LINDA J. DINDZANS, MD Office: 414-536-7000
JODI M. KORNAK, MD, MS,
FACS
Fax: 414-536-7001
SURGERY DATE:
__________________________
***IMPORTANT REMINDERS**
** LAB
WORK AND PHYSICAL EXAM MUST BE COMPLETED 14 TO 30 DAYS BEFORE SURGERY
** IF THE
HISTORY AND PHYSICAL IS NOT RECEIVED FROM THE PRIMARY PHYSICIAN 7 DAYS PRIOR
TO SURGERY DAY, THE SURGERY MAY BE
RESHEDULED.
** THE SURGICENTER OR
OF SURGERY CHECK-IN.
** YOU MUST CONTACT YOUR INSURANCE COMPANY PRIOR TO SURGERY
AND PAYMENT FOR ANY
NON- COVERED
AMOUNTS (COPAYS OR DEDUCTIBLES) MUST BE PAID IN FULL PRIOR TO SURGERY.
****PLEASE DO NOT TAKE ANY ASPRIN OR IBUPROFEN 10 DAYS
BEFORE OR AFTER SURGERY******
(These medications
are not restricted for ear tube surgeries alone)
Guidelines for Fasting Prior to Surgery
INFANTS
0-12 MONTHS
* No solids
after midnight
* Formula/breast
milk : must end
up to 6 hours before the scheduled surgery time
* Clear Liquids : must end up to 3 hours before the scheduled
surgery time
ANY CHILD
OVER 12 MONTHS
* No solids,
milk or milk products after midnight
* Gum is not
considered a solid unless it was swallowed
* Clear
liquids only up until 3 hours before scheduled surgery time
Instructions should be clarified during the pre-op
phone call with timing based upon the revised
surgery schedule, allowing for variations in surgical
time and possible advancement of the scheduled surgery time.
ADULTS 16
AND OVER
* No solids
after midnight
* Clear
liquids must end 3 hours before the surgery time at the discretion of the Anesthesiologist.