PAC Documentation Template

Document Name: PAC ORTHO ADMISSION: Procedure name

PAC – Name, Ortho Intern #Pager

Procedure:
Indication:
Date & Time:
Consented:
Surgeon:
BMI:

Past Medical History:


METS:
LUTS:
Skin breaks/tears/infections:

Cardiovascular:
– No HTN
– No IHD/angina
– No Stroke/TIA
– No CCF
– No Arrhythmias
– No recent CP/SOB/LL swelling

Ix:
– Previous Echo:
– Previous angiogram:

Respiratory:
– No Asthma, COPD
– STOPBANG:

– Respiratory function testing:
– Recent sleep tests:

Renal:
– Renal dysfunction/CKD

Endocrine:
– Diabetes
– Thyroid
– Liver disease

Haematological:
– Previous DVT/PE
– Coagulopathy

Medications:

– Steroid dependence
– Fish oil/OTC


Surgical History:
Previous surgeries:


Complications of surgery:


Social Hx:
– Smoking
– EtOH
– Drug Use
– Home with:
– Gait aids:

Examination:
Phone PAC – not performed

Plan:
– Consent:
– Ready for surgery:
– Campus suitable for:
– Imaging:
– Pathology: required: Ext G&H, FBE, UEC, CRP, LFT, CMP, coagulation studies, iron studies
– Iron infusion:
– ECG:
– Medications advice:
– Anaesthetic review: