Pre Operative Assessment By Patient
Use when asked to administer, score, or explain a Pre-operative Assessment by Patient — a UK NHS-aligned patient self-report questionnaire computing an ASA grade — grounded in FormExamples/form-examples; the patient counterpart to pre-operative-assessment-by-clinician.
A UK NHS-aligned, patient self-report pre-operative questionnaire that the patient (or their carer) completes before surgery. It collects patient-reported health data via a single-page, step-by-step wizard, computes an ASA (American Society of Anesthesiologists) Physical Status Classification grade, and flags safety-critical issues for anaesthetic planning.
This form is the patient counterpart to Pre Operative Assessment By Clinician, which records the clinician's objective findings (history, examination, vitals, laboratory results, imaging). Where the clinician form captures observed findings, this form captures what the patient reports about themselves.
Scoring
Instrument: ASA Physical Status Classification. Range I–VI:
- ASA I — normal, healthy patient.
- ASA II — mild systemic disease.
- ASA III — severe systemic disease.
- ASA IV — severe, incapacitating systemic disease.
- ASA V — moribund, not expected to survive without the operation.
- ASA VI — brain-dead patient for organ donation.
What it covers
Demographics; and a system-by-system self-report: cardiovascular, respiratory, renal, hepatic, endocrine, neurological, haematological, musculoskeletal and airway, gastrointestinal, medications, allergies, previous anaesthesia, social history, functional capacity, and pregnancy.
Common pitfalls
- Treating the patient-reported ASA grade as final — the clinician form (Pre Operative Assessment By Clinician) is where the ASA grade gets clinically verified and, where necessary, overridden with a documented reason; a patient self-report is an input to that process, not the final grading authority.
- Assuming health literacy is uniform — a self-report questionnaire depends on the patient understanding medical terminology (e.g. "hepatic," "musculoskeletal"); plain-language support or assistance may be needed for some patients to complete it accurately.
- Skipping functional capacity self-report — functional capacity (ability to perform everyday physical tasks) is a meaningful, easy-to-self-report predictor of perioperative risk that shouldn't be treated as optional.
Learn more
- FormExamples: pre-operative-assessment-by-patient for the full implementation, clinical references, and worked examples.
- Pre Operative Assessment By Clinician for the clinician-completed counterpart.