Consult with Your Case Manager, Nutritionist, and Exercise Therapist

• Case Manager: Arrange examinations prior to the surgery and help you understand the procedure of your surgery type. To make sure if you are allergic to medicine.
• Nutritionist: Make your diet plans and teach you how to choose appropriate foods and cooking methods.
• Exercise Therapist: To fortify your cardiopulmonary function and systemic circulation, to lower the surgical risks and help your recovery from surgery by doing low-intensity aerobic exercise.

Please Do the Following Examinations prior to the Surgery for Safety’s Sake:

• Blood Test: Fast for 8 hours for blood test. This is necessary for the safety of the surgery.
• Gastroscopy: Fast for 8 hours is required for this procedure. This surgery involves removing part of the stomach tissues; thus, gastroscopy is used to see if there is inflammation, ulcer, or helicobacter pylori infection. Patients must take medication for 14 days as instructed by doctor if tested positive (do not stop the medication on you own).
• Bone Density: Do a whole body bone density examination to check the status of osteoporosis.
• Abdomen Ultrasound: To see if there is fatty liver disease or gallstone.
• Chest X-Ray: A necessary examination before the surgery for safety’s sake.
• Electrocardiogram: A necessary examination before the surgery for safety’s sake.
• Anesthesia Evaluation: Conducted by anesthetist to clearly have patient’s conditions under control to assist with the surgery.
• Pulmonary Function Test: Do as instructed by the doctor to evaluate pulmonary function to avoid respiratory distress after the surgery.

Please Notify the Medical Staff ASAP if You Have the Following Conditions

• Implanted Cardiac Pacemaker.
• Coagulopathy.
• Allergic to medicine.
• Take any of the following medicine: anticoagulation, Chinese medicine, and supplement. Stop the medicine 1-2 weeksbefore the surgery as instructed by the doctor. (Note: 1. Anticoagulation medicines, such as medicine that contains aspirin and taken by mouth, like Clopidogrel (Plavix), Coumarin anticoagulant, AKA Warfarin, like Warfarin, Ticagrelor, and Ticlopidine.  Injection medicine, such as heparin and low molecular weight heparin. Supplements such as fish oil and gingko with anticoagulation effect as same as medicine.) (Please bring all your medicines and prescriptions to the hospital and show them to the nurse.)
• Arrhythmia, glaucoma, prostate hypertrophy, pregnant, contagious diseases, and other systemic diseases.

Confirm the Consent Form

• Read the Surgery Consent Form, Anesthesia Consent Form, and Anesthesia Paper carefully. Please consult with your nursing personnel before the surgery should you have any questions.
• Before signing the Surgery Consent Form, please follow the advice from the medical team after the surgery in order to achieve your goals.

If you are a smoker, please stop smoking one month prior to the surgery!

• The nicotine in tobaccos makes blood vessels contract and makes the heart work harder. The stickiness of the platelet will also increase and lead to the onset of heart attack and thrombosis, which increases the risks and causes poor wound healing and insufficient bronchiectasis.

Weight Control before the Surgery

• Please do not eat and drink excessively because you won’t be able to do so after the surgery. Weight gaining will increase the risks of the surgery and the amount of anesthesia.

Please notify the medical staff if you are on period prior to the surgery because the hemoglobin decreases during period.

• Please bring your own pads and disposable panties if you are on your period during the surgery.

Do NOT put nail polish on your fingernails and toenails.

• Please remove all acrylic nails and gel nails.

If you have a fever or get a cold, please tell the case manager before receiving the surgery.

• Please receive treatments ASAP and notify our medical staff. Laparoscopy requires general anesthesia, which will cause sputum accumulation and make the cold worse after the surgery.

Medications for chronic diseases, hypertension, and diabetes

• Stop the medicines the day before the surgery and resume the medicines on the day of surgery as instructed by doctors.

Please adjust your diet prior to the surgery for the safety surgery

• Please consume clear liquid foods the day before the surgery, such as sport drinks, juice, and soup without any solid ingredients. No fish and meat before the surgery. The waste in the intestinal may lead to infection and cause bloating after the surgery.
• Please fast from midnight until receiving the surgery, which helps the absorption of anesthesia and prevents vomiting during anesthesia.

Fees and Payment Instructions

Total charge is $__________________, including surgery charge and ______ days of hospitalization charge.

# Notes:

1. If you are a patient with higher risks (such as BMI exceeds 35 kg/m2, heart diseases), there will be an extra charge for devices used to monitor your cardiovascular functions for your safty. Please consult with the anesthetist during the anesthesia evaluation.
2. The surgery costs may be adjusted due to out-of-pocket charges for devices, days of hospitalization, or medicines.
3. A payment of $100,000 is required at the time of being admitted to the hospital and the balance may be paid at the time of being discharged from the hospital.

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