Patient Forms

These forms will help you with your journey. Feel free to download at your own leisure.

• Facility Pre-Op Form

The Day Before Your Surgery

EATING, DRINKING AND MEDICATIONS: For reasons of your safety, it is important to limit the intake of food and fluids before anesthesia and surgery. Depending upon the type of surgery, you may receive special instructions from your physician to prepare your body for surgery.

This information will be discussed with you during your pre-op appointment.

 

General Rule of Thumb: If your surgery is scheduled BEFORE 12 noon, patients may not have anything to eat or drink after midnight.

If scheduled at 12 noon or AFTER, patients may have clear liquid up until 6AM on the day of surgery.

Eating meats, eggs, fatty or fried foods are NOT ACCEPTABLE on the day of surgery and will result in the cancellation of surgery.

Patients having a history of heartburn, esophageal reflux, hiatal hernia, gastro paresis or similar conditions which impair gastric emptying should have no solid food after midnight.

Failure to heed these guidelines may result in cancellation of the planned surgery, for safety reasons.

 

Diabetic patients need to pay particular attention to their diet and medication on the day of surgery. Individual management of each diabetic provides the best and safest management. Prior to the day of surgery, patients should contact the physician who manages their diabetes. This will allow a specific plan for their diabetic management on the evening before and the day of surgery.

Fasting guidelines are the same for diabetic or non-diabetic patients:

Daily Medications

If you take medications regularly for heart and lung conditions (such as angina, chest pain, high blood pressure or asthma) or for seizure (epilepsy) control, we recommend that you continue to take them on your usual schedule including the day of surgery. These may be taken with a sip of water.

The Day of Your Surgery

Bring the following with you:

• Do wear comfortable, loose clothes. Do not wear anything that has to go over your head. Instead choose something that buttons or zips up the front..
• Do bring medical insurance cards.
• Do bring all medicines and follow all instructions given.
• Do bring a protective case for your eye glasses, contacts, or hearing aid.
• If you have long hair, it is recommended you bring a pony tail scrunchie for your hair.

Plan to arrive at the North Valley Outpatient Surgery Center at your appointed time. Check in with the receptionist to complete the necessary paperwork and take care of any payment necessary for your procedure.

Leave these at home:

• Do not wear any jewelry, including wedding bands or body piercing jewelry.
• Do not wear any make-up, hairpins, nail polish, contact lenses.
• Do not bring any money with you.
• Do not bring any extra luggage or clothing.

 

Your Surgery

• All family and visitors will be told where to wait.
• You may be asked to mark the place of your surgery. We will be sure we identify you, the type and place of your surgery.
• The nurse will take your temperature, blood pressure, pulse and review your health history and answer any questions.
• In some cases you will have an IV for fluid and medicine.
• Your anesthesiologist will review your health and blood tests, tell you what will happen and answer your questions.

IMPORTANT POINT: PLEASE UNDERSTAND THAT WE EXPECT YOU TO HAVE A RESPONSIBLE ADULT ACCOMPANY YOU TO THE SURGERY CENTER, TO BE AVAILABLE DURING YOUR TREATMENT AND TO TAKE YOU HOME. YOUR SURGERY CANNOT PROCEED WITHOUT YOUR COMPANION.

AFTER YOUR SURGERY

• After your surgery is completed you will taken to the recovery room. Your companion can join you in the lounge until you are released.
• If you feel very sleepy, cold, have a sore throat, have pain, or feel sick to your stomach, tell your nurse.
• To help you get better faster you must cough and take deep breaths when the nurse asks you.
• A common way for us to know how much pain you are having is to have you rate your pain using a number scale from 0 to 10.

 

Pain Guide

0 to 3 = mild pain - you can cough, move around and rest without pain being a problem.

4 to 7 = moderate pain that needs medicine or other treatment. With moderate pain you can't cough fully and moving around or getting out of bed is hard.

8 to 10 = severe pain and you need immediate pain treatment. It hurts even when laying still and breathing.

Before You Leave

Please be sure you understand all the instructions about medicine, diet and rest. You may feel sleepy and dizzy. You should plan to go home and stay at home for the rest of the day. For your own safety, it is important that you do not drive a vehicle, operate machinery, drink alcohol, or make any important decisions for at least 24 hours after discharge.

At Home:

You should plan to have a responsible adult stay with you after surgery. They may have special instructions that must be followed to help you with recovery. This will all be explained before you leave the surgery center.

Call if you have any questions when you get home. Your physician or nurse will call you to see how you are feeling and to answer any questions you may have.

IMPORTANT TELEPHONE NUMBERS:

North Valley Outpatient Surgery Center 480.991.6877

Physician: Your will be given your physician's cell number in case of an emergency.

THINGS TO REMEMBER:

• Call your doctor if you feel sick before your surgery.
• Follow the instructions you receive for eating, drinking and medicines carefully.
• Wear loose, comfortable clothes.
• Have a responsible adult bring you, take you home, and spend the night.
• Bring your medical insurance cards.
• Bring all your medicines.
• Bring a container to store your glasses, contacts, or hearing aid.
• Leave valuables at home.

For Consumers:

North Valley Outpatient Surgery Center is licensed by the Arizona Department of Health Services and Medicare Certified. The Arizona Department of Health Services is responsible for ensuring health care facilities comply with state laws and regulations. In addition, North Valley Outpatient Surgery Center is Medicare Certified to ensure the acceptance of Medicare payments meet federal requirements. North Valley Outpatient Surgery Center also oversees the certification of its faculty.