PRE -OPERATIVE CHECK LIST - 3sHealth Home
Date and Time of Surgery Surgery Verified Unit OR ... Pre -Op Teaching Done: Yes No Physical/Intellectual Challenges : (List) Health Care Directives (describe) Copies on chart Yes (If yes, check boxes) No Living Will Advanced Directive Feeding Restrictions Medication Restrictions Blood Product Restrictions Other Restrictions (Specify) Power of Attorney/Medical Proxy in place Palliative … ................
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