Anesthetic Plan - Stanford University

[Pages:1]Name Age:

PMH:

Surgery

PSH:

Diagnosis:

MEDS:

Surgeon Attending:

Room:

H:

W:

Allergies:

Labs/Studies:

History:

h/o Anesthesia: Airway Exam: Exam Other:

Anesthetic Plan:

PTT PT/INR:

EKG:

Echo:

CXR: Other:

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\Name

Surgery

Diagnosis:

Surgeon

Room:

Age:

Attending:

H:

W:

PMH:

PSH:

MEDS:

Allergies:

Labs/Studies:

History:

h/o Anesthesia: Airway Exam: Exam Other:

Anesthetic Plan:

PTT PT/INR:

EKG:

Echo:

CXR: Other:

For a copy email: jared.pearson@

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