Surgical Services Forms

For questions or concerns regarding surgery scheduling, contact Tricia Lillard at 616.643.9277. For questions or concerns regarding the Spectrum Health Surgical Optimization Center, contact Amy Pearce at 616.774.7792.

For questions or concerns regarding the pre-admission testing process, 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.

Helen DeVos Children's Hospital

Ordersets

Pediatric General Surgery Order Form 2/14 (PDF)

Misc. Patient Care Documents

Spectrum Health Grand Rapids

Consents

Invasive or Complex Procedures 12/5 (PDF)
Invasive or Complex Procedures 1/11 (Spanish) (PDF)
Transfusion of Blood or Blood Products 12/5 (PDF)
Release from Responsibility for Patient Refusal of Blood/Blood Product Transfusions 12/5 (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 08/16 (PDF)
Cardiothoracic Orderset 05/22 (PDF)
General Surgery Orderset 05/22 (PDF)
Genitourinary Orderset 08/16 (PDF)
Gynecologic Oncology Orderset 08/16 (PDF)
Head and Neck Orderset 08/16 (PDF)
Implantable Intrathecal Medication Pump (PDF)
Lower Gastrointestinal Orderset 08/16 (PDF)

Neurosurgery Orderset 05/22 (PDF)
Ophthalmology Pre-Scheduled Surgery 12/23 (PDF)
Orthopedic Orderset 08/16 (PDF)
Pediatric General Surgery Order Form 2/14 (PDF)
Peripheral Vascular Orderset 08/16 (PDF)
Plastic Surgery Pre-Scheduled Surgery 1/17 (PDF)
Upper Gastrointestinal Orderset 08/16 (PDF)
Urology Gynecology Orderset 08/16 (PDF)

Education

Communication Handbook 7/14 (PDF)
Orthopedic Handbook 10/14 (English) (PDF)
Orthopedic Handbook 12/01 (Spanish) (PDF)

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

Scheduling

Amended Boarding Slip 7/15 (PDF)
Block Release Form 3/16 (PDF)
Block Request/Change/Deletion Form 1/22 (PDF)
Case Booking Appeal Escalation Form (PDF)

Policies

Fasting Times Policy (PDF)
Pre-Admission Anesthesia Protocol (5/17/22) (PDF)
Preoperative Anesthesia Orders (PDF)
Scheduling Cases for Surgery (PDF)

Miscellaneous patient care documents

Anesthesia Risk Stratification (PDF)
Ambulatory Surgery Guideline Qualifications 9/11 (PDF)
Diabetes Management - Pre-Procedure form 12/15 (PDF)
Hard Stops (PDF)
Hard Stop Appeal Process Tip Sheet (PDF)
History and Physical 2/13 (PDF)
H&P Conditional Shortform 2/14 (PDF)

Helen DeVos Children's Hospital

Ordersets

Misc. Patient Care Documents

Spectrum Health Grand Rapids