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Ambulatory Surgery Center
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  • About Us
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  • Surgery
    • Pre-Registration
    • Early Preparation
    • The Night Before Surgery
    • The Morning of Surgery
    • Checklist Before Leaving Home
    • Patients with Special Needs
    • After Surgery
    • Recovery at Home
  • Anesthesia
  • Your Child
    • Preparing Your Child - FAQ's
    • PreOp Coloring Book
    • Pre-Surgery Tour
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  • For Physicians and Their Offices
    • Scheduling
      • Scheduling: Block Booking
      • Scheduling: Booking Procedure
      • Scheduling: Case Selection
    • Downloadable Forms
    • Patient Workup
      • Patient Workup: Case Selection
      • Patient Workup: PreOP Testing
    • General Topics
      • Financial Approval and Clearance
      • Credentialing
      • Hours of Operation
      • Punctuality
      • Admission Guidelines
      • Policy and Procedure for Operative Site/Side Marking
    • NPO Guidelines
    • ASA Physical Status Classification System
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  1. Welcome to the Ambulatory Surgery Center
  2. Downloadable Forms

Downloadable Forms

  • Adult Venous Thromboembolism Prophylaxis Assessment and Order Sheet
  • ASC Anesthesia Flow Sheet
  • Consent to Operation or Procedure and Anesthesia
  • Consentimiento Para Cirugía O Procedimento Y Anestesia
  • Consent for Pain Procedure or Regional Anesthesia
  • Consentimiento Para Procedimiento Para El Dolor O Anestesia Regional
  • Blood Consent
  • Consentimento / Rechazo A Productos Sanguíneos
  • History and Physical Examination (Short Form)
  • Surgery History and Physical Examination/ Anesthesia Pre-Op Assessment
  • Interdisciplinary Flow Sheet
  • Intraoperative Ophthalmic Surgery Orders
  • Pain Procedure Order Form
  • Physician's Intraoperative Progress Note
  • Pre Operative Services Orders: (Adult and Pediatrics)
  • Spinal Procedure Orders
  • ASC Day of Surgeryl Orders: (Adult and Pediatrics)
  • Progress Notes
  • Ortho Booking Form
  • OR Booking Form
  • Booking Change Form
Stony Brook Square Rays
Give us a call
(631) 444-9400
Ambulatory Surgery Center
1 Edmund D Pellegrino Road Stony Brook, NY 11794
Directions
Frequently Asked Questions
Downloadable Forms
Billing Information
Educational Videos
 
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