Focused Surgical H&P Template
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Chief Complaint / Planned Procedure:

History of Present Illness:
- Indication for Surgery:
- Prior Treatments:
- Relevant Timing/Severity:

Past Medical History:
- Chronic Conditions:
- Prior Surgeries:
- Anesthesia Complications:

Medications & Allergies:

Functional Capacity / Exercise Tolerance:

Family History (Anesthesia, Bleeding, Clots):

Social History:
- Tobacco/Alcohol/Substances:
- Support System:

Review of Systems (Focused):
- Cardio/Pulmonary:
- GI/GU:
- Endocrine:
- Hematologic:

Physical Exam Highlights:
- Airway:
- Cardiovascular:
- Respiratory:
- Surgical Site:
- Neuro:

Diagnostics:
- Labs:
- Imaging:

Assessment:
- Surgical Diagnosis:
- Perioperative Risk Assessment:

Plan:
- Pre-Op Orders:
- Medication Adjustments:
- Consults:
- Informed Consent Status:

Provider Signature & Credentials
Date / Time