Preoperative history and physical examinations and evaluations
WRHA SURGERY PROGRAM PREOPERATIVE History & Physical Form This form must be submitted to site at least 14 days prior to surgery date. Failure to do so may result in cancellation. ENSURE ALL CONTACT INFORMATION ON BOOKING CARD IS CORRECT. Page 2 of 2 06/16 PART C – PHYSICAL (Note any active or unstable system findings) ................
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