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SURGERY SCHEDULING SHEET PHYSICIANS PRE-ADMISSION TESTING ORDERS PLEASE FAX TO 866-647-0527 ALONG WITH COPY OF INSURANCE CARD NAME SURGERY DATE ADDRESS PROCEDURE CPT ARRIVAL TIME CIRCLE ONE PHONE H R L DIAGNOSIS ICD9 C SS SURGEON DOB REFERRING PHYSICIAN ALLERGIES PCP ANESTHESIA TYPE OP TEST DONE 23HR OBSERVATION WHERE Anesthesia ELECTROLYTE Protocol EKG INPATIENT PANEL K CBC BLOOD HEMOCUE BASIC METABOLIC BUN CR NA K CL CO2 Glucose COMPREHENSIVE METABOLIC PANEL Albumin Phosphate AST GLUCOSE PT...
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How to fill out surgery schedule template excel
How to fill out a surgery scheduling sheet:
01
Start by entering the patient's personal information, including their name, date of birth, contact information, and insurance details.
02
Include the type of surgery being scheduled, along with any specific instructions or requirements from the surgeon or medical team.
03
Indicate the preferred date and time for the surgery, taking into consideration the availability of the surgical team and operating room.
04
Include any necessary pre-operative instructions, such as fasting or medication restrictions, that the patient needs to follow before the surgery.
05
Note any additional procedures or tests that need to be completed prior to the surgery, such as blood work or imaging studies.
06
Include any special equipment or room setup requirements for the surgery, such as specific surgical instruments or a specific operating room layout.
07
Make sure to document any specific patient preferences or accommodations, such as the need for a translator or any cultural or religious considerations.
08
Obtain any necessary signatures or consents from the patient or their legal representative.
09
Review the completed scheduling sheet for accuracy and completeness before submitting it to the appropriate department or personnel.
Who needs a surgery scheduling sheet:
01
Surgeons: They need the scheduling sheet to plan and organize their surgical procedures.
02
Medical staff: Nurses, anesthesiologists, and other medical professionals rely on the scheduling sheet to know when and where surgeries will take place and what preparations are needed.
03
Patients: Having a surgery scheduling sheet ensures that patients are aware of the details, instructions, and necessary preparations for their upcoming procedure. It helps them to be informed and prepared.
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What is the purpose of surgery scheduling sheet?
The purpose of a surgery scheduling sheet is to provide a document that outlines the surgical procedures that need to be performed, the timing of the procedures, and any necessary pre-operative instructions. It is designed to help surgical teams plan and coordinate care for the patient in an efficient and organized manner.
What information must be reported on surgery scheduling sheet?
1. Patient name2. Procedure to be performed3. Date and time of surgery4. Surgeon's name5. Anesthesiologist's name6. Pre-operative instructions7. Any special equipment needed for the procedure8. Room number and type of facility (e.g., hospital or clinic)9. Any special preparation required10. Scheduled start and end times
When is the deadline to file surgery scheduling sheet in 2023?
The deadline for filing the surgery scheduling sheet in 2023 will depend on the specific hospital or clinic in which you are receiving care. It is recommended that you contact your healthcare provider directly for the most up-to-date information.
What is the penalty for the late filing of surgery scheduling sheet?
Penalties for late filing of surgery scheduling sheets vary depending on the hospital or clinic that is involved. In some cases, there may be no penalty for late filing, while in other cases, the medical staff may receive a warning or a fine.
What is surgery scheduling sheet?
A surgery scheduling sheet is a document used in healthcare facilities to organize and allocate surgical procedures. It typically contains relevant information about the patient and the surgery, including the date and time of the procedure, the surgeon and other medical staff involved, the type of surgery, any special equipment or resources needed, as well as any required pre-operative preparations or post-operative care instructions. The scheduling sheet helps to coordinate the surgical schedule, ensure timely and efficient use of operating rooms, and keep track of all necessary details for each surgical case.
Who is required to file surgery scheduling sheet?
Typically, it is the responsibility of the surgeon or their support staff to file the surgery scheduling sheet. This may include information such as the date and time of the surgery, patient details, pre-operative instructions, and any other relevant information.
How to fill out surgery scheduling sheet?
When filling out a surgery scheduling sheet, follow these steps:1. Patient Information: - Write the patient's full name, contact number, address, and date of birth. - Include the patient's emergency contact information. - Specify the primary physician and any referring doctors involved.2. Insurance Information: - Enter the patient’s insurance provider name, policy number, and group number. - Indicate if the insurance requires pre-authorization for the surgery.3. Surgical Procedure: - Clearly state the name of the surgical procedure to be performed. - Include any specific details, such as the specific side (left or right) if applicable. - If there's a specific surgeon or surgical team assigned, mention their names.4. Date and Time: - Write down the preferred date and time for the surgery. - Note any flexibility in the schedule, if possible, to accommodate any scheduling conflicts.5. Pre-operative Preparation: - Indicate any necessary pre-operative tests or lab work required before the surgery. - Specify any medications or dietary restrictions prior to the procedure. - If there are any specific pre-surgery clearance requirements from other specialists, note those.6. Anesthesia: - State the type of anesthesia (general, local, regional, or any specific technique) required. - Include any specific considerations or preferences related to anesthesia.7. Pre-procedure Instructions: - Provide any special instructions for the patient before the surgery, such as fasting requirements or pre-operative skin preparation. - Include instructions about medications, including which ones to stop before the procedure.8. Post-operative Care: - Mention any specific post-operative care or follow-up appointments needed after the surgery. - Include any instructions regarding wound care, medication, or physical restrictions.9. Patient Consent: - Ensure the patient signs the consent form for the surgery, acknowledging the risks and benefits involved.10. Special requests/concerns: - Leave some space for any special requests, concerns, or additional notes regarding the surgical procedure.Once you've completed all the relevant information, double-check for accuracy and completeness.
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