麻醉手术知情同意书.docx

麻醉手术知情同意书

姓名：__________性别：□男□女年龄：______岁科室：__________床号：______住院号：__________

诊断：________________________________________________________________________________

拟行手术名称：________________________________________________________________________

ASA病情分级：□Ⅰ级□Ⅱ级□Ⅲ级□Ⅳ级□Ⅴ级拟行麻醉方式：__________________