Name: ________________________________________
Date: _________________________________________
Procedure 9-5:
Scheduling an Outpatient Surgical Procedure
Objective: Schedule an outpatient surgical procedure.
Equipment and Supplies: Telephone; patient’s insurance card; notepad; pen; written instructions
for patient
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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GRADED
TRIAL
# 1
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# 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:
• Categoryunderwhichthe
surgical procedure falls (i.e.,
routine, elective, urgent)
• Nameofthesurgeonwhowill
perform the procedure
• Thesurgeon’sscheduling
preference for this type of
procedure
• Estimatedlengthoftimeforthe
procedure
3. Gather the following information
from the patient and the patient’s
chart:
• Patient’sfullname,age,
sex, and any other pertinent
identification or information
• Physician’scurrentdiagnosis
for the patient
• Anyexistingallergies
• Specialpreoperativeordersand
patient instructions
• Patient’sinsuranceinformation
• Days/timespatientavailablefor
surgery
4. Obtain preauthorization from the
patient’s insurance company, if
required.
5. According to the facility policy,
contact the outpatient scheduler
at the local hospital or clinic and
identify yourself and your oce.
Name: ________________________________________
Date: _________________________________________
POINTVALUE
= 3–6 points
= 7–9 points
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GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
6. Instruct the facility about the
type of procedure and the
amount of time the physician
expects to need the operating
room.
7. Determine available days at the
facility.
8. If possible, oer options to the
patient and have the patient
choose the best option.
9. Notify the facility of the date and
time chosen.
10. Create a patient instruction
sheet to include date and time
of procedure and necessary
preoperative information.
11. Document the conversation in the
patient’s chart.
12. Document the scheduled surgery
on appropriate physician’s
schedule.
GRADING
PointsEarned
Points Possible 87 87
PercentGrade(PointsEarned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
Name: ________________________________________
Date: _________________________________________
POINTVALUE
= 3–6 points
= 7–9 points
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