Printable patient document
Surgery Preparation Checklist
Printable surgery preparation checklist for medicines, fasting, admission and home support, authored and reviewed by Dr. Himanshu Yadav.
Dr. Himanshu Yadav
M.S., M.Ch. (Surgical Gastroenterology), SGPGIMS Lucknow
Director, Dr Himanshu's Clinic, Agra
Director, Dr Himanshu's Clinic, Agra
Surgery Preparation Checklist
Record the instructions supplied by your surgical and hospital teams. Their individual plan always takes priority.
Patient and planned procedure
Name
Procedure
Surgery date
Hospital
Admission time
Surgeon/team
Decision and pre-operative review
- I understand why surgery is advised
- Alternatives and no-treatment option discussed
- Benefits and important risks discussed
- Expected hospital stay discussed
- Required tests/anaesthetic review completed
- Expected recovery and support discussed
Medicines—record only the team's instructions
| Medicine | Continue | Stop/adjust from | Restart advice |
|---|---|---|---|
Do not stop blood thinners, diabetes medicines, weight-management medicines or any prescribed treatment without explicit instructions from the prescribing or surgical team.
My hospital's fasting instructions
Stop solid food at
Date
Clear liquids allowed until
Special instructions
If the written fasting plan is missing or unclear, contact the hospital. Do not guess or use a general internet rule.
Admission and home arrangements
- Admission papers and identification packed
- Reports/images requested by the team packed
- Allergy and medicine lists packed
- Loose clothing and essential assistive devices packed
- Transport home arranged
- Adult support at home arranged if required
- Food, fluids and prescribed medicines available at home
- Hospital contact and urgent-help plan saved
Questions before admission
Contact the treating team before admission if you develop fever, cough, vomiting, diarrhoea, a skin infection or another new illness. Seek emergency care for severe or rapidly worsening symptoms.