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  • Surgical Time Out

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    jose b. lingad
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    This document contains a surgical time out form with patient information including name, age, gender, admitting diagnosis, allergies, blood products, blood type, HBG, HCT, preoperative medications, RT-PCR/RAT result and date, procedure to be performed, anesthesia concerns, surgeon concerns, prayer, and introduction of the surgical team. The form is duplicated on the page.

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    This document contains a surgical time out form with patient information including name, age, gender, admitting diagnosis, allergies, blood products, blood type, HBG, HCT, preoperative medications, RT-PCR/RAT result and date, procedure to be performed, anesthesia concerns, surgeon concerns, prayer, and introduction of the surgical team. The form is duplicated on the page.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    2 views1 page

    Surgical Time Out

    Uploaded by

    jose b. lingad
    This document contains a surgical time out form with patient information including name, age, gender, admitting diagnosis, allergies, blood products, blood type, HBG, HCT, preoperative medications, RT-PCR/RAT result and date, procedure to be performed, anesthesia concerns, surgeon concerns, prayer, and introduction of the surgical team. The form is duplicated on the page.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    SURGICAL TIME OUT SURGICAL TIME OUT

    NAME: NAME:
    AGE: AGE:
    GENDER: GENDER:
    ADMITTING DIAGNOSIS ADMITTING DIAGNOSIS
    ALLERGIES: ALLERGIES:
    BLOOD PRODUCTS: BLOOD PRODUCTS:
    BLOOD TYPE: BLOOD TYPE:
    HBG: HBG:
    HCT: HCT:
    PREOPERATIVE MEDICATION: PREOPERATIVE MEDICATION:
    1. 1.
    2. 2.
    3. 3.
    RTPCR/RAT RESULT AND DATE: RTPCR/RAT RESULT AND DATE:
    PRODECURE TO BE PERFORM: PRODECURE TO BE PERFORM:
    ANESTHESIA CONCERN: ANESTHESIA CONCERN:
    SURGEON CONCERN: SURGEON CONCERN:
    PRAYER: PRAYER:
    INTRODUCTION OF SURGICAL TEAM: INTRODUCTION OF SURGICAL TEAM:

    SURGICAL TIME OUT SURGICAL TIME OUT


    NAME: NAME:
    AGE: AGE:
    GENDER: GENDER:
    ADMITTING DIAGNOSIS ADMITTING DIAGNOSIS
    ALLERGIES: ALLERGIES:
    BLOOD PRODUCTS: BLOOD PRODUCTS:
    BLOOD TYPE: BLOOD TYPE:
    HBG: HBG:
    HCT: HCT:
    PREOPERATIVE MEDICATION: PREOPERATIVE MEDICATION:
    1. 1.
    2. 2.
    3. 3.
    RTPCR/RAT RESULT AND DATE: RTPCR/RAT RESULT AND DATE:
    PRODECURE TO BE PERFORM: PRODECURE TO BE PERFORM:
    ANESTHESIA CONCERN: ANESTHESIA CONCERN:
    SURGEON CONCERN: SURGEON CONCERN:
    PRAYER: PRAYER:
    INTRODUCTION OF SURGICAL TEAM: INTRODUCTION OF SURGICAL TEAM:

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