Salem Laser and Surgery Center
Physician's Order Sheet
PRE-OPERATIVE ORDERS
Allergies/Reactions:
or list below:
Diagnosis:
- Admit to Salem Laser and Surgery Center
- Routine admitting vital signs
- Nurse Anethetist to evaluate patient if MAC
- Saline lock started
- H & P on chart
- PRE-OP MEDICATIONS
a.
b.
c.
Xanax PO per standing order on
admission if local
Proparacaine 0.5% 1-3 gtts prn
Neosynephrine 2.5%
1 drop surgery eye every 5 minutes x3 doses.
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)