{"text":"\u00a3 o \\\u2019P' be \nMEDICATION: piease list all mec!lcatlon \nN. f el on; Dose\/How much? ' ) How often? L \ne L \nL ,91 iCrd \n'\/IO 22|06 - ' lhw\ufb01t_\ufb02. L > ETEL \nORLE e \u00a3 PAe) As REAIRSY \nRGN SRR AT LS uiREY \nRIEP RO L | RS 6. GY \nr;_uDX\ufb01THU& 2 1D ) CA \nMEDICATION R RPN \u2018 , \nPlease circle if you take any.of.t : WARFARIN - CLOPIDOGREL \nPlease Tick Please Tick YES NO \nDiabetes T Heart Attack \nTB \u2018o Stroke \nAsthmq or \u2014 High Blood ~ \nBronchitis Pressure \nRheumatic Angina \u2014 \nFever ' \nJaundice Epilepsy \nStomach Uicer Hiatus Hernia \nClots in legs or . | Recent Heart, \nlungs -{ Chest or New \nHealth Probs \n\u201cPlease read the following ist and tell us if you ever suffer from any of these things. \nPlease Tick \n[YES \nIf yes, use this box to give more details \nPain or tightness in your chest \nShortness of breath or wheezing - \nIill\\\\llllllllll\ufb02ll|II||l\ufb02llll\\l\\l\ufb02lll\ufb02\\l\ufb02ll!\\l\ufb02lll\\ \nCLELLAND \nA cough, do you have a spit as_w\u00e9ll? \n1z \nAgnes 08\/09\/1 955 \n39 Rennie Road \nUpset stomach or heart burn \nKilsyth \n. Glasgow, Lanarkshire \nBowel problem\u00e9 \nG65 9PQ \nHeadaches or dizzy spelis \n| Blackouts or faints \nWeakness or loss of function \nk\\\\\\\\<\\\\s \nTO BE COMPLETED BY NURSING STAFF- \nBP 1) )Q& \/. \nBP2) .., \nUrinalysis : ......c.cceeeeueees \nPatient cancelled : \nTemperature \nSaturatlon q..g Weight- OK)L(KQ \n' .Pullse.,g[ ...... \nPre-operative Assessmenf Redui}ed : YES \n. YES \no LN \nBMI:.oeeriveenae \nNO MRSA Screening: YES NO \nNO Lettersentto GP: YES N0 \nIf BP recordmgs > 180 systohc and\/or >110 dlastollc refer back to GP for recheck \nOrtho -~ North \u2014 Last undated 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