http://www.liverpoolwomens.nhs.uk/Library/our_services/Aneasthetics/Preopera tive_assessment_health_questionnaire.pdf PRE-OPERATIVE ASSESSMENT HEALTH QUESTIONNAIRE Welcome to the pre operative assessment clinic. Here you will be seen by a pre-op nurse assessor who may ask questions about your general health. You will also have an opportunity to ask questions regarding your admission for your surgery, reducing any anxieties you may have. To help us with the assessment process we ask you to take 5 - 10 minutes of your time to fill in this health questionnaire. It is important you give as much detail as possible as it will help us to establish your medical fitness for anaesthetic so that the procedure can proceed safely. This questionnaire is based on a scoring system and will help us to place you in the appropriate clinic. If you are unsure about any of the question's or having difficulty completing the health questionnaire please ask one of the Nurse's who will be happy to help. All information given will be treated in confidence. Date Pre-operative Nurse http://columbiaeye.org/sites/default/files/4.6%20Attachment_Preoperative%20M edical%20Questionnaire.pdf 66 pitanja i ispunjava i potpisuje sam pacijent http://www.pah.nhs.uk/files/C%20-%20Pre%20Operative%20Health%20Questionnaire %20V4.pdf Please sign below as an indication that all the above information has been fully explained to you by the pre assessment staff regarding your admission in hospital Signature of patient .............................. Signature of nurse ...................Date........ http://www.epaq.co.uk/news_content.aspx?page=epaq_po ePAQ-PO: Pre-operative Assessment Questionnaire ePAQ-PO has been developed and trialed at Sheffield Teaching Hospitals NHS FT over the last 3 years and is now being introduced into clinical practice. With over 500 patients having completed ePAQ-PO thus far, 300 in the context of a protocol driven validation study, increasing numbers are now being invited to complete the questionnaire, at home, as part of routine clinical practice. This screening questionnaire can be completed at a surgical clinic, using a touch screen terminal, following the patients initial listing for surgery or subjects can be issued with a voucher that allows EPAQ to be completed online, at their convenience, typically at home. ispunjavaju pacijenti ili uz pomoć bolničkog osoblja...