Dr. Poveda Xatruch
Dr. Poveda Xatruch
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ANESTHETIC EVALUATION

This questionnaire is strictly confidential and he/she will allow to be carried out a preoperatory anesthetic evaluation, for what we request him it is filled in the most complete way

Name:
Email:

Age:
Sex:
Previous sufferings:
(Diabetes; hypertension, cardiopaties, cancer, etc)

Treatments or medications that he/she is taking: :
Surgical antecedents:
Anesthetic antecedents:
(Allergies to medications; foods or anesthetics in you or their family; fevers of non certain origin):
Non pathological antecedents:
(Tabaquism; etilism; drug abuse, etc)
Labor activities:
 

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