---
tags: PPS, cu arp
---
# PPS clinic visit template
Patient interview template/checklist for periprocedural services (PPS) clinic vists

## Anesthesia Hx
- Functional status
- Anesthesia Hx? Complications?
- Transfusion Hx?
- GERD?
- COVID? Vaxination?

## Risk stratification items
- OSA ([STOP-BANG](https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea))
> [ ] **S**noring? [ ] **T**ired? [ ] **A**pnea? [ ] High **B**P?
- PONV | [Apfel score](https://www.mdcalc.com/calc/10104/apfel-score-postoperative-nausea-vomiting)
- Non-smoker? Hx of PONV or motion sickness?
- [Caprini Score (VTE)](https://www.mdcalc.com/calc/3970/caprini-score-venous-thromboembolism-2005)
- Malignancy?

## Family history
- Cancer
- Bleeding, Clotting
- Early MI (under 70)

## Other ROS

## Med Rec
- [ ] Meds
- [ ] When taken?

## Physical Exam
Anesthesia focused physical exam

### Airway
- Mallampati, opening width
- Neck ROM
- TMD
- Bite test

### Neuro

### Cardiac

### Pulmonary