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
C. It is usually desirable to wear hearing aids until
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
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