Patient Forms

Pre-anesthesia Questionnaire

Preoperative and Postoperative Instructions

Advanced Directive Letter (english)

Advanced Directive Letter (espanol)

Bill of Rights (english)

Bill of Rights (espanol)

Pediatric Bill of Rights (english)

Pediatric Bill of Rights (espanol)

Disclosure of Ownership (english)

Disclosure of Ownership (espanol)

Acknowledgment of

Bill of rights, Disclosure of ownership & advanced directive

Pre-operative Instructions

Patients are required to be NPO (nothing by mouth) prior to surgery.  The policy varies depending upon the age of the patient.

Adults (including children 12 and older)

For cases scheduled prior to 2:00PM, all patients should be NPO after midnight prior to their procedure day.

For cases scheduled after 2:00PM, patients may take CLEAR LIQUIDS prior to 7:00AM on the day of their procedure. CLEAR LIQUIDS are those fluids which, when held to the light, are transparent. They include glucose-based drinks and clear juices. This does not include particulate or milk-based products.

For cases scheduled after 4:00PM, patients may have a “light breakfast” consisting of dry toast, clear liquids, and black coffee.

Children (Age less than 12)

A child is anyone under the age of 12. Attempts will be made to schedule all children as early in the day as possible. Recognizing that this will not always be possible, children should be NPO for six (6) hours prior to their procedure.

The following pre-operative instructions MUST be followed

• Take your regular medicines as directed with a small amount of water.
• Refrain from smoking at least 12 hours prior to your surgery. No gum or breath mints as they stimulate acid in the stomach.
• Have a responsible adult accompany you to and from the surgical center. Private automobile or taxi is recommended. Public transportation is not acceptable. A parent or guardian must be present with patients under 18 years of age.
• Wear loose, comfortable clothing. Whenever possible, leave valuables at home. We make every effort to protect your belongings while you are with us, but they are best secured by leaving them at home.
• Do not wear jewelry or make-up. You will be asked to remove your contact lenses and any body piercing jewelry prior to your surgery. Please bring an appropriate case to store them in.
• Contact your surgeon prior to the day of the surgery if your medical condition changes (e.g., severe cold, fever, etc.)
• After surgery, arrange to have a responsible adult remain with you for the rest of the day and during the night.

REMEMBER:

• Failure to follow these instructions may result in the cancellation of your surgery.
• If you have any general questions, please call the Ramapo Valley Surgical Center.

On the day of your surgery, you should arrive at least one hour before the surgery is scheduled to allow time for preparation. You will be asked to sign a consent form, which gives your physician and the center permission to care for you. If the patient is a child or minor, the consent form must be signed by a parent or legal guardian.

For patients who have received General Anesthesia or Intravenous Sedation

Following general anesthesia or intravenous sedation, 24 to 36 hours are required for the full effects of the drugs to wear off. During this period, it is important that you follow these instructions:

• After your surgery you MUST be accompanied by a responsible adult, who may either drive you home or accompany you home in a taxi. Public transportation is not acceptable. We also suggest that you have a responsible adult stay with you for the rest of the day and night.
• On arrival home it is common to feel sleepy. Rest quietly at home for the remainder of the day.
• Lie flat if you feel dizzy or light headed.
• Drink non-citrus juice or non-diet soft drinks for the first 4 - 6 hours. Light meals are recommended following your operation (i.e., soup, toast, Jell-O)
• Avoid alcohol in any form for 48 hours.
• Avoid any drugs apart from prescription drugs or your prescribed pain killers.
• Do not operate motor vehicles, boats, power tools or machinery for 24 hours.
• Do not operate an aircraft for at least four days following general anesthesia.
• Do not sign or enter into any legal contract for 24 hours.
• You may experience some muscular aches in you back or neck area. As well, you may develop a sore throat or stuffy nose following a general anesthetic. These symptoms are common and will disappear in a short time.

If you have any questions or concerns regarding post-operative signs or symptoms, please call your surgeon.

Click here for downloadable instructions