and Physical include?

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

Pre-operative assessment This is an appointment with a nurse, either in person or as a video or telephone call. Youll be asked questions about your health, medical history and home circumstances. If the assessment involves a visit to the hospital, some tests may be carried out.

What is a preoperative history and physical?

Preparing for Surgery Stop drinking and eating for a certain period of time before the time of surgery. Bathe or clean, and possibly shave the area to be operated on. Undergo various blood tests, X-rays, electrocardiograms, or other procedures necessary for surgery.

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