{"text":"7 \nAclite\u2018Services Division \nSurgery and Anaesthetics Directorate | \nDepartment of Pre Op Assessment Unit \nNHS \nN, s \nGreater Glasgow \nSpecialty: Ear, Nose & Throat (ENT) and Clyde \nPreAdmission Form Release 1.0 \nH05p|ta| Name: Gartnavel Royal Infirmary \nPatlent Details GP Detalls \nName: CLELLAND AGNES Name. \u2018 \"STEPHENS, MARJORY \" \nAddress: 39 RENNIE ROAD Address: KILSYTH HEALTH CENTRE \n: . KILSYTH . BURNGREEN PARK \na ' s \u2019 _ GLASGOW KILSYTH \n\u2019 s STIRLINGSHIRE \n_ _ G65 OHU \nPostcode: GB5 9PQ Te]ephone: \nCorrespondence Address 1: ; Consent: Yes \n\u2018Correspondence Address 2: Sensitivity: Sensitive \n-Forrespondence Postcode \u2018 : Consultant Name';, . MRIRVINE \nL ephone: -, 01236 822191 Adm:ss:on Date \u2018 \u2018 \n. CHI Number: . 0809555328 Time:: . \nCLCRN: o \" 10338654X, ZM06407457 Ward:\u2019 T 2e \nD.O.B. -, 08\/09\/1955 \u201c\u00ab* PHARYNGOSCOPY AND BALLOON \nProcedure\/ Operatlon. \nDILATATION \u2019 \n. \n. Temperature (celcrus) o \n~ Blood:Pressure (mmHg) \nChanges Since POA? Yes' \" No \nResps (p\u00e9r min) - \n02 Sats (%) - \n. There are no allergles to d:splay \nHeart Rate (bpm) \ns\/ Mews Score \n\u201cName , -~ \nRelationship - _ \nPhone - \u2018. : : v \n\\EPRY \n\u2018with Famnly Carer - \n_ Alone \n\" Elderly \nDistrict Nurse, \n\"\"Home Help' \nOwn Supplled \nPartner \ndays\/wks \n- \" Positive \nOther Services T T\u2014\u2014 \n* Estimated Date ) \nTransport Required . B \nSupennsmg Adult for D:scharge \": * \nFr.\/.wr e \nKo, \u2019 \nValuables \nValuables Returned \n, Negatlve \n. 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