Orthopedic Clinic Preoperative Checklist
at The American Center
Please set up your outpatient physical therapy appointments with your local
clinic. These visits should begin 10 - 14 days after your surgery date.
Your surgery is scheduled on: ___________________________________
Your Orthopedic Pre-Surgical Visits are scheduled for: __________________
Orthopedic Clinic Preoperative Check List
______ Meet with a Physician Assistant.
______ Patient Education about total joint replacement surgery - you will be
____ Joint 101 class (the Orthopedic staff will tell you where the
room is for this class)
______ Meet with a Social Worker.
______ Meet with a Financial Counselor.
______ Make a post-op appointment.
Your Physician Assistant or clinic staff will tell you if you need to have any tests,
x-rays, or labs drawn or meet with the Anesthesia Nurses .
______ EKG (electrocardiogram)
______ Anesthesia Staff
Please come for your visits at your scheduled time. The visits may take 1-3 hours.
Feel free to eat before you come. Also, please take your normal medicines.
Please read your Outpatient Surgery booklet to help you prepare for your clinic
visits. Please write down any questions you have and bring them with your
booklet to your clinic visits.
If you can’t keep an appointment, please call the Orthopedic Clinic at
Things to Bring with you:
Your insurance information
Your HMO referral, if needed
A list of your medicines, including
name, dose, frequency and any
herbs and natural remedies
Information about recent physical
exams, blood work, x-rays, EKG,
or other tests
Pre-operative folder information
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©7/2015. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7796.