Patient Name: ____________________________

Surgery Date: ____________________________

Doctor: _________________________________

BEFORE YOUR HOSPITAL VISIT

If You're Taking Any Medication:

• Write down any medicines you're currently taking. List the exact name, dosage and number of times a day you take each medicine.
• Ask your doctor if he or she wants you to bring any medicines from home.
• Remember, never take any medication without first checking with your nurse once you're in the hospital.

Aspirin/Anti-Inflammatories:

• Unless your doctor tells you otherwise, avoid aspirin and anti-inflammatories for 1-2 weeks prior to surgical procedures or tests that could cause bleeding. If you're not sure if a particular medicine contains an anti-inflammatory or aspirin, ask your doctor.

Documents to Bring:

• Social security number
• A form of personal identification, such as a driver's license, passport, or an official identification card
• Medical plan information (health care card)
• Any outside medical records or lab results that could be useful
• If you have a living will, or other advance directive, bring a copy with you.

Note:   Parents or legal guardians will need to sign for the admission of those under age 18.   

Eating and Drinking:

• If your admission is for a surgical procedure, it's important that you have nothing to eat or drink after midnight on the night before your surgery.
• If you are taking a medicine at home that has a morning dose, ask your doctor if he or she wants you to stop the medication the night before your admission/procedure.

Hygiene Instructions:

• Shower the night before, and avoid using perfumes, hair sprays, nail polish or makeup.
• If you wear contact lens, be sure to have your glasses to wear just before and after your procedure.  

What to Pack:

• Toothbrush
• Slippers
• Robe
• Reading Material
• Comfortable clothing

NOTE: Leave valuables, such as jewelry or large amounts of cash, at home.

What to Wear:

• Wear comfortable, loose clothing to the hospital.

Cautions:

• DO NOT bring any electrical appliances or cellular phones.
• Hospitals have a no-smoking policy for patients and visitors in all areas.  

WHEN YOU ARRIVE AT THE HOSPITAL

What You Should Tell Us:

• If you've ever had a reaction to a medicine, local anesthetic, tape, latex or skin cleanser
• Any special needs you may have, such as religious or dietary preferences
• If you'll need special physical assistance
• If there's ANY possibility that you COULD be pregnant
• If you've brought any prescriptions from home

Please let your physician know if:

• You develop an acute illness or have an asthma attack within three days prior to your scheduled surgery.
• You've never had measles, mumps, or chicken pox but have been exposed to them within 21 days of your scheduled visit.

BEFORE YOU LEAVE THE HOSPITAL

What to Know Before You Leave:

• Your nursing staff will give you specific instructions about limitations on physical activity, diet, and proper use of medications.
• Your discharge plan will also include detailed instructions about what to do if you experience any problems like fever, infection, bleeding, or excessive pain, etc.
• Discuss a time for a follow-up visit with your doctor.

Prescription Medications:

• You may need prescription medications.   In some hospitals, the doctor's order for those medicines will be handled by one of the hospital pharmacies. In other cases, your doctor may give you a written prescription or call one in to the pharmacy of your choice.
• If you have any questions about possible side effects or unusual drug interactions, talk with the pharmacist or call your doctor.
• Follow instructions on your prescription bottle exactly.

Transportation Home:

• After any admission, you MUST have someone available to take you home. You may feel fine when it's time to leave, but you could have a problem with drowsiness or nausea from medicines or lingering anesthetic. This could endanger you and others if you attempt to drive.
• If you are taking a child home: We recommend that there be two adults to take a child home after anesthesia - one to drive and one to care for the child.

AFTER YOUR STAY AT THE HOSPITAL

• Have someone available to check on you during the first few days you're at home.
• If you feel that a particular medicine doesn't seem to be working properly or you develop a rash or allergic symptoms, call your doctor. The doctor will decide if your medication should be continued, changed, or stopped.
• Never take old, expired medications or someone else's medicine.
• Always dispose of unused medications promptly.
• NEVER drink alcohol while taking medications.

PERSONAL NOTES:

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