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👤 Patient Information

Name *

Date *

Date of Birth

Weight (kg) *

Sex

🏥 Provider

Surgeon

Asst.

Anes Provider *

Anes Asst.

Procedures

⚠️ ASA Class *

🕐 NPO & Checklist

NPO Since

NPO Date

Pre-Op Checklist

Pre-Op Meds

💊 Medications / Allergies / Anes Type

Current Medications

Allergies *

Anesthesia Type — All That Apply *

📊 Pre-Op Vitals

SpO2 %

Temp °C

Wt lbs

⏱️ Case Timing

Monitors On

Anes Start *

Surg Start

Surg End

Anes Stop

Total (min)

🌬️ Inhalation Log

Time	Event	Agent	O2 L/m	N2O L/m	Conc%	Note

💊 Medication Log

Time	Drug	Dose	Unit	Route	Note

📈 Vitals Grid

TIME	ECG	SpO2%	EtCO2	SYS	DIA	HR	RR	Temp	VENT	TV mL	PEEP

📊 Vitals Chart

🔵 HR↓ SYS↑ DIA— SpO2-- EtCO2

🩸 Fluids & Totals

Fluid Type

Total Fluids (mL)

Remi Waste (mg)

Fentanyl Waste (mcg)

Other Waste

⚖️ Drug Waste — Provider Sign-Off

Anesthesia Provider

Total Fluids

— mL

EBL

💊 Propofol Infusion Log

Log each event with timestamp. Rate in mcg/kg/min.

📊 Propofol Chart

— Rate▲ Bolus▶ Start■ Stop

📋 Summary

Pt Weight (kg)

Duration (min)

Approx. Total (mg)

🫁 Airway Management

O2 Via

Mask Fit

Adjuncts

Airway Device

ETT Size (mm)

Depth (cm)

Cuff Air (mL)

Cuff Leak

Intub Time

🔦 Laryngoscopy & Blade

Type

Blade (tap selected to deselect)

Mac

Miller

D-Blade — Adult

D-Blade — Pediatric

Cormack Grade

Attempts

🥢 McGill Forceps

Used

Type

Notes

🩹 IV Access

IV Start

Gauge

Site

Attempts

Position

💉 Local Anesthetics

2% Lidocaine (mg)

4% Septocaine (mg)

0.5% Marcaine (mg)

Rubber Dam/Isolite

Throat Pack/Curtain

📋 Anesthesia Notes

Pt Behavior

Restraint

Induction

Induction Quality

Intra-Op Steps

Airway Notes

Throat Pack @

Pack Out @

Post-Op Notes

Extubated @

IV Out @

POI Given @

Free-Text Notes

🏥 Recovery Vitals

📝 Case Notes

Intraoperative Notes

Post-Op / Recovery Notes

Handoff Notes

✅ Discharge Summary

✓

Awake, responsive & oriented

✓

Vital signs WNL

✓

Minimal / No PONV

✓

SpO2 > 94%

✓

Post-op pain controlled

✓

Instructions discussed — escort present

✓

Written post-op instructions given

✓

All questions answered prior to D/C

Discharge Mode

D/C Time

Anes Total Time

Provider Name & Credentials *

📥 Import Daily Case Schedule

Your office assistant emails you a CSV or JSON file. Download it on this iPad, then tap below. All cases load automatically.

📂

Tap to select file

CSV or JSON · or drag and drop here

📋 CSV Template — Send This to Your Office Assistant

Office assistant fills this in each morning and emails it to you. Each row = one patient.

patient_name,date,time,procedure,provider,asa,allergies,notes
Doe John,2025-01-15,08:00,Full mouth extraction,David Pfeffer,II,NKDA,
Smith Maria,2025-01-15,10:30,Implant placement,David Pfeffer,I,Penicillin,Anxious patient
Johnson Bob,2025-01-15,13:00,Wisdom teeth x4,David Pfeffer,III,NKDA,HTN on lisinopril

➕ Add Case Manually

Patient Name *

Date

Scheduled Time

ASA

Anes Start Time

Weight (kg)

Procedure

Provider

Allergies

Notes

⚠️ Data Storage & Device Info

✓ auto-saved