Surgery scheduling checklist

Use this surgery scheduling checklist to ensure successful bookings. Before sending a surgery packet to a surgery partner, double check.

Categorized as Operations Tagged
Surgery Scheduling checklist

Before sending a surgery packet to your surgery partner (ambulatory surgery center or hospital), you need to ensure that your surgery packet contains most of the following (for successful surgery booking):

  1. Surgery information sheet of the surgical center / hospital including patient’s Insurance Prior Authorization. Make sure the prior authorization number is included as well as proof of prior authorization.
  2. Surgery consent form signed by the patient and the surgeon
  3. Signed informed consent forms for any special procedures. Ensure that the patient and surgeon signatures are included.
  4. Pre-operative instructions signed by the patient.
  5. Patient Record Release. Make sure this is signed by the patient before they leave your clinic else you will not be able to receive patient records from the primary care office.
  6. History and physical (medical clearance) signed and dated by the primary care physician. This should include the Preoperative Medical Consultation, Lab and EKG
  7. Specialty History form. This will depend a lot on your specialty, Ensure that this is signed by the admitting physician / surgeon.
  8. Materials Request Form. This will also depend on your specialty. However, the ASC/Hospital has to be given ample notice to ensure that the surgeon’s desired equipment/lenses etc are available during the time of surgery.
  9. Operative Report Request Form. While this is not a must have, it is a good idea to send it along with the surgery packet itself. This helps your billing department.

If you use our surgery scheduling software (included in ezhcrm), the surgery checklist looks like this (you can create your own as well).

Surgery Scheduling checklist
Surgery Scheduling checklist

Surgery scheduling checklist

Read about the the surgery scheduling process here.