Surgical Checklist In Patient

Hip Replacement & Inpatient Surgery

Thank you for choosing to schedule surgery with Dr. Benjamin G Domb. We are excited to be involved in your surgical experience. In preparation for your surgery, we would like to inform you of all the necessary steps to be completed prior to your procedure.

Dr. Domb's surgery scheduler will contact you to set a date and location.

• If you do not hear from her within 2-3 days, please call 630-455-7130.

Surgical Checklist

to be completed prior to your preoperative visit

• Letter for medical clearance from your primary care physician
• Letter for medical clearance from specialist (if necessary)
• Preoperative lab tests
• Blood Work
• EKG
• Chest Xray
• Urine test
• Nasal Swab
• Additional testing if necessary or recommended by your Medical Doctors
• CT scan required for preoperative planning of your Hip Replacement
  • (Makoplasty ONLY). Must be within 8 weeks prior to your surgery date
• Discontinue Anti-inflammatories 7-10 days before surgery
• Discontinue Birth Control 1 month before surgery
• If on anticoagulation/blood thinners, immunomodulators, supplements
  • Obtain preoperative plan for medication

You MUST have ALL tests and preoperative clearance completed within 30 days of your surgery and prior to your preoperative visit.