老年患者麻醉知情同意书.docx

老年患者麻醉知情同意书

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

术前诊断：________________________________________________________________________________

拟行手术名称：____________________________________________________________________________

拟行麻醉方式：□全身麻醉□椎管内麻醉□神经阻滞麻醉□局部浸润麻醉□监护麻醉□复