Preoperative Checklist, Ortho III Unit, Department of Orthopaedics Government Medical College, Kozhikode

Name Address Date Pulse Blood Pressure Respiratory rate Temperature Date Hb TC DC ESR Platelet count Bleeding time Clotting time Blood Group Date RBS FBS PPBS HbA1C Culture and Sensitivity Age IP No Phone Mobile DOA Phone

Date Urea Creatinine Sodium Potassium Chloride Bicarbonate Calcium Phosphorus Consultations Surgery Medicine Neurosurgery Neuromedicine Plastic Surgery Pulmonology Gynaecology Physical Medicine Pain Clinic Cardiology Radiology Date Advice Review Date Advice Review Date Advice Review

Date Total Bilirubin Direct Bilirubin SGOT SGPT SAP TP Alb Globulin A/G Ratio Date HIV HBsAG HCV Brucella PSA AFP CEA Serum Electrophoresis ECG CT Findings

X-Ray Side Chest Skull Pelvis TL Spine C. Spine Shoulder Arm Forearm Wrist Hand Thigh Knee Leg Ankle Foot

Findings

MRI Findings