Free template · PDF
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 is on the form
- 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.
Less paperwork to fill in at all.
Ask Brigid keeps the diary, the record and the practice paperwork in one place, hosted in AWS Dublin. Theatre lists and procedures for private urologists.
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