Schedule a Procedure at Grand View Health

To schedule a surgery or procedure at Grand View Health please use One Medical Passport. This tool allows offices to schedule surgeries or procedures anytime from anywhere.

One Medical Passport

Surgical / Procedural Forms

Below you will find forms that may be required for surgeries at Grand View Health. Please read through these instructions and then download the appropriate form.

1. Click to download the necessary form below.
2. Fill out the form. You may type directly into the form.
3. Print the form.
4. Obtain any appropriate signatures.
5. Scan form into PDM

Orders:
Elective Surgery Order Sheet (Updated January 2021)
Elective Surgery Orders Addendums and Changes Communication Sheet
New Joint Orders (Revised September 2020)
History and Physical
History and Physical Update
Medical Clearance for Surgery
Outpatient Automated Internal Cardiac Defibrillator (AICD)
Blood Product Orders

Forms:
Consent – Surgical
Consent – Blood
Downtime Demographics and Insurance Form
Pre-Surgical Health Assessment

Short Procedure Unit Forms:
Blood Transfusion Booking Sheet
Physician Infusion Order Form
Non-Surgical Reservation Form
Non Surgical Reservation Form Scheduling Instructions