Name: 
birth:
Family history:
Personal history:
Medication:
 Allergies: 

Previous anaesthesia: ( GA: LA: complications) 
Transfusion: (YES,NO, reaction ) 

Subjective: 

Objective: 
Airway: MP , neck mobility, mouth opening 
Breathing: 
Circulation: 
Laboratories: 
Other: 
RESUME: The patient is capable of surgery under general or regional anaesthesia. ASA ....