Deshmukh Eye Hospital Inpatient Document
Preop Evaluation / Checklist / OT Notes/ Postop Details
 
Patient Details:
Patient's Name
MRD No   Age/Gender   Contact  
Address
Date of Admission Date of Surgery Date of Discharge
Provisional Diagnosis at the time of Admission
Final Diagnosis at the time of Discharge
   
Preoperativenotes (Ophthalmologist) (Ward)              Surgeon
Sac patent   IOL Power Fundus Xylocaine testing negative
Ocular condition is as noted. Patient can be taken up for surgery
Modified WHO Surgical Safety Checklist
Name &Sign:
Time& Date:
SIGN IN
रुग्णाचे नाव सुनिश्चित केले
ऑपरेशनची बाजू /डोळा सुनिश्चित
गुंगी:यंत्र, औषधे सुरक्षा तपासणी
ऐअरवे / रक्तस्त्राव / एलेर्जी
झायलोकेन एलर्जी नाही
TIME OUT
मेडिकल टीमची ओळख
रुग्णाचे नावसुनिश्चित केले
ऑपरेशनची बाजू /डोळा सुनिश्चित
लेन्स कन्फर्म केले
अपेक्षित धोक्याची उजळणी केली ाही
SIGN OUT
ऑपरेशनचे/ प्रक्रियेचे नाव लिहिले
स्टीकर लावले / औषधे / सूचना दिल्या
   
   
   
     
Nurse Anaesthetist Surgeon
Sign:
Time:
Date :
Sign:
Time:
Date :
Sign:
Time:
Date :
 
Operative Notes (See Software for further details)
Add Stickers / Implant details here
 
 
Surgeon
Sign:
Time:
Date :
Surgeon
Sign:
Time:
Date :
 
 
Preoperative notes (Ophthalmologist)(ward)
Patient comfortable
Postoperative dressing done and instructions given
Please discharge the patient. Continue treatment & review schedule as per discharge summary

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Deshmukh Eye Hospital Inpatient Document
PAC / Anesthesia notes / Postoperative Evaluation
Preanesthetic Evaluation (PAC):  COMORBITY
Diabetic/ डायबीटीस Htn/ बिपी HEART DISEASE/हृदयरोग ASTHMA/श्वासाचा त्रास
ALLERGY /अलर्ज    ALLERGY /अलर्ज    H/O भर्ती झाले होते   इतर/OTHER  
Co-morbidity-DM/ HTN / IHD/ Others
Current Medications/ चालू औषधी
P   R   BP   SPO2    
Plan of Anesthesia
Anesthetist
Name &Sign:
Time& Date:
Anesthetist
Name &Sign:
Time& Date:
Fitness for surgery under planned anesthesia: Yes / High Risk Consent.     ASA Grade
PreoperativePreanesthetic Evaluation (Anesthesia) (Ward): Anesthetist
P   R   BP   SPO2    
Medication

To take for surgery as advised

  Anesthesia Notes and Monitoring
Topical Anesthesia with 0.5 % Proparacain drops instilled in Conjunctival Cul-de-sac 3 times over 5 minutes 
3 cc of 2% Xylocaine Injection given in peribulbar space with a 24G blunt Needle
Others
  Pulse Resp BP SpO2
Preoperative        
Intraoperative        
Postoperative        
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Postoperative Notes (Anesthetist)(Ward)
Patient Comfortable
P   R   BP   SPO2    
Medication
 
Patient is fit to be discharged
To Continue medicines as per discharge summary      
Anesthetist
Name &Sign:
Time& Date:
Additional Notes
 
आम्हाला ऑपरेशननंतरची काळजी समजवली आहे,ऑपरेशननंतरच्या सूचनांचा वऑपरेशनच्या संभाव्य धोक्यांचा व्हिडियो दाखवला. डिस्चार्ज कार्ड, सर्व रिपोर्ट मिळालेत
 
पेशंटचे नाव _____________________________________ पेशंटची सही _________________ तारीख_____________
नातेवाईकांचेनाव__________________________________ नातेवाईकांची सही __________ नाते_____________
डिस्चार्ज देणाऱ्याचे नाव _______________________ सही__________________ वेळ_____________