{"text":"Acute Services Division \nNHS \nT nmuwmnmmumnmuu \nSurgery & Anaesthetics ot CLELLAND \nGG&C Day Surgery\/23 hour Care Plan e Clyda Agnes oamgngss \ny gery 39 Rennie Road \nKilsyth \nAdmission Checklist \nGlasgow, Lanarkshire \nG65 9P \nwoms: FH STDK 1L \nConsultant : \\\/m 5 . \nDa}e:\"b}\u2019o \u2019 l% \nProposed Operation:- | \u20ac =1 \ne e (SU\\W\/\\ \nPatient Questionnaire Completed? Yes O No |2 \nPre-Op assessment Completed? Ys [ No O \nEscort Details (responsible Adult)Name: OM\" Q\\V\\.\\-Q\u2018\/ . Telephone Number: O%\u2014L;.\u2019}\u2019A\u2014S\u2019LL\" \nLR \nConfirm \u201cNext of Kin\u201d on pre-assessment \n\" Yes Named\u2014-?mcdma-delepmne No: D\\\"ij\u2014z,l\\\"\\ A \n\" Interpreter Required? If \u201cYES\u201d confirmation of booking Yes a No . \nDuration of booking (if KROWn)....cocuiriiirvnmiiniiscinivnniiniecieissnsneiios \nCarer required to stay with patient? Yes [ N B\u2014 \ne of LMP? Date.....ovuvuuenivnneen [\\) [P- \n, eyou, or could you be pregnant? Yes O ' No O\u2014 \nIf \u201cYes\u201d pregnancy test must be performed \nPregnancy test results +VE -VE ,QJ ta~~ \nGroup and save results checked Yes No CN-;LA\u2014) \nDate done.........ccocoinnuninmiiniiienes \nAnti D required Yes O No [B\u2014 \nIs the patient on Anti-Coag therapy? \u2019P@H\\V\\M Yes 0 \u2014 No E\u2018\\a\u2018\\ \ne N sl sl Wi 2407 G} e O -y \nre INR results available within las rs? \u00a2 Yes . \nIf \u201cNo\u201d INR taken date ............ time.....oeeene \/\\ A m Result............ q 3 a ; O\"&I\u2018I@I O \n! \nIs the patient diabetic If \u201cYes\u201d ,-\u2018\u2014\\_,\\P\u00e9-\"r ves [ N O \nBM on admission resulits... m_\ufb01\u2014\u2018f\u2018!\u2019\\\/\\\/\u201c\u2014\u2019\\\\\/\\ NDOD [0 pp O \nUrinalysis done Results... Yes O No \nCJD single question asked Yes B oo O Comment if required \nIf at risk theatre notified \nAnswer to C]D single question At Increased Risk O BY.ovurirrrrinriennes \nNot atincreased Risk [ 0 YOO \nir CD question has not been asked then ask the question \u201c Have you ever \nbeen notified that you are at an increased risk of C|D or vC]D for public \nhealth purposes?\u201d \nYes, I have been notified \n( No, | hgve not been notified \nComment if required \nAlert Sticker (if required) Yes [ na L~ \nDoes the patient have any pressure area issues? If \u2018Yes\u201d: Yes O No AL~ \nAra..ucceeniitiamine e saeseans \u2019 \nIssue+\/- SCOTC.uuirienvreaniieiinirarnenns \nTissue Viability contacted Yes N\/A . ) \nOther Information- Document any other relevant information e.g. needle \ufb02_ \nphobia , request for female practitioner \u201cGetting to know you\u2019 information. Y\u2122\\ \nFit Form required Yes O No R~ \nBaseline Observations \n8P \nHR \nTemp \nStaff tnitials \nPlease print & sign name when checklist completed \nName ; \nTime: \nQA OF (0Pt \nGGCO121 1 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