Pre-Operative History and Physical
  Review of systems  & PMHx
Fevers     Headaches     Chest pain    Sinus     Edema    Dyspepsia
Nocturia    SOB     DOE       Joint-muscle problem     BM change/Bleeding
HTN    DM     CAD    Stroke    CA     Asthma    COPD

BP    P      RR   Wt    lbs    Allergy 
Physical Exam: check if normal explain if abnormal

  Head Vision Neck

  Speech Teeth Trachea

  Good breath sounds and effort

  No heart murmur or edema

  Abdomen soft non tender

  Gait and Extremities

Calm and comfortable

Anesthesia   -ASA Class   

   
         Submit H&P form or Print and fax to: 708.563.0916           
                                 Call: 708.594.3500 for additional information