Pt Sticker

You are scheduled for …………………………………………………………..(name of surgery) at BURJEEL HOSPITAL, AL

KHUWAIR on …………………………………….(date) at……………..(time).

For this you are to report to the Burjeel Hospital Reception at…………………………..(time) on ……………………..(date).

You should have your last meal by………………….. of……………………..and after this are allowed to drink PLAIN water till
2 hours before surgery. Please bring with you any medicines that you are taking regularly and any Medical reports,
X-rays/ Scan reports that you have with you.

Please remove nail polish, ornaments if any before coming.

Surgeon’s Name:

For any clarifications please contact GSM…………………………..

GENRAL INSTRUCTIONS BEFORE SURGERY

 Do not smoke or consume alcohol 24 hours prior to

surgery.
 Do not wear make up on the day of surgery. Remove all
fingernail and toenail polish
 Wear your glasses instead of contact lens on the day of
surgery (if required). If you need to wear contact lens
then we requests you to bring a container for lenses.
 All Jewelry must be removed, including any body piercing.
 Wear loose comfortable clothing.
 Please notify your surgeon if you develop a cold,
persistent cough, Fever or other health-related problems
prior to surgery.
 And if you must cancel your surgery, please notify your
surgeon immediately.
 Patients who are having day surgery must arrange for a
responsible adult to take them home and stay with them
for 24 hours after discharge.

Pleases bring your Insurance Card & Resident Card on

the day of your procedure.

Instructions Given by:

Doctor Name Signature & Stamp

I have read and understood the above instructions.

Patients / Next of kin Name Signature