Surgical services forms

Corewell Health Southeast Michigan

Scheduling

Record Surgical Procedure Scheduling Request (PDF)

Helen DeVos Children's Hospital

Helen DeVos Children's Hospital

Ordersets

Pediatric General Surgery Order Form 8/22 (PDF)

Misc. Patient Care Documents

Corewell Health West Michigan

Consents

Invasive or Complex Procedures (PDF)
Invasive or Complex Procedures (Spanish) (PDF)
Transfusion of Blood or Blood Products (PDF)
Release from Responsibility for Patient Refusal of Blood/Blood Product Transfusions (PDF)

Anesthesia Consent (PDF)
Anesthesia Consent (Spanish) (PDF)
Treatment and Release of Information General Consent (PDF)
Treatment and Release of Information General Consent (Spanish) (PDF)

Ordersets

Bariatric Orderset (PDF)
Cardiothoracic Orderset (PDF)
General Surgery Orderset (PDF)
Genitourinary Orderset (PDF)
Gynecologic Oncology Orderset (PDF)
Head and Neck Orderset (PDF)
Implantable Intrathecal Medication Pump (PDF)
Lower Gastrointestinal Orderset (PDF)

Neurosurgery Orderset (PDF)
Ophthalmology Pre-Scheduled Surgery (PDF)
Orthopedic Orderset (PDF)
Pediatric General Surgery Order Form (PDF)
Peripheral Vascular Orderset (PDF)
Plastic Surgery Pre-Scheduled Surgery (PDF)
Upper Gastrointestinal Orderset (PDF)
Urology Gynecology Orderset (PDF)

Education

Surgical Services Handbook (PDF)
Surgical Optimization Center Brochure (PDF)
Surgical Optimization Center Brochure (Spanish) (PDF)
Surgery During Covid-19 (PDF)

Scheduling

Amended Boarding Slip (PDF)
Block FAQ (PDF)
Block Release Form (PDF)
Block Request/Change/Deletion Form (PDF)
Block Appeal Escalation (PDF)
Case Booking Appeal Escalation Form (PDF)

Policies

Miscellaneous patient care documents

Anesthesia Risk Stratification (PDF)
Ambulatory Surgery Guideline Qualifications (PDF)
Diabetes Management - Pre-Procedure Form (PDF)
Hard Stops (PDF)
Hard Stop Appeal Process Tip Sheet (PDF)
History and Physical (PDF)
H&P Conditional Shortform (PDF)

Levels of Surgery (PDF)
Pre-admission Testing (PDF)
Request for History/Physical - Outpatient, Pediatric Sedation Team (PDF)
History/Physical 24 Hour Update (PDF)
History & Physical Preprocedure/Time of Procedure (PDF)