Ophthalmology | Royal Brisbane and Women's Hospital

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Specialty

Introduction

This RBWH pre-surgery checklist is a self-assessment tool used to ensure you are correctly prepared and fit for your surgery. If any of the questions you answer require further investigation, the survey will notify your case manager. If you have any concerns relating to your surgery, please call you case manager.

URN:

Name*

Given Name: Surname:

Date of Birth:*

Operation date:*

Section A: Your Health

It is very important for your own health and wellbeing that you are fit for your surgery, especially to undergo anaesthesia. To avoid the inconvenience of having your surgery cancelled on the day of surgery after you have already turned up at the hospital, please complete the following checklist. Do you have any of the following:

High temperature/fever*

Yes
No

Sore throat/cough/wheeze*

Yes
No

Vomiting/diarrhoea*

Yes
No

Skin breaks, tears, cuts, abrasions, rashes, scratches, wounds, blisters*

Yes
No

Location(s)*

Any significant change in your physical condition or medical conditions since we saw you last at the RBWH*

Yes
No

Please specify*

Section B: Your Preparation

Have you filled out your patient registration form?*

Yes
No

You will need to fill out the registration form on the morning of your surgery at the general admissions desk. Please arrive 10-15mins earlier to ensure you have adequate time to fill out the registration form

Medication

If you have been instructed to cease any of your medication prior to surgery, please review the information given to you by your case manager, pharmacist or medical team.

Fasting

Please make sure you follow the instructions you have been given regarding when you need to commence fasting before your surgery (stopping eating and drinking). Please remember clear fluids include: water, black tea, black coffee, cordials, clear fruit juice without pulp. You are NOT allowed to drink: milk, milkshakes, coffee or tea with milk cloudy fruit juices or alcohol. Please remember chewing gum, breath mints and lollies are NOT allowed.

Section D: If you need to cancel your surgery

If you have any concerns or for any reason you decide to cancel your surgery, please notify your case manager ASAP.

Your Case Manager Details

ENT (07) 36463147 RBWH-ENT-CaseManager@health.qld.gov.au

Your Case Manager Details

SURG 1 (GENERAL SURGERY)
(07) 3646 0539
RBWH-EndoSurg-CaseManager@health.qld.gov.au
(07) 3646 1975
RBWH-Breast_Health_Service@health.qld.gov.au

Your Case Manager Details

SURG 2/4 (GENERAL SURGERY)
(07) 3646 0538
RBWH-GenSurg2&4-CaseManager@health.qld.gov.au

Your Case Manager Details

SURG 3 (GENERAL SURGERY)
(07) 3646 0539
RBWH-ColorectalSurgery-Coordinator@health.qld.gov.au

Your Case Manager Details

Gynaeoncology
(07) 3646 2391
RBWH-GynaeOncology@health.qld.gov.au

Your Case Manager Details

Plastics/dermatology/skin/burns
(07) 36467245
RBWH-Plastics-CaseManager@health.qld.gov.au

Your Case Manager Details

Ophthalmology
(07) 36467245
RBWH-Ophthalmology-CaseManager@health.qld.gov.au

Your Case Manager Details

Orthopaedics
(07) 36463141
RBWH-Orthopaedics-CaseManager@health.qld.gov

Your Case Manager Details

Urology
(07) 36467076
RBWH-Urology-SurgicalCaseManager@health.qld.gov.au

Your Case Manager Details

Vascular
(07) 36463752
RBWH-Vascular-CaseManager@health.qld.gov.au

If you need to speak to a staff member outside of regular business hours please call the RBWH switchboard (07) 3646 8111. It is much preferred that you let us know before your surgery date, so we have as much time as possible to organise another patient for surgery. If for any reason your surgery does need to be cancelled due to not being surgically fit, we will work to rebook your surgery when you are healthy enough to attend.

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Case Manager

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Email

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RBWH Pre-surgery – Patient Health & Wellness Check

Introduction

Section A: Your Health

Section B: Your Preparation

Medication

Fasting

Section D: If you need to cancel your surgery

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

Your Case Manager Details

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Case Manager

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