What is on a standard anesthesia pre-op form?

A standard anesthesia pre-op form (often based on the AANA P-1 template) captures: patient demographics, surgical procedure planned, past medical history with focus on cardiac, pulmonary, renal, hepatic, and endocrine systems, allergies (drug + environmental), current medications with hold instructions, social history (tobacco, alcohol, recreational drugs), prior anesthetic history and complications, airway assessment (Mallampati, dentition, neck range of motion), lab studies (CBC fishbone, BMP, coagulation), ASA Physical Status Classification, NPO status, and anesthesia plan. Each section maps to a specific risk that needs to be evaluated before induction.

What's the difference between the surgeon's H&P and the anesthesia pre-op form?

The surgeon's H&P documents the surgical problem, indication, planned procedure, and the surgeon's risk-benefit decision. The anesthesia pre-op form documents the airway, the cardiovascular and pulmonary reserve, the anesthetic plan, the ASA class, and the perioperative risk. They overlap on past medical history and medications but answer different questions. Anesthesia wants to know if you can deliver the planned anesthetic safely. The surgical H&P documents that you should operate. Both are required by JCAHO and state licensing.

Can a pre-op form be filled out electronically?

Yes. Most EMRs (Epic, Athena, eClinicalWorks) have an anesthesia pre-op module. The advantage is integration with the rest of the chart. The disadvantage is that EMR templates often miss the clinical nuance that a free-text or AI-driven form captures — for example, a structured EMR field for 'GLP-1 hold' may not exist, so the field gets typed into a free-text comment that nobody parses. Standalone PDF forms (AANA P-1, custom practice forms) preserve clinical detail at the cost of integration. AI-driven pre-op forms (like MyPreOp.ai) combine the two — extract chart data automatically, preserve the clinical nuance, and produce a PDF the anesthesia provider can sign.

What does the lab fishbone diagram mean on a pre-op form?

The lab fishbone is shorthand notation used in anesthesia and emergency medicine to display common lab values in a compact spatial format. A CBC fishbone is an X — WBC on the left, hemoglobin on top, hematocrit on bottom, platelets on the right. A BMP is a grid with Na/K/Cl/CO2 on top and BUN/Cr/glucose on bottom. A coag panel is a Y or V with PT/INR on the left, PTT on the right. The fishbone format lets a provider scan a chart in seconds for the values that matter. It's still in active clinical use because it's faster than reading a printed lab report.

Anesthesia Pre-Op Form Template: What Each Section Actually Means (2026)

A field walkthrough of the standard pre-op form. What each section is for, the common errors that delay cases, and how to read one without missing the things that get patients cancelled.

The Anesthesia Pre-Op Form — whether it's an AANA P-1, an EMR template, or a custom practice form — answers one question: can we safely deliver anesthesia to this patient for this procedure? Every section is there to evaluate a specific risk. And every section has a common failure mode that I see weekly in real charts.

I'm Dennis Diaz, CRNA, and below is the field-by-field walkthrough of the form as I actually use it.

Section-by-section

Demographics & Procedure

Purpose: Identifies the patient and the planned surgery. Age and procedure type drive baseline risk stratification.

Common error: Wrong procedure listed (the surgeon scheduled a tummy tuck, the form says lipo) — case delayed or cancelled.

Past Medical History

Purpose: Cardiac, pulmonary, renal, hepatic, endocrine, neurologic. Drives ASA class and anesthetic plan.

Common error: PMH copied from old visit without verifying current status. A patient with prior CHF noted as 'history of' may be in active decompensation today.

Allergies

Purpose: Drug reactions, latex allergy, environmental allergies. Drives med selection and equipment.

Common error: Vague entries ('upset stomach' on penicillin) listed as anaphylaxis. Costs the patient access to first-line antibiotics.

Current Medications

Purpose: What's on board, what needs to be held, what needs to be continued.

Common error: Missing the supplements — fish oil, ginkgo, ginseng, garlic, vitamin E, turmeric. Bleeding risks the patient doesn't think to mention.

Social History (Tobacco, Alcohol, Drugs)

Purpose: Smoking affects wound healing and pulmonary risk. Alcohol affects metabolism and withdrawal risk. Drugs affect anesthetic requirement and respiratory drive.

Common error: Patient minimizes — half a pack a day becomes 'occasional,' 2 drinks daily becomes 'social.' Ask directly and document what the patient actually says.

Anesthetic History

Purpose: Prior reactions, difficult airway, PONV, awareness, malignant hyperthermia family history.

Common error: Missing the MH family history because the patient was never asked. Triggering agents in family = stop and dantrolene plan.

Airway Assessment

Purpose: Mallampati, mouth opening, neck ROM, thyromental distance, dentition. Drives the airway plan.

Common error: Done on the day of surgery without a difficult-airway backup plan documented. Should be done at clearance and re-verified day-of.

Lab Studies (Fishbone)

Purpose: CBC, BMP, coags, type & screen. Provides last-known values for perioperative decisions.

Common error: Out-of-date labs (>30 days) accepted as current. Or labs missing entirely on a comorbid patient.

ASA Physical Status Class

Purpose: Communicates baseline patient health to the perioperative team. I, II, III, IV, V, VI (+E for emergency).

Common error: Coordinator writes 'ASA II' without rationale. The anesthesia provider assigns ASA, not the coordinator.

NPO Status

Purpose: Documents last solid food and last clear liquids.

Common error: GLP-1 patients — even when NPO 8 hours, gastric emptying may be delayed weeks. Document the GLP-1 hold dates, not just the NPO status.

The lab fishbone, explained

If you've never seen one, the fishbone notation looks cryptic. It's actually a compact way to display the values anesthesia checks most often:

CBC fishbone — an X. WBC on the left, hemoglobin on top, hematocrit on bottom, platelets on the right.
BMP grid — Na / K / Cl / CO2 on top row, BUN / Cr / glucose on bottom row.
Coagulation Y/V — PT/INR on the left, PTT on the right.

The format lets a provider scan a chart in seconds for the values that matter — faster than reading a printed lab report. It's still in active clinical use across anesthesia and emergency medicine.

Auto-generating the pre-op form

Filling out the pre-op form by hand the morning of surgery is the old workflow. The new workflow: the form is generated from the chart, ready before you walk in. Upload H&P, labs, and meds to MyPreOp.ai and a complete Anesthesia Pre-Op Form is ready in 30 seconds — populated, in fishbone format, with the ASA class assigned and the flags noted. The provider reviews, edits if needed, and signs.

Built by a practicing CRNA. Used daily across private-practice cosmetic, ortho, and general surgery.