手术麻醉知情同意书.docx

手术麻醉知情同意书

患者姓名：__________性别：□男□女年龄：__________岁体重：__________kg

科室：__________床号：__________住院号：__________门诊/病案ID：__________

术前诊断：________________________________________________________________

拟行手术名称：____________________________________________________________

拟实施麻醉方式：□全身麻醉（□气管插管静吸复合全麻□喉罩静脉全