"Surgery Scutsheet Template"

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Patient:
MRN:
ID:
Rm:
Admitted:
Height:
Weight:
Code:
Surgeon:
Date:
Surgery:
HPI:
PMH:
PSH:
VITALS
FamHX:
Allergies:
RX:
ECG:
CXR:
PTT:
SHX:
Airway Exam:
PT/INR:
Anesthesia Plan:
Patient:
MRN:
ID:
Rm:
Admitted:
Height:
Weight:
Code:
Surgeon:
Date:
Surgery:
HPI:
PMH:
PSH:
VITALS
FamHX:
Allergies:
RX:
ECG:
CXR:
PTT:
SHX:
Airway Exam:
PT/INR:
Anesthesia Plan:
www.FreePrintableMedicalForms.com
Patient:
MRN:
ID:
Rm:
Admitted:
Height:
Weight:
Code:
Surgeon:
Date:
Surgery:
HPI:
PMH:
PSH:
VITALS
FamHX:
Allergies:
RX:
ECG:
CXR:
PTT:
SHX:
Airway Exam:
PT/INR:
Anesthesia Plan:
Patient:
MRN:
ID:
Rm:
Admitted:
Height:
Weight:
Code:
Surgeon:
Date:
Surgery:
HPI:
PMH:
PSH:
VITALS
FamHX:
Allergies:
RX:
ECG:
CXR:
PTT:
SHX:
Airway Exam:
PT/INR:
Anesthesia Plan:
www.FreePrintableMedicalForms.com