{"text":"Nt \nDate: < @ Affix [abel - or completa detalls below L \nNurse name: Contact No: WS C(\u2018Q\/M . ' \nPlanned pfocedure. ['W UA\/\\\\O\\\u2018) NOK: \/\\7? S%Y%Q O(,?\/(\u2014\/('\/a'd \u2019 \n. Contact No NOK: , \nPlease Circle: @) R F'OCAL Email-address:. O|23(_0 w\/ \ufb02 \u2018 s \nPLEASE BRING A LIST OF ALL MEDICINES TO YOUR PRE-OP APPOINTMENT \n\" YOUR OPERATION MAY BE APPOINTED WITHIN 12 WEEKS. MMMI \ng \nF \n08\/09\/1955 \nPlease list any holidays or dates you will be unavailable in the next 12 weeks ( 0809555'328 \nabsences could lead to your operation being cancelled or you being removed from t A D \n= 0P8 B LUC N \nKusyt Pi\u00e9Road \nSasgow, Lanarkshire i \nG65 9pQ \nPAST MEDICAL HISTORY \n| 1. Please record any health problems that you have including any operations \nAUGAAY A Eil\u2018?&\ufb01 RS MUD EooT\u2122 moSIow \nDIAREAIES AR QI AES TEATPoR \n\u2019 RtV Toe \n2. Have you ever had a-bad reaction to anaesthetic? \nO \n3. Please tell us about any other illnesses or medical problems that have not been mentioned yet. \n. . A (o \nAre you allergic to any medicines or other things (eg Penicilin)? 1\\ ~\u2014 \nWho lives with you at home? HOSIZ I \nDoyousmoke? AL2O - ' How many per day? .~ \n' Doyou drink aicohol? \\J C\u2014\u2018:(Lg Q\ufb01{l@ How much per dayiweek? 2 VWMLOAITE) \n- Are you workmg at the moment? i\u2019\\\u00abo If so, what is your job? \n- \n\"Do you sleep lying flat, sitting up or propped up? 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