[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-392851-105":53,"doc-detail-392851-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","st-charles-surgery-center-scheduling-booking-sheet","St. Charles Surgery Center - Scheduling Booking Sheet","","This document serves as an official scheduling booking sheet for the St. Charles Surgery Center, designed to facilitate the organized collection of essential patient and surgical information. The form is structured to capture comprehensive data including patient demographics, specific surgical procedure details, anesthesia requirements, specialized lens measurements, and cardiac device status. It also incorporates sections for primary and secondary insurance information, authorization details, and necessary regulatory compliance checklists, such as HIPAA releases and patient rights acknowledgment. The template ensures that all critical clinical and administrative prerequisites are met prior to a surgical intervention, streamlining the coordination between the surgeon, the scheduling department, and the healthcare facility's operations. This standardized instrument is crucial for maintaining accurate medical records and ensuring efficient facility management.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/st-charles-surgery-center-scheduling-booking-sheet/392851/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/st-charles-surgery-center-scheduling-booking-sheet/392851.png","ImageObject",442,249,{"name":88,"@type":89},"hdkawk","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-25",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required regarding cardiac devices for surgery patients?","Question",{"text":109,"@type":110},"The form specifically asks if the patient has an ICD or defibrillator; if the answer is 'YES', EP clearance is mandatory and must be documented using the 'ICD Patient Clearance Form'.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What documentation must be attached to the booking sheet?",{"text":114,"@type":110},"Staff are required to attach enlarged photocopies of the patient's insurance cards to the booking sheet before faxing it to the facility.",{"name":116,"@type":107,"acceptedAnswer":117},"Which specific anesthesia types are listed for selection on this form?",{"text":118,"@type":110},"The form provides options for Straight Local, MAC with Retrobulbar, MAC, and General anesthesia.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},392851,1791389635,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Scheduling Booking Sheet  \n□ 1st visit □ 2nd visit □ 3rd visit □ Rescheduled Patient  \nToday’s Date:  Surgeon:  Scheduler:  Patient Name (First, Middle, Last):  DOB:  SSN(Required):  Sex: □ Male □ Female Home: (  )  Work: (  )  Cell: (  )  Address:  City:  State:   Zip:   \n\n| Procedure Date: | Procedure Time: | Arrival Time: | Duration: |\n| --- | --- | --- | --- |\n\nCPT:  Description:   \n________________ ___________________________________________________________ __  \n________________ _____________________________________________________________  \nICD-9:          \nAnesthesia Type (Circle One): Straight Local MAC with Retrobulbar MAC General  \nLENSX □ YES □ NO Lenstar Measurements: □ YES □ NO Restor Lens: □ YES □ NO Toric Lens: □ YES □ NO Implant Needed/Information:   Specify IOL:  Equipment Needed:   \nPatient has ICD or Defibrillator? □ YES □ NO  \n(answer required) If “YES” EP Clearance is required. Use “ICD Patient Clearance Form”  \nIs power of attorney required for this patient? (answer required) □ YES □ NO  \nIf “YES” Name of POA:  PH\\#:   \nIs a translator required for this patient?(answer required) □ YES □ NO If “YES” Language:   \nPrimary Insurance Information:  \nPlan:  Group No:   \nInsured ID No:   \nPre-Cert/Referral/Notification No (if applicable):   \nSecondary Insurance Information:  \nPlan:  Group No:   \nInsured ID No:   \nPre-Cert/Referral/Notification No (if applicable):   \n□ Signed HIPPA Release on file □ Patient has been provided with information regarding physician ownership, patient  \nrights & responsibilities, and advanced directives  \nPlease attach enlarged photocopies of insurance cards. Thank You. FAX: 636-757-1963","cbCailEspqQzkG3A","https://ap.wps.com/l/cbCailEspqQzkG3A","pdf",96920,"English","# Patient Information\n## Demographic Details\n# Surgical Procedure Details\n## Procedure and Anesthesia\n## Lens and Equipment Requirements\n# Clinical and Administrative Status\n## Cardiac and Legal Clearances\n## Insurance and Authorization","[{\"question\":\"What information is required regarding cardiac devices for surgery patients?\",\"answer\":\"The form specifically asks if the patient has an ICD or defibrillator; if the answer is 'YES', EP clearance is mandatory and must be documented using the 'ICD Patient Clearance Form'.\"},{\"question\":\"What documentation must be attached to the booking sheet?\",\"answer\":\"Staff are required to attach enlarged photocopies of the patient's insurance cards to the booking sheet before faxing it to the facility.\"},{\"question\":\"Which specific anesthesia types are listed for selection on this form?\",\"answer\":\"The form provides options for Straight Local, MAC with Retrobulbar, MAC, and General anesthesia.\"}]","St. Charles Surgery Center - Scheduling Booking Sheet | PDF",1790375004]