Free template
Pre-op assessment form
One page that answers "is this patient ready for theatre?", from allergies and fasting to investigations and bed booking.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe secretary completes
- Assessment and surgery dates
- Patient: name, MRN, weight, height and BMI
- Procedure, anaesthetist and ASA grade
- Allergies and alerts
- Regular medications
- Airway, cardiovascular and respiratory review, last meal and fasting plan
- Investigations: bloods, ECG, group and save, chest X-ray
- Readiness: VTE risk, consent, fitness for surgery and whether an HDU or ICU bed is needed
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- Follow your hospital's pre-assessment pathway for which investigations each procedure needs.
- Flag anything that changes the list, such as a critical-care bed, as early as it is known.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Theatre lists and procedures for private urologists.