Patient Counseling Checklist

Patients will be contacted prior to the procedure to review 
pre-procedure restrictions, if any, and to assure that they 
understand all instructions.  Patients will be given the 
opportunity to ask questions regarding the facility as well 
as to obtain logistical information.
1.  Confirm with the patient:
    - Date, day and time of surgery
    - Address of office
    - Time patient should arrive at the office
2.  Remind the patient:
    A.  No make-up, jewelry, purse or other valuables;
    B.  No dentures, partial dental plates, glasses, or 
        contact lenses.
    C.  It is usually desirable to wear hearing aids until 
        procedure starts;
    D.  Children who are not patients should not be brought 
        to the waiting room.
    E.  Patients undergoing IV sedation or general 
        anesthesia should not eat anything for eight hours 
        prior to admission.  Diabetics and those with special
        requirements should follow instructions received from
        their surgeon.

        Colonoscopy prep is an exception and can be taken upto 3 hours before procedure.
    F.  Aspirin and NSAID's will have been discontinued a
        week prior to surgery; if this did not occur, the
        surgeon will be immediately notified.
  G.  If the patient is on anticoagulants, any special
        instructions of the surgeon will be reviewed for 
        proof of compliance.
3.  Evidence of pre-operative medical clearance from the
    patient's primary care physician or completion of 
    requested pre-operative laboratory or x-ray studies will
    be present on the patient chart.  All such documents will
    be initialed or otherwise authenticated by the physician
    scheduled to perform the procedure.  
4.  Listing of all medications currently being taken by the 
    patient, including strength and dosage.  This listing 
    will include all over-the-counter preparations used by
    the patient on a regular basis.
5.  The patient must supply the name and telephone number of 
    the caregiver who will be driving the patient and 
    assisting in the patient's care after surgery.
Approved By Governing Board    
Control #55.0