ENT Surgery Pre-Operative Checklist
Patient Name
MRN / Patient ID
Date of Birth
Date of Surgery
Surgeon
Procedure
Pre-operative Checklist
Patient identification confirmed
Consent form signed
Surgical site marked
Allergies checked
Medical history reviewed
Recent labs available
NPO status confirmed
Anesthesia evaluation complete
Blood products arranged (if required)
Implants/prosthesis ready (if required)
Imaging available and reviewed
Jewellery removed
Dentures/Contact lenses removed
Pre-medications administered
Additional Notes
Nurse Name
Date
Signature