Information For Patient

MEMORANDUM

Dear patient, you are kindly asked to read the Memorandum very carefully, to clear all the questions, if any and to sign this document.

Dear Sir/Madam, the date and time of the planned surgery (procedure):

____ day of ________________ month of the year ________; ________ hours at Valakupiai plastic surgery clinic (UAB Valakupių plastinės chirurgijos klinika – Vitkusclinic), at Svajonių str. 48, Vilnius, tel. +370 5 2762111.

Arrival to the Clinic: ______________________________________.

The planned surgery (procedure) ______________________________________________________.

Dear Sir/Madam, we ask You to provide to the Clinic the whole and exhaustive information about his health condition, past and present diseases, allergic reactions, pharmaceuticals being used and other circumstances, which might have influence on the process and consequences of the services provided by the Clinic. The Clinic shall not be liable for damages, made to the health of the Patient in case it occurred due to the non-provision by the Patient to the Clinic of all needed information or if the Patient did not follow the instructions of the Clinic or its staff or otherwise hindered the Clinic or its staff.

  • If You have any health disorder (i.e. allergic reactions, the disorder of heart work, congenital diseases, chronic diseases, etc.), please inform the surgeon about that before the surgery (procedure).
  • If due to unforeseen circumstances You are not able to arrive for the surgery (procedure) at the established time, You shall necessarily inform the surgeon and the personnel of the clinic about that not later than forty eight hours before the established time of the surgery (procedure).
  • If after the last consultation with the doctor Your health conditions have changed, You shall necessarily inform the doctor or the personnel of the Clinic about that before the surgery (procedure).
  • Plastic surgeries during which implants are to be used(e.g. breast augmentation, gluteus implants, calf augmentation, face correction operations with the implants) arenot to be done during menses.
  • Other plastic surgeries are not recommended to be done during menses.
  • Operations are not performed to pregnant women.
  • You shall not eat, drink and chew chewing gums eight hours before the surgery (procedure).
  • If your surgery (procedure) is scheduled in the afternoon, you may have one glass of tea or water, eat yogurt before 9 am.
  • You should have results of all the testing indicated by the doctor before the surgery (procedure).
  • You should have all the results of the doctor’s indicated tests, which have to be done not earlier than 2 weeks before the surgery. The list of the tests is a part of this Memorandum.
  • Do not smoke for at least two weeks before the operation.
  • Do not take any blood liquefying medicine (e.g. aspirin, ibuprofen, paracetamol, etc) for at least two weeks before the surgery.
  • You cannot be on a severe diet for at least a month before the operation.

On the day of surgery (procedure), You should arrive to the clinic 2 hours before the established time of the surgery (procedure), if the doctor or the personnel of the clinic have not indicated other time. You have to have your identification card or passport.

All the stated cost of the surgery (procedure) is paid before the operation, if it is not stated otherwise by the administration of the clinic.

Please inform the reception of the clinic about the arrival and wait in the reception room until You will be piloted to the ward by the doctor or the personnel of the clinic.

It is requested not to use any make-up and not to wear any jewellery on the day of surgery (procedure).

Before the surgery (procedure) You will be handed to sign consent to surgery (procedure) and consent for anaesthesia. You should read these consents carefully and in case of any misunderstandings or questions, You should ascertain them with the surgeon and/or the physician anaesthetist before signing the consents. Change Your dress and be ready in the ward until you are invited to the surgery room.

We kindly ask You to pay the deposit for the reservation of the operation day during the first 14 (fourteen) days starting from the date your have done the reservation. If you fail to pay the deposit during the above stated period, the reservation of the operation day is to be cancelled. The paid deposit is not redeemed if you inform the administration of the Clinic about the cancellation of the reservation less then 7 (seven) working days before the operation day.

After the surgery (procedure) You should eat only after You feel hungry (starting with a glass of water, thereafter – soup, and later – usual food).

24 hours after the surgery (procedure) (48 hours recommended) do not drive the car, do not work any work that requires attention and agility, do not solve any complicated questions.

24 hours after the surgery (procedure) (48 hours recommended) do not drink any alcohol, and do not use any medicine without consultations with the doctor.

In case of any problems after you leave the clinic (headaches, backaches, diplopia, weakness of the muscles of legs, etc.), immediately call the clinic tel. +370 5 2762111.

One copy of the Memorandum is handed to the patient, the second copy of the Memorandum is kept at the Clinic.

Please confirm by your signature that you have received the Memorandum and the list of Tests on the form presented by the administrator.

I have been familiarised and understood the requirements of the memorandum, I received all explanations upon all questions, and I confirm that with my signature:

Date _______________________________

The name, surname, signature of the patient ________________________________________________.

The name, surname, signature of the representative of the Clinic ________________________________.
 

TEST REQUIRED FOR SURGERY

  1. Blood group and rhesus factor

  2. Complete blood count

  3. Biochemical blood test:

    GOT (AST)                         creatinine

    GPT (ALT)                          urea

    protein                                 bilirubin common

    glucose                                bilirubin direct

    Potassium, Na, Ca

  4. Blood coagulation indexes

    Prothrombin

    INR

    fibrinogen

    APTT (blood coagulation time)

  5. Complete urine test

  6. Cardiogram

  7. Women under age 45 – breast ultrasonography (only prior to breast plastic surgeries). Ultrasonography must have been performed no earlier than one month before the surgery.

  8. Women over age 45 – breast mammogram (only prior to breast plastic surgeries). Mammogram must have been performed no earlier than one month before the surgery.

    All the above-listed tests are necessary.  Tests should be performed no earlier that 2 weeks before the expected date of the surgery.

     If tests are performed in another clinic, the test results should be sent to our clinic by fax 8-5 276 21 12 or e-mail at [email protected] no later than four labour days before the date of surgery.

 

CORRECT SELF-PREPARATION FOR A BLOOD TEST

     Do not eat for 8-12 hours before a blood test.

     One should remember that juice, tea and coffee, especially sugared, is also regarded as food. Only a small quantity of water is allowed.

     Blood indicators after meal may change even up to 50%! Eating leads to the increased levels of enzymes, fat, sugar, proteins, and blood cell count.

     Do not use alcohol for 1-2 days before a blood test. If an evening party is expected in the blood test eve, it is better to postpone the test for 1-2 days.

     Both single and permanent alcohol consumption change blood composition.

     Do not smoke for 2 weeks before a blood test.

     Smoking changes blood cell count and size. It also results in the increased levels of some certain enzymes and hormones.

     Have a rest of 10-15 minutes before blood collection.

     Physical activity may result in the increased levels of some certain hormones and blood cell count.

     Avoid nervous strain. Have a rest and relax for at least 10-15 minutes before blood collection.

     Stress results in the increased levels of hormones and blood cell count.

    Some drugs may influence the results of a blood test. Be sure to tell your doctor about drugs you are using.

     For example, antibiotics may change the structure of cells.

     It is inadvisable to have a blood test after radioscopic examinations, massages, reflex therapy or physical therapy, as well as small surgical interventions.

     Even a minor surgery changes liver enzyme count and increases white blood cell count.

CORRECT SELF-PREPARATION FOR AN URINE TEST

It is advisable to collect morning urine for testing. Morning urine sample is collected into a plastic urine sample collection container.

Prior to collecting a sample, you must:

  • Wash your hands with soap under running water;
  • Wash your genital area under running water and do not use any disinfectants;
  • During menstrual cycle, women are recommended to use tampons;
  • Dry up your external genitals;
  • Urinate for a couple of seconds into the toilet;
  • Collect your urine midstream (about 50 ml), urinate the remaining urine into the toilet;
  • Dry up the outer part of the container and close the cap.