Name/type of requested intervention

Indication for procedure

List of current medications

• • Do any medications need to be stopped for procedure?

History of drug allergy

• • Are any of these going to be given in procedure?

History of contrast allergy

• • Do premedications need to be given?

Level of anesthesia required

• • None, moderate sedation, or general anesthesia?

Confirm NPO status

• • o For inpatients, does NPO order need to be entered?

Targeted physical exam

• • Heart and lung auscultation

  • Airway assessment

  • Evaluation of procedure access site

Obtain consent