[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-285594-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-285594-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","preop-clearance-letter-arizona-institute-for-sports-knees-and-shoulders","Preop Clearance Letter - Arizona Institute for Sports, Knees, and Shoulders","","This pre-operative clearance document is a standardized medical form used by the Arizona Institute for Sports, Knees, and Shoulders to ensure patient safety before elective surgeries. It requires a healthcare provider to formally certify that a patient has been thoroughly examined and that all necessary laboratory tests have been reviewed to confirm the absence of medical contraindications for general or regional anesthesia. The form facilitates clear communication between the primary care provider and the surgical team led by Dr. David S. Bailie. Providers are instructed to document any special instructions for the surgery and transmit this information to the institute via secure fax, email, or direct patient delivery. The form captures critical identifying information, including the patient's name, date of birth, and the examining provider's verification. By requiring formal authorization, the document serves as a vital clinical tool for risk mitigation and surgical preparation coordination.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/preop-clearance-letter-arizona-institute-for-sports-knees-and-shoulders/285594/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/preop-clearance-letter-arizona-institute-for-sports-knees-and-shoulders/285594.png","ImageObject",442,249,{"name":42,"@type":43},"Jacob","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the purpose of the Preop Clearance Letter?","Question",{"text":63,"@type":64},"The purpose is for a healthcare provider to examine a patient, review lab work, and certify that there are no medical contraindications for the patient to undergo elective surgery under general or regional anesthesia.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How should the provider share special surgical instructions?",{"text":68,"@type":64},"Special instructions should be indicated in a letter to Dr. Bailie, which can be faxed to 855-661-0505, emailed to surgery@azisks.com, or given to the patient to hand carry.",{"name":70,"@type":61,"acceptedAnswer":71},"What information must be filled out on the form?",{"text":72,"@type":64},"The form requires the patient's name, the patient's date of birth, and the examining provider's name, degree, signature, and the date of the examination.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},285594,1790177115,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":4},962084931830,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","PREOP CLEARANCE LETTER  \nPlease give this to the provider who will be clearing you for surgery  \nI,  MD/DO/NP/PA, have  \nexamined this patient, checked all appropriate lab work and tests and certify, that to the best of my knowledge, there is not a medical contraindication for undergoing elective surgery with a general and/or regional anesthesia. If special instructions are required, I have indicated those clearly in a letter to Dr. Bailie, which accompanies this form. I have faxed the required information to Dr. Bailie’s staff at 855- 661-0505 or emailed to surgery@azisks.com or given it to the patient to hand carry.  \nPATIENT NAME:    \nPATIENT DOB:    \nEXAMINING PROVIDERNAME/DEGREE:    \nEXAMINING PROVIDERSIGNATURE/DATE:","cbCainFxQLroPKUi","https://ap.wps.com/l/cbCainFxQLroPKUi","pdf",144120,"English","# Preop Clearance Letter\n## Provider Certification\n## Patient Identification","[{\"question\":\"What is the purpose of the Preop Clearance Letter?\",\"answer\":\"The purpose is for a healthcare provider to examine a patient, review lab work, and certify that there are no medical contraindications for the patient to undergo elective surgery under general or regional anesthesia.\"},{\"question\":\"How should the provider share special surgical instructions?\",\"answer\":\"Special instructions should be indicated in a letter to Dr. Bailie, which can be faxed to 855-661-0505, emailed to surgery@azisks.com, or given to the patient to hand carry.\"},{\"question\":\"What information must be filled out on the form?\",\"answer\":\"The form requires the patient's name, the patient's date of birth, and the examining provider's name, degree, signature, and the date of the examination.\"}]","Preop Clearance Letter - Arizona Institute for Sports, Knees, and Shoulders | PDF",1789630091]