Ambulatory Surgical Facility Preoperative Screening and Assessment Checklist
The components of this sample checklist are intended as a cue for ambulatory surgical facilities to confirm that the essential items needed for screening patients preoperatively.
Specific instructions for use are included in the checklist, which may be downloaded for electronic entry or printed for handwritten entry.
Nursing Preoperative Screening
This sample form may be used for nursing preadmission before the day of surgery.
Health History
This sample form may be sent to the primary care physician or the referring physician for completion before the day of surgery by anesthesia and nursing staff.
ASF Cancellation and Transfer Tracking Tool
Ambulatory surgical facilities (ASFs) can use this tool in tracking and trending day-of-surgery (DOS) cancellation and transfer rates, as well as event information and costs associated with DOS cancellations. Four versions of the tool are available, per scope of care: multispecialty ASFs, endoscopic ASFs, ophthalmologic ASFs, and single-specialty ASFs.
Note: To download copies or if the links fail to open, please right-click on the links below and select "save target as." This action will allow download of zipped files containing copies of the tool.
