OR RESERVATION REQUEST FORM
Revision: R01
DOI: 17/06/2023
DOR: 17/06/2028
WBM-ITD-002-FM003-003
PATIENTS INFORMATION | |||
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Pantient's Name : | Hari Krishna | ||
Date of Birth | 11/12/2018 | Gender | Male |
QID No : | 00123 | Nationality | Indian |
MRN No : | 1234 | Contact No : | 8898544343 |
SURGERY | |||
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Surgeon Name : | Dr. Ali | Specialty : | Excision of a Skin Lesion |
Surgery Description | The patient is evaluated to determine suitability for local anesthesia. | ||
This includes a review of medical history, allergies, current medications, and any contraindications. | |||
The procedure, risks, benefits, and alternatives are explained to the patient. | |||
Approximate Length of Operation : | 5 hours | ||
Suggested Date : | 12/03/2014 | Suggested Time : | 16:10:33 |
Duration of Stay After Surgery : | 3 hr | Anaesthesia Type : | Local Anaesthesia |
Needed Equipment/Supplies : | Sterile Drapes, Antiseptic Soolution, Sterile Gloves. | ||
Surgical Instruments: Scalpel, Scissors, Needle Holder etc |
PRE-ANAESTHESIA CHECK-UP TESTS
(Patient test are to be scanned and sent to orreservation@westbaymedicare.com.An appointment with anaesthesia doctor is to be scheduled 48 hours prior to the surgery)
(Patient will be reffered to WBM earlier 24-48 hours prior to the surgery to book an appointment to perform the needed laboratory test.The patient should have the doctor's referral for the tests and are to pay to WBM the test fees seperately.)
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