Patient Forms

Download Procedure Forms

Thank you for giving us the opportunity to care for your patient. Below, you will find the necessary forms for procedures performed at our hospital. These forms are in PDF format. If you do not have Adobe®Reader® on your computer, you can download it for free by going to Get Adobe Reader.com. If you have any questions, please feel free to contact Leslie.Baker@thcds.com.

Disclosure and Consent Form

Disclosure and Consent Form

This form authorizes the patient’s disclosure and consent to medical and surgical procedures.

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H&P Interactive Form

H&P Interactive Form

This form collects history and physical information for short stay patients.

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Post-op Physicians Orders

Post-op Physicians Orders

This form details physician orders for post-op outpatient care.

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Pre-Assessment Services Instructions

Pre-Assessment Services Instructions

This form provides information for scheduling surgeries and tests (for physicians).

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Pre-Testing Info Sheet

Pre-Testing Info Sheet

This form allows the patient to acknowledge pre-testing and scheduling information.

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THCDS Sleep Apnea Form

THCDS Sleep Apnea Form

This form provides the “STOP-BANG” patient survey and scoring model.
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THCDS CPAP Equipment Checklist

THCDS CPAP Equipment Checklist

This form collects important information about CPAP machine/equipment requirements.

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Surgery Scheduling Form

Surgery Scheduling Form

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Pain Care Procedures

Pain Care Procedures

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Pre-Op Testing & Day of Surgery Orders

Pre-Op Testing & Day of Surgery Orders

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