Untitled Document

Deshmukh Eye Hospital Inpatient Document
Preop Evaluation / Checklist / OT Notes/ Postop Details

Patient Details :

Patient's Name

{{$data->PatientName}}

Age/Gender

{{$data->Age}}/ {{$data->Gender}}

MRD No

{{$data->MrdNo}}

Address

Contact

Date of Admission :

{{date('d/m/Y', strtotime(str_replace('-', '/',$data->AdmissionDate)))}}

Date of Surgery :

{{date('d/m/Y', strtotime(str_replace('-', '/',$data->SurgeryDate)))}}

Date of Discharge :

{{date('d/m/Y', strtotime(str_replace('-', '/',$data->SurgeryDate)))}}

Provisional Diagnosis at the time of Admission :

Final Diagnosis at the time of Discharge : {{$data->Diagnosis}}

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: {{$data->Surgeon_Name}}

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

Name & Sign:

Time & Date :

Name & Sign:

Time & Date :

Name & Sign: {{$data->Surgeon_Name}}

Time & Date :

Operative Notes (See Software for further details)

Add Stickers / Implant details here

Surgeon

Name & Sign: {{$data->Surgeon_Name}}

Time & Date :

Surgeon

Name & Sign: {{$data->Surgeon_Name}}

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

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		H/O भर्ती झाले होते		इतर/OTHER

Co-morbidity-DM/ HTN / IHD/ Others

Current Medications/ चालू औषधी

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 {{$data->PatientName}}	पेशंटची सही _________________	तारीख_____________
नातेवाईकांचेनाव {{$data->RelativeName1}}	नातेवाईकांची सही __________	नाते_____________
डिस्चार्ज देणाऱ्याचे नाव _______________________	सही__________________	वेळ_____________