Community Physicians Resource Link

 For Community Physicians:

Welcome to Pre-Operative services.  Our goal is to assist you as much as possible in caring for and preparing your patients for surgery.  This section of our website contains guidelines that we follow in preparing patients for surgery and downloadable forms that may be useful to you in preparing patients for surgery.  Please feel free to contact us with any issues, questions, or concerns you may have.



The Department of Anesthesia has developed guidelines based on recommendations from the ASA for for which pre-operative tests are necessary prior to anesthesia.  Please click the link below if you require more information

Stony Brook Medicine - Department of Anesthesia - Guidelines For Pre-Operative Testing

Cardiac Devices:  Patients with implantable cardiac devices should primarily be booked for the Main OR.  The ASC will accept patients with cardiac devices on a case by case basis.  If they are accepted to the ASC they require evidence of device interrogation within the past 6 months.  Attached below under Main Hospital Forms is the CIED Form we send to cardiologists for device interrogation information.  For any questions regarding cardiac device patients and the ASC please call the ASC booking office at 444-9431. 

All patients with cardiac devices booked in the Main OR also need up to date device interrogation.


Main Hospital Forms

Department of Surgery History and Physical (SU2CO31) 

Consent to Operation or Procedure and Anesthesia (OR2C261)

Consent/Refusal for Blood Products (RM2CO11)

Pre-Admission/Surgical Orders (Adults & Pediatrics) (AS2COO6)

Antimicrobial Prescription Form (PH2CO37)

Adult DVT Prophylaxis Assessment (ME2CO43)

Physicians Intraoperative Progess Notes (OR2COO2) 

Cardiac Implantatble Electrical Device (CIED) Pre-Operative Consult Request From Operative Team to CIED Physician (CA2C441)

Ambulatory Surgery Center Forms

Ambulatory Surgery History and Physical Examination (AS2COO8)

Consent to Operation or Procedure and Anesthesia (OR2C261)

ASC PreOperative Services Power Plan (AC2C320)

ASC Day of Surgery Orders (AS2C321)

Antimicrobial Prescription Form (PH2CO37)

Physicians Intraoperative Progress Notes (OR2COO2)

Additional Forms

Lap Band

X-Ray Information for Pre-op Patients (We have moved to our new location and we will no longer be able to perform radiology studies on site.  If you think your patient will require a pre-operative x-ray, please give them a prescription for the necessary study and the x-ray form (click on the link) or we would be happy to assess their radiological needs at their pre-operative evaluation and refer them if necessary)

Spanish OR Consent

Spanish Blood Consent