GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. ✦ Review the patient’s chart for
the most current information.
Make sure the chart contains
the physician’s notes and orders
regarding the surgical procedure.
2. ✦ Verify with the physician the type
of procedure for which you are to
schedule the patient, and gather
the following information from the
physician:
• Categorythesurgicalprocedure
falls under (routine, elective,
urgent)
• Nameofthesurgeontoperform
the procedure
• Thesurgeon’sscheduling
preference for this type of
procedure
• Estimatedlengthoftimeforthe
procedure
• Estimatedlengthofstay
3. ✦ Gather the following information
from the patient and patient’s chart:
• Patient’sfullname,age,
sex, and any other pertinent
identification or information
• Physician’scurrentdiagnosis
• Anyallergies
• Specialpreoperativeordersand
patient instructions
• Patient’sinsuranceinformation
Name: ________________________________________
Date: _________________________________________
POINTVALUE
✦ = 3–6 points
✶ = 7–9 points
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