PRE SURGICAL TESTING REQUIREMENTS HISTORY AND …
PLEASE REVIEW THE FOLLOWING GUIDELINES WHICH WERE APPROVED BY THE MEDICAL BOARD BEFORE COMPLETING THE FORM
PRE SURGICAL TESTING REQUIREMENTS
HISTORY AND PHYSICAL
All Patients
EKG
Any patient with Diabetes, Hypertension, Cardiac, Vascular, Pulmonary, Renal, or Hepatic Disease
All patients >50 years old
Within 30 days of surgery Within 6 months of surgery
CHEST X-RAY
LABORATORY WORK
Healthy Patient
General Anesthesia none
Diabetes Hypertension Cardiac/Pulmonary Renal
BMP
Liver disease
CBC, BMP PT/PTT, LFT
Coumadin therapy
INR
Not required
MAC none BMP
Within 30 days of surgery
Anterior Chamber Surgery- MAC only
none none
CBC, BMP PT/PTT
INR
none none
For history of anemia or for surgeries where blood loss is expected to be >200cc, please include CBC For patients on kidney dialysis, K+ should be obtained day of surgery All diabetic patients glucose levels (i.e. finger stick) to be checked day of surgery Urine pregnancy day of admission for all women of menstruating age For patients with AICDs, please see NYEE's policy concerning defibrillators
Patients with more complex medical conditions may require further workup (i.e stress tests, echocardiogram, cardio/pulmonary consult, etc). Please consult anesthesia department or patient's PMD.
CBC = complete blood count, BMP = basic metabolic profile, LFT = Iiver ftinction test, K+ = potassium PT/PTT/INR = prothrombin time/partial prothrombin time/international normalized ratio AlCD = internal cardiac defibrillator
06/2014
adm.020bForm Fast 3/09
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