Aneszteziológiai kérdőív (#9)

Background Health Questionnaire and Informed Consent Form for Procedural

 

Esteemed Patient!


The following questions provide critical medical background information for the safe and proper
administration of anesthesia required for your medical procedure(s). We kindly ask that you take the time to
fill it out as accurately and completely as possible providing all pertinent medical background information for our anesthesiologist to best perform their procedure(s) and providing you, or the patient, with the highest standard of care possible. Any omissions or inaccurate information could expose you, or the patient, to unnecessary dangers. If anything is unclear regarding the questions below, please consult the anesthesiologist prior to answering the form.

Individual characteristics


Do any of the ailments below pertain to you?



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