{"text":"% \n- \nDate:\u2019 W l b l 1\u20197 Affix label - or complete details below. \n| urse name:t-.,, .\\ st \u2018 ) ..... S\\\u201d . ..ContactNo\\. \\ \u00e9gzz_\/ q t . \nPlanned procedure: %\\\"K l' Nok: O Q\u2019g ) \u2018 \n: CAVOM contact o NoK: ( - Sl LAAD \nPlease ercl@ Mmg%\ufb01) LOCAL \" NOKCJG{%%%ZQ:Q i \n- Email address: \n. PLEASE BRING A LIST OF ALL MEDICINES TO YOUR PRE-OP APPOINTMENT \nYOUR OPERATION MAY BEE\\APPOINTED WITHIN 12 WEEKS. \nPlease list any holidays or dates you will be unavailable in the next 12 weeks (failure to inform us of your \nabsences could ]ead- to your operation being cancelled or you being removed from the waiting list) . \n\u2019 \no \nI \n. \u2018 CLELLAND 7 F \ni N \u2018 : . Agnes 08\/09\/1955 \n| i \u2018 . ] _ - i 39 Rennie R \n; ; . ; \u2014 T - \u2014 Kilsyth \u00a2 \n| ) ; . . . . Glasgow \n-PAST MEDICAL HISTORY\" . , G659PQ \n1. Please re\u00e9ord:any health pr'oblems\u2019 that you have including any operations - \nPAB (LR DI abeTeat | \nAETHRITS - . \nAR A \n2. .Haveyou-everhad a bad'r\u00e9a\u00e9tion fo anaesthetic? \nWO \n, 3. Plea_s'e\u201ctell us about any other illnesses or medi\u00e9:al probl\u00e9\u2018f\ufb01s that have not been mentioned yet. \n\u00a2 \nAre you allergic to any medicines or other things (eg Penicillin)? I\u00abJ'O ' \n- Who lives with you at-home? \\\"'-\\OS\\@ \nDo you'smoke?\u2019 MO \u2018 \" How-many per day? o \nDo you drink alcohot? ST \u2018\/\u00e9 How much per gafiweek? \/ ~ 72 \n. Are'you working atthe moment? \u2122 O - If so, what is your job? \nDo you sleep lying flat, sitting up orpropp\u00e9d\u2018 up? FL.:Q\u2019T_ ) \n' . ' . \u2018 Ortha - North \u2014 Last uodated. 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