Neurosurgery Pre-Operative Checklist
Patient Information
Patient Name
Hospital ID
Date of Birth
Surgery Date
Pre-Operative Assessment
Diagnosis
Surgical Procedure Planned
Allergies
Current Medications
Past Medical History
Relevant Imaging Reviewed
Yes
No
Pre-Op Investigations
CBC
Coagulation Profile
Electrolytes
ECG
Chest X-Ray
Blood Prepared
Yes
No
If Yes, Units Cross-Matched
Consent
Surgical Consent Signed
Anesthesia Consent Signed
Blood Products Consent Signed
Other Preparation
NPO Status Confirmed
IV Access Secured
Operative Site Marked
Pre-Op Antibiotic Given
Baseline Vitals Checked
Notes / Additional Comments