Review

Click on the headings above to move back to the different sections to amend your details

Demographics

Name: %patient_title% %first_name% %last_name% Gender: %patient_gender% DOB: %date_of_birth% Email: %patient_email% Contact Number: %contact_number% Home Address: %street_address%, %patient_suburb% %post_code%

Operation Details

Procedure/Operation: %procedure__operation% %date_of_procedure% %procedural_doctor__surgeon% %hospital_location%

Basic Health information

Allergies: %patient_allergies% %allergies_detail% Medications: %medications_boolean% %medications_detailed% Height: %patient_height% cm Weight: %patient_weight% kg BMI: %patient_bmi% Exercise Tolerance: %exercise_tolerance% METS < 4 = you can walk indoors, 1 to 2 blocks on the flat, walk 1 set of stairs, can perform light house work
METS > 4 = you can mow lawns > 30 minutes, can climb 2 sets stairs, carry groceries (> 5kg) up 1 floor, can walk ground level for 60 minutes

Social History

%patient_smoking_boolean% %smoking_details% Alcohol use: %etoh_boolean% %etoh_details% Recreational Drugs: %recreational_drugs_boolean% %recreational_drugs_details%

Surgical History

Previous Surgeries: %surgeries_boolean% %surgery_details% %compications_surgery_boolean% %complications_details% Dental work: %dental_boolean% %dental_more_detals% %neck_movement_boolean% %neck_movement_detail%

Medical History

Cardiovascular

%cvs_nil_test% %patient_hypertension_boolean% %heart_attack_boolean% %heart_attack_details% %patient_arrhythmias_boolean% %patient_arrhythmias_details% %heart_failure_boolean% %heart_failure_details% %heart_operations_boolean% %heart_operations_details%

Respiratory

%patient_asthma_boolean% %asthma_detilas% %copd_boolean% %copd_details% %osa_boolean% %cpap_boolean% OSA STOPBANG Score: %stopbang_score% %bmi_35% %osa_questionnaire%

Endocrine

%diabetes_boolean% %diabetes_details% %thyroid_disease_boolean% %thyroid_disease_details%

Other Systems

%gord_boolean% %renal_disease_boolean% %dialysis_boolean% %anaemia_boolean% %vascular_disease_boolean% %liver_disease_boolean% %stroke_boolean% %stroke_details% %seizures_boolean% %anxiety_depression_boolean% %neuropathic_pain_boolean% %neuropathic_pain_details% %other_medical_hx_boolean% %more_medical_hx_detail%

Once you are ready to proceed, please click the submit button below.

Dr Geoff Crawford

Identification

Contact Details

Home address