Transcription of NMH Preoperative Clinic Order Form
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NMH Preoperative Clinic Order Form
NMH Preoperative Clinic Order FormPATIENT INSTRUCTIONS - Scheduling a Preoperative Clinic appointmentCall 312-926-4566 to schedule an appointment with the Preoperative Clinic When you call, you will be informed whether you will need an appointment at the clinicOR a phone appointment with a nurse (based on your medical history and the surgery or procedure you will have)Please request an appointment date that is 4 to 21 days before your surgery or procedureThe Clinic is located at: 233 East Superior Street - 1st bring these 5 items to your appointment:This Order formYour current medical insurance cardA photo Your complete, up-to-date medication list (or all your medication bottles)Medical records, if available: lab results, ECG tracing, stress test, sleep study or recent note from your primary care doctor or cardiologistYou do not need to fast on the day of your visit unlessyour surgeon told you to do soSURGEON / OFFICE INSTRUCTIONS - Ordering tests and visitsPatient name (last, first): Patient DOB: Diagnosis/ICD-9: Planned procedure(s): Date of Procedure.
NMH Preoperative Clinic Order Form PATIENT INSTRUCTIONS - Scheduling a Preoperative Clinic appointment Call 312-926-4566 to schedule an appointment with the Preoperative Clinic
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