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Surgical Documentation and Scheduling

Surgical Documentation and Scheduling

Scheduling - Bend Campus

New Requests and Changed Requests
Complete Surgery Scheduling Sheet for your Specialty
Fax to Surgery Schedulers at 541-706-6342
Or send via Relay Health, click here for enrollment instructions.

Changes or Cancelations
Mark Revised, Rescheduled or Canceled on Scheduling Sheet
Resubmit to Surgery Schedulers with updated information and/or new surgery date

Same Day Add-Ons
Call in request directly to the Operating Room Desk at 541-706-7400

Required Clinical Documents

Submit clinical documentation at least 24 hours prior to surgery. Must include surgeons orders and patient history and physical. Fax to the medical records fax queue at (541) 598-3403.
Physician History and Physical Form
Pre-Op Physician Order Forms


For the convenience of our MD offices, the forms listed below are formatted as Adobe Acrobat fillable .pdf forms. Click the links below to access the forms and save a copy to your desktop.

Surgery Scheduling Sheets Fax to Surgery Scheduling541-706-6342
Special RequestsFax to Materials541-598-3480
History and PhysicalFax to Medical Records541-598-3403
Pre-Op Physician Order FormsFax to Medical Records541-598-3403
Surgery Block Release Fax to Surgery Scheduling541-706-6342
Surgical Block RequestSee Form for Submission Options 
Flat Fee Request FormSee Form for Submission Options 
Informed Consent FormsSee Form for Submission Options 


Surgery Scheduling
Phone: 541-706-7788
Fax: 541-706-6342

Medical Records
Phone: 541-706-7166
Fax Queue: 541-598-3403 (Surgery Related Medical Only)

Phone: 541-706-4902
Fax: 541-598-3480

Main Operating Room
Phone: 541-706-7789

Pre-Surgery Clinic
Phone: 541-706-2718