Pre Admission Assessment

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Pre Admission Assessment - Ivanhoe Endoscopy Centre

IVANHOE ENDOSCOPY CENTRE

Pre Admission Assessment

Form: QF-11-01

1 Booking Details

2 Patient Details

New Patient?
Interpretation needed on day of procedure?
Staff available to assist on the day?
Is TIS required?

3 Suitability for Procedure

If any 'Yes' is ticked below, a consultation with a medical officer needs to be booked prior to the procedure date.

Medical History Questionnaire Yes No
Do you weigh over 120kg or BMI over 35? *

4 Medications

Any anti-coagulant and or blood thinners? (e.g. Plavix, Iscover, Clopidogrel, Coplavix, Prasugrel, Pradaxa, Warfarin)
*book consult with Proceduralist
Taking more than 4 medications?
Do you require to see a doctor at our Centre before your procedure?

* Book pre-operative consult with Anaesthetist, all other patients will consult with Endoscopist prior to procedure.

Clinical Staff Use Only

Patient is advised:

If they take Aspirin without heart problems, there is no need to stop
If they take Iron tablets, they need to cease 7 days prior to procedure

Patient bowel Prep:

Bring the following documentations:

Clicking submit will securely open your email client to send this data directly to team@ivanhoeendoscopy.com.au.

The Ivanhoe Endoscopy Centre is a specialist day surgery for the investigation and treatment of digestive disorders.

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