Name:

birth:

Family history:

Personal history:

Medication:

 Allergies:


Previous anaesthesia: ( GA: LA: complications)

Transfusion: (YES,NO, reaction )


Subjective:


Objective:

Airway: MP , neck mobility, mouth opening

Breathing:

Circulation:

Laboratories:

Other:

RESUME: The patient is capable of surgery under general or regional anaesthesia. ASA ....