Plastic Hand Surgery Pre-Operative Checklist
Patient Information
Name
Date of Birth
Medical Record Number
Surgery Date
Surgery Time
Surgeon
Pre-Operative Checklist
Consent form signed
ID band checked
Surgical site marked
Allergies reviewed
NPO status verified
Pre-op labs reviewed
Relevant imaging available
Implants/prosthesis ready (if applicable)
Pre-op medications given
Hand/arm prepped (hygiene)
Venous access secured
Recent vital signs checked
Special Instructions / Notes
Pre-Op Nurse / Coordinator Verification
Verified By
Date
Signature