Surgery Preparation

Orange Park Surgery Center

272-2550

Pre-Op Instructions

Patient’s Name­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­______________________________________________________________________________________________

Please arrive at the Surgery Center by­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­___________On(day)______________________(date)_______________________________

Your surgery is scheduled to start at_______________________________am/pm

DO NOT have anything to eat or drink, NOT EVEN WATER, after midnight the night before the scheduled day of surgery. DO NOT  use any hard candy, chewing gum, or tobacco products after midnight. Your surgery may be cancelled if anything is consumed.

                As directed, you may take the following medicines with a sip of water on the morning of surgery:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

DO NOT come alone. A member of your family or a responsible person must accompany you, drive you home, and stay with you for 24 hours after your procedure if you receive anesthesia.

DO NOT wear any jewelry including body piercing or bring valuables to the Surgery Center.

DO NOT wear makeup if surgery is on your face or eyes.

DO NOT wear nail polish if surgery is on an arm, hand, leg or foot; otherwise it can be worn but polish from one digit may need to be removed for the pulse oxymetry.

Avoid bringing small children to the Surgery Center. If you find it necessary to bring small children, they must be supervised at all times by an adult.

Contact lenses, glasses, dentures or dental bridges may be worn but may need to be removed prior to surgery.

Surgical patients under 18 years of age must be accompanied at all times.

Patients and visitors that use assistive devices at home should bring them to the center.

Report to this facility by your scheduled time as noted on the top of this page. It is absolutely necessary that you be on time or you will run the risk of having your surgery cancelled. Keep in mind you will be here approximately 1 ˝ to 2 hours prior to your procedure.

Bathe the morning of the procedure and wear loose, comfortable clothing.

Please refrain from wearing cologne or perfume.

Make sure that you have followed your physician's instructions carefully and completely.

SPECIAL INSTRUCTIONS:____________________________________________________________________________________

____________________________________________________________________________________________________________________________

I have received a copy of "Rights and Responsibilities of Surgical Patient"

I understand my right to accept or refuse care.

As required by Florida law, I declare that: I do / do not have an Advanced Directive (Living Will) a life - prolonging document.

Signature of patient or responsible person_________________________________________________________________________

Nurse's signature_________________________________________________________________________Date_______________________

IF WE HAVE NOT REACHED YOU TWO DAYS PRIOR TO SURGERY to review your medical history, pre-operative instructions, and financial arrangements, please call the Center at (904) 272-2550.

Opsc(12/04)