Northbank Surgical Center
Physician's Order Sheet
PRE-OPERATIVE ORDERS
Allergies/Reactions:
or list below:
Diagnosis:
- Admit to Northbank Surgical Center
- Routine admitting vital signs
- Anethesiologist to evaluate if MAC
- Saline lock started
- H & P on chart
- PRE-OP MEDICATIONS
a.
Neosynephrine 10%
Ocufen 0.03%
Proparacaine 0.5%
Per drop protocol on admission;
1 gtt every 5 min x 3
7.
Check serum glucose level if on medication for diabetes
INTRA-OPERATIVE ORDERS
- Routine per preference card
-
Other:
POST-OP APPOINTMENT:
Date:
Time:
PHYSICIAN ORDER SHEET - GENERAL OPHTH 5/07
(PATIENT LABEL)