Pre Operative CheckList
 
Doctor Discipline Ward/Room/Bed No
General
Date CBD     Voided
Pre Medication
Time Given
Drug
Dosage
Route

Consent Form Signed/Patient
Consent Form Signed/Surgeon Known Allergies
Anaesthetic Assessment Form
Time of Last Meal
Unit Consultant Known Alergies
Proposed Surgery
Anaesthesist

Investigation
Urinalsys CXR
Specific X-Ray ECG
Temperature
B/P mmHg
Respiration
Blood Group
RH Factot
HB% mg
Blood Availability Units
Pulse
Weight kg
Buse
SR, Na+
SR, K+
SR.CI
SR.Urea
Pre Op Preparation
Patient In or Attire Prosthesis Removed Specific Skin Preparation Done NasoGastric Tube Inserted
Under Clothing Removed Nail Polish/Lipstick Removed IV Line/CVC/Arterial Line Case Screened
Valuables Removed Surgical Shave Done CBD/Cystofix Case Unscreened
Known Infectious Disease
OR R/N
Ward R/N