Surgical Services Forms
Patient Information Forms
Outpatient Pre-Admission Packages
Name |
Number |
Language |
|---|---|---|
| Patient Instructions for Pre-Admission Clinic | RHC 259 | English |
| Preparing for Surgery – Anesthesia Explained | RHC 778 | English |
| Venous Thromboembolism | RHC 807 | English |
| Information About Your Hospital Stay and Discharge | RHC 1682 | English |
Inpatient Pre-Admission Packages
Name |
Number |
Language |
|---|---|---|
| Patient Instructions for Pre-Admission Clinic | RHC 259 | English |
| Preparing for Surgery – Anesthesia and Pain Control Explained | RHC 778 | English |
| Venous Thromboembolism | RHC 807 | English |
| Information About Your Hospital Stay and Discharge | RHC 1682 | English |
Questionnaires
Name |
Number |
Language |
|---|---|---|
| Pre-Operative Questionnaire | RHC 2026 | English |
| Pre-Procedure Questionnaire | RHC 2568 | English & French |
Referral Forms
Name |
Number |
Language |
|---|---|---|
| Colorectal Cancer Screening Clinic Referral Form | RHC 427 | English |
| Referral to Patient Blood Management Program at North Bay Regional Health Centre | RHC 3083 | English |
| North East Hip and Knee Replacement Referral Form (PDF) | Fillable Word Form | No RHC # | English |
Other Forms
Name |
Number |
Language |
|---|---|---|
| Surgical Information for Surgeon/Anesthesiologist/Surgical Assistants | RHC 871 | English |
| Surgical Booking Checklist | RHC 2021 | English |
| Ophthalmology Clinic Physician Appointment (Dr. Vijay) | RHC 2835 | English |
| Pacemaker Generator Change Pre Op | PPO-1-001 | English |
| Permanent Pacemaker Initial Implantation Pre-op | PPO-1-007 | English |
| Cataract Surgery | PPO-6-061 | English |
| Post-Operative Laparoscopic Total Hysterectomy | PPO-6-072 | English |
| Preoperative Patient Orders | PPO-6-080 | English |
North Bay
50 College Drive,
P.O. Box 2500
North Bay, ON
P1B 5A4
Tel: 705-474-8600
Sudbury
680 Kirkwood Drive,
Sudbury, ON
P3E 1X3
Tel: 705-675-9193
Fax: 705-675-6817
