{"id":12111,"date":"2016-03-29T13:14:32","date_gmt":"2016-03-29T17:14:32","guid":{"rendered":"http:\/\/www.nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/12082-2\/"},"modified":"2025-12-18T14:42:17","modified_gmt":"2025-12-18T19:42:17","slug":"formulaires-services-chirurgicaux","status":"publish","type":"page","link":"https:\/\/nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/formulaires-services-chirurgicaux\/","title":{"rendered":"Formulaires de services chirurgicaux"},"content":{"rendered":"

Formulaires d’information des patients<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Orthopaedic Clinic Patient Information<\/a><\/td>\nRHC 280<\/td>\nanglais<\/td>\n<\/tr>\n
Carpal Tunnel Release<\/a><\/td>\nRHC 368<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Bladder Surgery<\/a><\/td>\nRHC 367<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Knee Arthroscopy<\/a><\/td>\nRHC 372<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Your Guide to Total Knee Replacement (Colour Booklet)<\/a><\/td>\nRHC\u00a0375<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Hernia Repair<\/a><\/td>\nRHC 376<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Laparoscopic Cholecystectomy<\/a><\/td>\nRHC 384<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Release of Liability For Refusal of Blood and Blood Products<\/a><\/td>\nRHC 421<\/td>\nanglais<\/td>\n<\/tr>\n
Instructions pr\u00e9op\u00e9ratoires – Le nettoyage de la peau avant l\u2019op\u00e9ration<\/a><\/td>\nRHC 425<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
Blood Transfusion Information<\/a><\/td>\nRHC\u00a0603<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Total Knee Arthroplasty – Patient Plan of Care<\/a><\/td>\nRHC\u00a0756<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Pre-Admission Passport<\/a><\/td>\nRHC 887<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Instructions aux patients\/proches aidants concernant une ponction lombaire<\/a><\/td>\nRHC 1040<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
Influenza Letter – Infection Control<\/a><\/td>\nRHC 1194<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
How to prepare for your gynecology procedure<\/a><\/td>\nRHC 1282<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Tonsillectomy, Adenoidectomy, or Adenotonsillectomy Surgery<\/a><\/td>\nRHC 1487<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
How to prepare for your surgery<\/a><\/td>\nRHC 2022<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Pre-Op Hip Class<\/a><\/td>\nRHC 2109<\/td>\nanglais et fran\u00e7ais<\/td>\n<\/tr>\n
Pre-Op Knee Class<\/a><\/td>\nRHC 2110<\/td>\nanglais et fran\u00e7ais<\/td>\n<\/tr>\n
Shoulder Surgery Discharge Instructions<\/a><\/td>\nRHC 2161<\/td>\nanglais<\/td>\n<\/tr>\n
Patient and Family Experience Survey<\/a><\/td>\nRHC 2286<\/td>\nanglais et fran\u00e7ais<\/td>\n<\/tr>\n
Hysterectomy Surgery Post-Operative Discharge Instructions<\/a><\/td>\nRHC 2599<\/td>\nanglais<\/td>\n<\/tr>\n
Hysterectomy Surgery<\/a><\/td>\nRHC 2600<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Self-monitoring in preparation for surgery\/procedure<\/a><\/td>\nRHC 2983<\/td>\nanglais<\/td>\n<\/tr>\n
COVID 19 Screening for Elective Surgery<\/a><\/td>\nRHC 3090<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Instructions aux patients concernant une ponction lombaire<\/a><\/td>\nRHC 3511<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
Renseignements pr\u00e9op\u00e9ratoires Interventions orthop\u00e9diques mineures de la main<\/a><\/td>\nRHC 3552<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
Gastroscopie, coloscopie et sigmo\u00efdoscopie flexible<\/a><\/td>\nRHC 3592<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n
3M™ SoluPrep™Antiseptic Skin Cleanser\u00a0Sponge<\/a><\/td>\nNo RHC #<\/td>\nanglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Paquets de pr\u00e9admission pour patients externes<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Patient Instructions for Pre-Admission Clinic<\/a><\/td>\nRHC 259<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Preparing for Surgery – Anesthesia Explained<\/a><\/td>\nRHC 778<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Venous Thromboembolism<\/a><\/td>\nRHC 807<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Information About Your Hospital Stay and Discharge<\/a><\/td>\nRHC 1682<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Paquets de pr\u00e9admission pour patients hospitalis\u00e9s<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Patient Instructions for Pre-Admission Clinic<\/span><\/a><\/td>\nRHC 259<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Preparing for Surgery – Anesthesia and Pain Control Explained<\/span><\/a><\/td>\nRHC 778<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Venous Thromboembolism<\/span><\/a><\/td>\nRHC 807<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Information About Your Hospital Stay and Discharge<\/a><\/td>\nRHC 1682<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Questionnaires<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Questionnaire Pr\u00e9-Anesth\u00e9sique<\/a><\/td>\nRHC\u00a02026<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Pre-Procedure Questionnaire<\/a><\/td>\nRHC 2568<\/td>\nanglais et\u00a0fran\u00e7ais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Formulaires de r\u00e9f\u00e9rence<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Colorectal Cancer Screening Clinic Referral Form<\/a><\/td>\nRHC\u00a0427<\/td>\nanglais<\/td>\n<\/tr>\n
Referral to Patient Blood Management Program at North Bay Regional Health Centre<\/a><\/td>\nRHC 3083<\/td>\nanglais<\/td>\n<\/tr>\n
North East Hip and Knee Replacement Referral Form (PDF)<\/a> | Formulaire Word remplissable<\/a><\/td>\nNo RHC #<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Perioperative Services Lumbar Puncture Referral Form<\/a><\/td>\nRHC 3512<\/td>\nanglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Autres formulaires<\/h2>\n\n\n\n\n<\/colgroup>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Nom<\/h3>\n<\/th>\n

\n

Num\u00e9ro<\/h3>\n<\/th>\n

\n

Langue<\/h3>\n<\/th>\n<\/tr>\n<\/thead>\n

Surgical Information for Surgeon\/Anesthesiologist\/Surgical Assistants<\/a><\/td>\nRHC 871<\/td>\nanglais<\/td>\n<\/tr>\n
Surgical Booking Checklist<\/a><\/td>\nRHC 2021<\/td>\nanglais<\/td>\n<\/tr>\n
Ophthalmology Clinic Physician Appointment (Dr. Vijay)<\/a><\/td>\nRHC 2835<\/td>\nfran\u00e7ais<\/td>\n<\/tr>\n
Pacemaker Generator Change Pre Op<\/a><\/td>\nPPO-1-001<\/td>\nanglais<\/td>\n<\/tr>\n
Permanent Pacemaker Initial Implantation Pre-op<\/a><\/td>\nPPO-1-007<\/td>\nanglais<\/td>\n<\/tr>\n
Cataract Surgery<\/a><\/td>\nPPO-6-061<\/td>\nanglais<\/td>\n<\/tr>\n
Post-Operative Laparoscopic Total Hysterectomy<\/a><\/td>\nPPO-6-072<\/td>\nanglais<\/td>\n<\/tr>\n
Preoperative Patient Orders<\/a><\/td>\nPPO-6-080<\/td>\nanglais<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

Formulaires de r\u00e9f\u00e9rence, de r\u00e9servation et d’information pour le programme de conservation p\u00e9riop\u00e9ratoire du sang, salle d’op\u00e9ration, patients externes, patients hospitalis\u00e9s, USPA, clinique de pr\u00e9admission, clinique d’urodynamique et clinique de vasectomie.<\/p>\n","protected":false},"author":17,"featured_media":0,"parent":5962,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":"","_wp_rev_ctl_limit":""},"tags":[2510,2627,2626,2546,2615,2539,2128,2137,2129,2130,2131,2511,2512,2138,2132,1589,2513,2514,2624,2515,2133,2516,2517,2613,2518,2272,2123,2537,2621,2135,2519,2520,2124,2274,2521,1561,2125,2126,2522,2523,1599,2127,2136,2144,2153,2145,2146,2147,2524,2525,2154,2148,1590,2526,2527,2625,2528,2149,2529,2530,2614,2531,2271,2139,2538,2620,2151,2532,2533,2140,2273,2534,2587,1562,2141,2142,2535,2536,1600,2143,2152],"class_list":["post-12111","page","type-page","status-publish","hentry","tag-nejac-fr","tag-ppo-1-001","tag-ppo-1-007","tag-ppo-6-061-fr","tag-ppo-6-072-fr","tag-ppo-6-080","tag-rhc-1081","tag-rhc-1100","tag-rhc-1136","tag-rhc-1194","tag-rhc-1282","tag-rhc-1487-fr","tag-rhc-1682-fr","tag-rhc-2021","tag-rhc-2022","tag-rhc-2026-fr","tag-rhc-2109-fr","tag-rhc-2110-fr","tag-rhc-2161-fr","tag-rhc-2286-fr","tag-rhc-2447","tag-rhc-2568-fr","tag-rhc-259-fr","tag-rhc-2599-fr","tag-rhc-2600-fr","tag-rhc-268","tag-rhc-280","tag-rhc-2983-fr","tag-rhc-3090-fr","tag-rhc-340","tag-rhc-367-fr","tag-rhc-372-fr","tag-rhc-375","tag-rhc-376","tag-rhc-384-fr","tag-rhc-427-fr","tag-rhc-603","tag-rhc-756","tag-rhc-778-fr","tag-rhc-807-fr","tag-rhc-871-fr","tag-rhc-887","tag-rhc-917","tag-rhc1081","tag-rhc1100","tag-rhc1136","tag-rhc1194","tag-rhc1282","tag-rhc1487-fr","tag-rhc1682-fr","tag-rhc2021","tag-rhc2022","tag-rhc2026-fr","tag-rhc2109-fr","tag-rhc2110-fr","tag-rhc2161-fr","tag-rhc2286-fr","tag-rhc2447","tag-rhc2568-fr","tag-rhc259-fr","tag-rhc2599-fr","tag-rhc2600-fr","tag-rhc268","tag-rhc280","tag-rhc2983-fr","tag-rhc3090-fr","tag-rhc340","tag-rhc367-fr","tag-rhc372-fr","tag-rhc375","tag-rhc376","tag-rhc384-fr","tag-rhc421","tag-rhc427-fr","tag-rhc603","tag-rhc756","tag-rhc778-fr","tag-rhc807-fr","tag-rhc871-fr","tag-rhc887","tag-rhc917"],"acf":[],"yoast_head":"\nFormulaires de services chirurgicaux - NBRHC<\/title>\n<meta name=\"description\" content=\"Cette page contient des formulaires d'information patient \u00e0 remplir, des questionnaires, des formulaires de r\u00e9f\u00e9rence, des trousses de pr\u00e9-admission\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/formulaires-services-chirurgicaux\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaires de services chirurgicaux - NBRHC\" \/>\n<meta property=\"og:description\" content=\"Cette page contient des formulaires d'information patient \u00e0 remplir, des questionnaires, des formulaires de r\u00e9f\u00e9rence, des trousses de pr\u00e9-admission\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nbrhc.on.ca\/fr\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\/formulaires-services-chirurgicaux\/\" \/>\n<meta property=\"og:site_name\" content=\"NBRHC\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/nbrhc\" \/>\n<meta property=\"article:modified_time\" content=\"2025-12-18T19:42:17+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/nbrhc.on.ca\/wp-content\/uploads\/2015\/07\/icon_col.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"619\" \/>\n\t<meta property=\"og:image:height\" content=\"619\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/nbrhc.on.ca\\\/fr\\\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\\\/formulaires-services-chirurgicaux\\\/\",\"url\":\"https:\\\/\\\/nbrhc.on.ca\\\/fr\\\/formulaires-pour-les-fournisseuses-et-fournisseurs-de-soins-de-sante\\\/formulaires-services-chirurgicaux\\\/\",\"name\":\"Formulaires de services chirurgicaux - 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