DAY OF SURGERY CHECKLIST
DO NOT:
• Do not bring valuables such as jewelry, large amounts of cash, or multiple credit cards. We are
not responsible for any lost items.
• Do not wear makeup, false eyelashes, fingernail polish, lotion, perfume, or body piercings
• Do not consume solids or liquids (including tube feedings, chewing gum, or mints) after midnight
the night before your assigned arrival time
DO:
• Wear loose, comfortable clothes that are easy to remove
• Wear your dentures or partials as you normally do
• Bring your driver’s license or identification card, insurance card, and appropriate payment method
for your insurance co-pay
• Bring medications you are currently taking in their original containers
• Have an escort to drive you home
• Bring items that will make you comfortable, such as a jacket or blanket, a book, music with
headphones, and electronic devices such as a tablet, smart phone, and charger
• Bring your UAB Callahan Eye Hospital Patient and Visitor Guide
DISCHARGE PLAN & INSTRUCTIONS
• Do you have someone to drive you home
after your procedure?
Name:__________________________________
Phone #:________________________________
• Is there follow-up care you must do at
home?
• _Have you been shown how to perform these
tasks?
• Are you comfortable performing these
tasks?
• When is my follow-up appointment?
Date:___________________________________
Time:___________________________________
Who/Where: ____________________________
• Note to family members and caregivers:
If you plan to assist the patient with care
at home, please make plans to be at his/
her hospital bedside to learn about helping
your loved one.
Discharge Checklist
• What are my discharge instructions?
• Do I have any restrictions, and if so, what
are they?
• Who do I call if I have questions?
• What symptoms should I watch for?
Medication Checklist
• Do I understand what medications to take,
including when and how much?
• Do I understand what the medications
are for?
• If I need any prescriptions, do I have them,
or have they been sent to my pharmacy?
Follow-Up Appointment with
Your Physician
Make sure you talk to your physician’s office
about your follow-up appointment if it is
not already scheduled or indicated on your
discharge plan.
uabmedicine.org/eye
9