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To view, download or print any of the forms Outpatient Surgery Magazine offers online, please select it from the choices
below.
Note: Documents marked with "PDF" (portable document format) are readable with Acrobat Reader, available here for free. Documents marked with "XLS" (Excel spreadsheet) are readable with Microsoft Excel or any spreadsheet software.
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Post-Operative Discharge Instructions for Cervical Spine Surgery
Courtesy of Diagnostic and Interventional Surgical Center
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Size: 403kb
Type: PDF
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Post-Operative Discharge Instructions for Lumbar Spine Surgery
Courtesy of Diagnostic and Interventional Surgical Center
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Size: 403kb
Type: PDF
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Prophylactic Antibiotic Regimen Selection for Surgery
Courtesy of Outpatient Surgery Magazine
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Size: 63kb
Type: PDF
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"Legal Update: ASC Hospital Transfer Requirements Summary, by State" References
Courtesy of Outpatient Surgery Magazine
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Size: 35kb
Type: PDF
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Sharps Safety Form
Courtesy of Outpatient Surgery Magazine
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Size: 115kb
Type: PDF
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Cataract Cost Sheet
Courtesy of Outpatient Surgery Magazine
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Size: 64kb
Type: XLS
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"What Do You Know About Regional Anesthesia" References
Courtesy of Outpatient Surgery Magazine
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Size: 46kb
Type: PDF
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"What Do You Know About Products Treated With Antimicrobials" References
Courtesy of Outpatient Surgery Magazine
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Size: 28kb
Type: PDF
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"Materials That Help Reduce Pressure Injuries" References
Courtesy of Outpatient Surgery Magazine
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Size: 23kb
Type: PDF
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Infection Control Surveyor Worksheet
Courtesy of Outpatient Surgery Magazine
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Size: 234kb
Type: PDF
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"What Do You Know About Skin Preparation" References
Courtesy of Outpatient Surgery Magazine
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Size: 27kb
Type: PDF
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"Protect Yourself from Head to Toe" References
Courtesy of Outpatient Surgery Magazine
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Size: 25kb
Type: PDF
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Patient Hand-off Checklist
Courtesy of Charlene DiNobile, RN, Med, CNOR, CNAA, CST
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Size: 24kb
Type: PDF
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Perioperative Skin Assessment Tool
Courtesy of Christine Kennedy, RN, BSN, MA, CNOR
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Size: 42kb
Type: PDF
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Biopsy Report Form Letter to Patients
Courtesy of Endoscopy Center of Colorado Springs
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Size: 37kb
Type: PDF
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"Recipe for a Successful Safety Scalpel Trial" References
Courtesy of Outpatient Surgery Magazine
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Size: 23kb
Type: PDF
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"What Do You Know About...Vascular Access" References
Courtesy of Outpatient Surgery Magazine
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Size: 28kb
Type: PDF
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"What Do You Know About...Pre-op CHG Showers" References
Courtesy of Outpatient Surgery Magazine
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Size: 27kb
Type: PDF
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Perioperative Block Record
Courtesy of Cathy Rice, MD
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Size: 68kb
Type: PDF
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Making Time for Blocks References
Courtesy of Michael F. Mulroy, MD
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Size: 67kb
Type: PDF
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Financial Management of the Center
Courtesy of Outpatient Surgery Magazine Editors
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Size: 81kb
Type: PDF
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Pre-op Form 1: Patient Questionnaire
Courtesy of Truvista Surgery Center
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Size: 97kb
Type: PDF
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Pre-op Form 2: Medication Form
Courtesy of Truvista Surgery Center
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Size: 67kb
Type: PDF
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3 Steps to Right-sizing Your Suture Stock
Courtesy of Robert Schaff
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Size: 683kb
Type: PDF
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Why Scrub When You Can Rub? References
Courtesy of Janet P. Haas, RN, DNSc, CIC
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Size: 86kb
Type: PDF
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What's Your Consciousness Telling You? References
Courtesy of Colletta A. Richards, MD
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Size: 86kb
Type: PDF
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Diet Sheet
Courtesy of Denise Kohler, RN, BSN, MSN
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Size: 72kb
Type: PDF
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Prep Instructions
Courtesy of Denise Kohler, RN, BSN, MSN
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Size: 82kb
Type: PDF
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Contract Checklist
Courtesy of Alicia R. Cooper, Little Rock, Arkansas
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Size: 99kb
Type: PDF
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Eye Preps: When You Can't Use Povidone Iodine
Courtesy of Jean Hill, RN, MSN, CRNO and Lisa (Mary) Hill, RN, BSN
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Size: 107kb
Type: PDF
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The Essentials of Competency Programs for Ambulatory Surgery and Hospital Outpatient Settings
Courtesy of Dawn Q. McLane, RN, MSA, CASC, CNOR
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Size: 98kb
Type: PDF
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Surgical Pricing Schedule
Courtesy of Jay Schorr of Advanced Cosmetic Laser Center
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Size: 75kb
Type: XLS
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"How to Head off Deep Vein Thrombosis" References, June 2006
Courtesy of Anita Johnston, RN, BSN, CNOR
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Size: 95kb
Type: PDF
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2006 Medicare Injection and Infusion Flowchart
Courtesy of Lolita M. Jones, RHIA
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Size: 17kb
Type: PDF
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Orthopaedic Discharge Form
Courtesy of Lacey Dyer, RN
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Size: 32kb
Type: PDF
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Sample Assignment of Benefits Form
Courtesy of MedBridge Development, LLC
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Size: 64kb
Type: PDF
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Safety References, May 2006
Courtesy of Scott DeBoer, RN, MSN, CEN, CCRN, CFRN
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Size: 105kb
Type: PDF
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Sample Provisions for Partnership Agreements
Courtesy of Scott Becker, JD, CPA and Alison Vratil Mikula, JD of McGuire Woods in Chicaco, Ill.
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Size: 110kb
Type: PDF
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"Busting 7 Back Injury Myths" and "Inside the Numbers" References, March 2006
Courtesy of Jamie Tessler, MPH
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Size: 111kb
Type: PDF
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Sample Surgeon Survey
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI
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Size: 71kb
Type: PDF
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Ambulatory Surgery: Surgical Site Infection Surveillance: Pt 1
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI
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Size: 72kb
Type: PDF
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Ambulatory Surgery: Surgical Site Infection Surveillance: Pt 2
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI
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Size: 77kb
Type: PDF
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Infection Control Construction/Renovation Monitoring Checklist
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI
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Size: 87kb
Type: PDF
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Infection Control Construction Permit
Courtesy of Janice E. Rey, MP (ASCP), CIC, St. John Hospital and Medical Center, Detroit, MI
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Size: 75kb
Type: PDF
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Unanticipated Care After Discharge From Ambulatory Surgical Facilities
Courtesy of The Patient Safety Authority
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Size: 489kb
Type: PDF
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January, 2006 Safety Column References
Courtesy of Joy L. Hawkins, MD
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Size: 82kb
Type: PDF
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Patient Surgery Cost Sheet
Courtesy of Betsy Sharp, Administrator, Orthopaedic Associates Surgery Center LLC in Augusta, Georgia
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Size: 94kb
Type: PDF
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Precertification for Surgery Form
Courtesy of Betsy Sharp, Administrator, Orthopaedic Associates Surgery Center LLC in Augusta, Georgia
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Size: 90kb
Type: PDF
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General Post-operative Guidelines for Patients with Known History of Obstructive Sleep Apnea Requiring Use of CPAP
Courtesy of Marjorie N. Blouin, RN and Shannon Magro, RN, Frederick Surgical Center, Frederick, Maryland
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Size: 93kb
Type: PDF
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PCC BMI/CPAP Protocol
Courtesy of Marjorie N. Blouin, RN and Shannon Magro, RN, Frederick Surgical Center, Frederick, Maryland
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Size: 88kb
Type: PDF
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Myths of Pediatric Anesthesia References
Courtesy of Zeev Kain, MD, MBA, Professor and Chief of Pediatric Anesthesiology, Yale University School of Medicine
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Size: 94kb
Type: PDF
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Vacation & Sick Leave Accrual and Utilitization
Courtesy of Kristine Bedford, RN, Clinical Director, Endoscopy Center of Marin, Greenbrae, California
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Size: 67kb
Type: PDF
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Adverse Incident Report
Courtesy of The American Society of Plastic Surgeons
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Size: 71kb
Type: PDF
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Penicillin Allergy Algorithm
Courtesy of Outpatient Surgery Magazine
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Size: 300kb
Type: PDF
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Adult Pre-Operative Antibiotic Physicians Order Form
Courtesy of Southwest Generat Hospital Center, Middleburg, Ohio
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Size: 420kb
Type: PDF
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Operating Room Par Levels
Courtesy of Beverly Kirchner, RN, BSN, CNOR, CASC
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Size: 89kb
Type: PDF
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Sample Narcotics Form
Courtesy of Kris Fisher, RN, CNOR, BSN, Turtle Creek Surgery Center
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Size: 85kb
Type: PDF
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Checklist for Adding a Service Line
Courtesy of Sharon Davis, RN, RVT
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Size: 81kb
Type: PDF
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July "Legal Update" References
Courtesy of Outpatient Surgery Editors
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Size: 89kb
Type: PDF
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Plastic Surgery Safety Checklist
Compiled by Contributing Editor Dianne Taylor
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Size: 112kb
Type: PDF
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NCMC/SPC Case Cart Quality Inspection Sheet
Courtesy of Jennifer L. Misajet, RN, BBA, CNOR: Director of Surgical Services, Western States Burn Center
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Size: 71kb
Type: PDF
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Initial Appeal Documentation
Courtesy of Deborah L. Mack, MSN, CASC, CNOR
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Size: 34kb
Type: DOC
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Sample EOC Plan
Courtesy of Nancy Burden, RN, MS, CPAN, CAPA
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Size: 134kb
Type: DOC
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Example Table of Contents for Administration Manuals
Courtesy of Nancy Burden, RN, MS, CPAN, CAPA
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Size: 90kb
Type: PDF
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Coding the Most Common Colonoscopies
Courtesy of Stephanie Ellies, RN, CPC
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Size: 84kb
Type: PDF
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Sample Side-by-Side Surgical Lighting Trial Evaluation Form
Courtesy of Phyllis Rozema, BS, Borgess Hospital, Kalamazoo, Michigan
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Size: 101kb
Type: PDF
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March "Overcoming the Roadblocks to Regional Anesthesia" References
Courtesy of Outpatient Surgery Magazine
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Size: 82kb
Type: PDF
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Evaluating Skin Preps Pullout Full Version
Download by page:
Courtesy of Outpatient Surgery Magazine
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Size: 2.8Mb
Type: PDF
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February "Fast Facts About Fast Track Anesthesia" References
Courtesy of Outpatient Surgery Magazine
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Size: 105kb
Type: PDF
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NCMC/SPC Case Cart Quality Inspection Sheet
Courtesy of Jennifer L. Misajet, RN, BBA, CNOR: Director of Surgical Services, Western States Burn Center
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Size: 71kb
Type: PDF
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Medicare Survey Checklist
Courtesy of Genesee Associates, Inc.
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Size: 101kb
Type: PDF
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Employee Human Resource File: Chart Order
Courtesy of Genesee Associates, Inc.
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Size: 71kb
Type: PDF
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Initial Medical Executive Committee/Board Meeting Surgery Center
Courtesy of Genesee Associates, Inc.
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Size: 84kb
Type: PDF
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Surgery Center Organizational Chart
Courtesy of Genesee Associates, Inc.
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Size: 50kb
Type: PDF
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Development Team Assignments / Time Line: Surgery Center
Courtesy of Genesee Associates, Inc.
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Size: 50kb
Type: XLS
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Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures
Courtesy of Department of Health and Human Services
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Size: 352kb
Type: PDF
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"If You're Thinking of Buying..." References
Courtesy of Outpatient Surgery Magazine
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Size: 90kb
Type: PDF
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Crash Cart Inventory Checklist
Courtesy of Progressive Surgical Solutions, LLC.
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Size: 56kb
Type: PDF
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Pain Management Fee Schedule
Courtesy of Mowles Medical Practice Management, LLC.
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Size: 100kb
Type: PDF
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Surgical Glove Evaluation
July, 2004 - 107kb - PDF
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Size: 100kb
Type: PDF
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Sample Man Hours/Case Worksheet
Courtesy of Caryl A. Serbin, RN, BSN, LHRN
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Size: 94kb
Type: PDF
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Sample Surgical Site Infection Tracking Form
Adapted from St. John’s Mercy Medical Center Infection Control Department
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Size: 99kb
Type: PDF
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Professional Associations and Nursing Organizations
Courtesy of Ann Geier, RN, MS, CNOR
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Size: 94kb
Type: PDF
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Patient-Controlled Analgesia (PCA) Pump Safety Protocol
Courtesy of Institute for Safe Medication Practices (ISMP), Huntingdon Valley, Pa.
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Size: 68kb
Type: PDF
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Nurse Endoscopy Training Protocol
Courtesy of Alaska Native Medical Center, Anchorage, Alaska.
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Size: 64kb
Type: PDF
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Flexible Sigmoidoscopy Screening Protocol
Courtesy of National Naval Medical Center Division of Gastroenterology, Bethesda, Md.
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Size: 51kb
Type: PDF
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Index of Corporate Partners, Managers and Consultants
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Size: 82kb
Type: PDF
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A Sample Policy on Supply Pilfering
Courtesy of Jerrie Smith
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Size: 92kb
Type: PDF
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Provider-Specific Trends: Rennaissance and Baroque Artists Hospital
Courtesy of Siegel and Krohn, PC
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Size: 91kb
Type: PDF
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2004 Patient Safety Principles for Office-Based Surgery Utilizing Moderate Sedation/Analgesia, Deep Sedation/Analgesia, or General Anesthesia
Courtesy of American College of Surgeons
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Size: 79kb
Type: PDF
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The Fraud and Abuse Statute and Investor-Owned Ambulatory Surgery Centers
Courtesy of Scott Becker and Nicholas Harned
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Size: 666kb
Type: PDF
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4 Tips for Assessing Post-op Pain in Elderly Patients
Courtesy of M. McCaffrey and C. Pasero
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Size: 74kb
Type: PDF
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A Latex Allergy Patient Screening Questionnaire
Courtesy of Lauren Charous, MD
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Size: 78kb
Type: PDF
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