DO NOT DRIVE OR OPERATE MACHINERY FOR 24 HOURS. Some anesthetics have a delayed metabolism and could interfere with ability to perform these tasks.

DO NOT DRINK ALCOHOLIC BEVERAGES FOR 24 HOURS.

DO NOT MAKE IMPORTANT DECISIONS UNTIL THE NEXT DAY.

DO NOT EAT HEAVY OR LARGE MEALS UNTIL NEXT DAY.
A heavy meal may be difficult to digest.

Make an appointment to see your doctor in _______ days.

Diet____________________________________________________

Activity_________________________________________________

Medications_____________________________________________

Shower/Bath_____________________________________________

Prescription written: YES____ NO____

Wound Care: Follow instructions that are checked.
___ Remove dressing in _____ days.
___ Keep wound dry.
___ Apply ice.
___ Keep elevated _____ hours.
Other__________________________________________________

Observe for any redness, swelling, extreme pain or foul odor. If any of these occur, notify your doctor immediately.

Special instructions:

If you have any further questions, please call your doctor’s office.
Phone# (707) 226-2031 Date: