As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Outpatient Surgery and Ambulatory Services Policy and Procedure Manual includes this customizable template, Surgical Checklist and Preoperative Nursing Record Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Surgical Checklist and Preoperative Nursing Record Form:

	SURGICAL CHECKLIST AND PREOPERATIVE NURSING RECORD Patient Name: Procedure include site: Floor CheckPreoperative ChecklistOR CheckPreoperative Nursing RecordChartChartPRE-OP HOLDING AREA ADMIT TIME: Date: Time: History and Physical on Chart or DictatedSkin Assessment CompletedConsultation on ChartCBC Report on Chart: Date: Time:UA Report on Chart: Date: Time:Blood Ordered WB, PC, FFP, PLT, No. Units:Addressograph Plate with ChartPrevious Charts to OREKG on Chart Date: Time:Chest File...
Second excerpt:
	...on Chart Pos NegSterilization Permit: Signed, Date, Time, on ChartPatientPatientYesNoYesNoID Band on Patient and CorrectPrep: Shave and/or Skin Done Initial:NPO Since: TimeDentures, Plates, Partials, removed, left in, noneGlasses, Contact Lenses, removed, left on, noneProthesis, i.e., hearing aid removed, left on, noneVoided or Cath'd secured Time:Jewelry: Secured Removed NoneHairpins, makeup, nail polish ...