Referral & Pre-Op Assessment

My day Ilham Mukhriz bin OmarMV-702133

Ilham Mukhriz bin Omar Not started No Known Allergy

17y · M · MV-702133 · 081102-01-8341 · Squint Surgery · Left eye (OS)

MOH PRP-BOR-38/A · Squint Surgery

Pre-anaesthesia assessment

Height (cm)

Weight (kg)

BMI (kg/m²)

Pain score

PONV history

Emergency / Elective

Physical status (ASA)

CFS

METS

Airway (Mallampati)

TMD (cm)

Neck ROM

STOP-BANG /8

Dentition

Allergies

Emergency (E)

Medications

Assessment (1)

Assessment (2)

Others

Year · operation	Anaesthesia
None on record. Add any earlier operation below.

Year

Operation

Anaesthesia

Complication

Previous transfusion

ISEC/OT-F02 · Rev. 02