Free Doctor’s Note for Pre-Surgery Assessments Template
Doctor's Note for Pre-Surgery Assessments
Hospital Name: Springfield Medical Center
Address: 123 Health St. Springfield, IL 62701
Phone Number: (555) 123-4567
Patient's Information
Name: Jonny
Date of Birth: March 15, 2050
Address: 456 Maple Street, Springfield, IL 62702
To Whom It May Concern,
This note confirms that the patient, Jonny, underwent a comprehensive series of pre-surgery assessments at Springfield Medical Center on October 1, 2090. These evaluations were conducted under my care to determine the patient's readiness for the upcoming surgical procedure scheduled on October 15, 2090.
The assessments included:
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Physical Examination: A thorough examination assessing vital signs (blood pressure: 120/80 mmHg, heart rate: 72 bpm), general health status, and no physical conditions that may impact the surgical procedure.
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Blood Tests: Comprehensive blood work was performed, including a complete blood count (CBC) showing normal hemoglobin levels (14.5 g/dL) and a metabolic panel indicating normal kidney and liver function. Coagulation studies revealed normal clotting ability (PT: 12.5 seconds, INR: 1.0).
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Cardiac Evaluation: An electrocardiogram (ECG) showed a normal sinus rhythm without any signs of ischemia or arrhythmia. A cardiac stress test was also performed, which demonstrated adequate exercise tolerance without any adverse effects.
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Imaging Studies: A chest X-ray was conducted, revealing clear lung fields and no evidence of cardiac enlargement or other abnormalities. An MRI of the abdomen was performed to assess the condition requiring surgery.
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Other Relevant Tests: A pulmonary function test indicated normal lung capacity and function, and allergy screening confirmed no significant allergies that would affect anesthesia.
The results of these assessments indicate that the patient is fit for surgery. All further instructions regarding pre-operative medications (such as acetaminophen for pain management) and dietary restrictions have been provided to the patient to ensure optimal preparation.
For any inquiries regarding these assessments, please do not hesitate to contact my office at (555) 123-4567.
Thank you for your attention to this matter.
Regards,
Dr. [Your Name], M.D
Board-Certified Surgeon
Springfield Medical Center
