Surgical services forms

For questions or concerns regarding the Spectrum Health Surgical Optimization Center/Pre-Admission Testing please reach out to Amy Pearce at 616.774.7792 or Nicki Kraai at 616.267.8062.

For questions or concerns regarding procedures at the Ambulatory Surgical Centers, please reach out to Brett Pfeiffle at 616.285.1823.

If you are a patient with questions or concerns regarding scheduling, please contact your providers office. For medical offices regarding scheduling please contact Tricia Lillard at 616.643.9277.

Helen DeVos Children's Hospital

Helen DeVos Children's Hospital

Ordersets

Pediatric General Surgery Order Form 8/22 (PDF)

Misc. Patient Care Documents

Spectrum Health Grand Rapids

Consents

Invasive or Complex Procedures (PDF)
Invasive or Complex Procedures (Spanish) (PDF)
Transfusion of Blood or Blood Products (PDF)
Release from Responsibility for Patient Refusal of Blood/Blood Product Transfusions (PDF)

Anesthesia Consent (PDF)
Anesthesia Consent (Spanish) (PDF)
Treatment and Release of Information General Consent (PDF)
Treatment and Release of Information General Consent (Spanish) (PDF)

Ordersets

Bariatric Orderset (PDF)
Cardiothoracic Orderset (PDF)
General Surgery Orderset (PDF)
Genitourinary Orderset (PDF)
Gynecologic Oncology Orderset (PDF)
Head and Neck Orderset (PDF)
Implantable Intrathecal Medication Pump (PDF)
Lower Gastrointestinal Orderset (PDF)

Neurosurgery Orderset (PDF)
Ophthalmology Pre-Scheduled Surgery (PDF)
Orthopedic Orderset (PDF)
Pediatric General Surgery Order Form (PDF)
Peripheral Vascular Orderset (PDF)
Plastic Surgery Pre-Scheduled Surgery (PDF)
Upper Gastrointestinal Orderset (PDF)
Urology Gynecology Orderset (PDF)

Education

Surgical Services Handbook (PDF)
Surgical Optimization Center Brochure (PDF)
Surgical Optimization Center Brochure (Spanish) (PDF)
Surgery During Covid-19 (PDF)

Scheduling

Amended Boarding Slip (PDF)
Block Release Form (PDF)
Block Request/Change/Deletion Form (PDF)
Case Booking Appeal Escalation Form (PDF)

Policies

Miscellaneous patient care documents

Anesthesia Risk Stratification (PDF)
Ambulatory Surgery Guideline Qualifications (PDF)
Diabetes Management - Pre-Procedure Form (PDF)
Hard Stops (PDF)
Hard Stop Appeal Process Tip Sheet (PDF)
History and Physical (PDF)
H&P Conditional Shortform (PDF)

Levels of Surgery (PDF)
Pre-admission Testing (PDF)
Request for History/Physical - Outpatient, Pediatric Sedation Team (PDF)
History/Physical 24 Hour Update (PDF)
History & Physical Preprocedure/Time of Procedure (PDF)