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Complete Your Pre-Surgical Assessment

Thank you for choosing Samaritan North Surgery Center for your upcoming surgery or procedure. To start the pre-surgical assessment process, Samaritan North Surgery Center requests that you fill out your medical history online with One Medical Passport.  

We recommend that you enter your medical history online as soon as your surgery has been scheduled. Once you do this, our Pre-Surgical Assessment nurse will be able to access the information you entered online. This information will assist the nurse in organizing and documenting your complete medical history to prepare for surgery.

Information You’ll Need

Be sure to have the following information available before starting One Medical Passport:

  • Your health insurance information
  • The names, addresses and phone numbers of your physicians
  • A list of all medications you are taking, their dosage and frequency
  • A list of surgical procedures you have had
  • The name of the surgeon who will be performing your upcoming procedure

About One Medical Passport

Completing a One Medical Passport medical history online is easy. For most patients, filling out the entire questionnaire takes less than 30 minutes. Please fill out the questionnaire accurately, and be assured that all of your information is kept confidential, and you will be thoroughly reviewed by your medical team. At any time, you can quit filling out the questionnaire and come back to complete the unfinished portion at a more convenient time.

One Medical Passport is a website that allows you to enter your information at any time from anywhere. You can also print out a copy of your medical history after you create it online and keep it with you or with your other health care documents, as well as have access to it online anytime you need it or want to update it.

Information Security

One Medical Passport uses the highest grade of internet security available: 128 bit-encryption with SSL (secure socket layer) technology.  Your information is stored on servers at a secure web hosting site and will only be released to your medical team at Samaritan North Surgery Center. Your information is never released to anyone other than your medical team.

Fill out your pre-surgical assessment now.

Content Updated: November 22, 2014

These Good Samaritan Hospital locations offer Surgery Services.
Outpatient Surgery at Good Samaritan North Health Center
9000 N. Main St. Englewood, OH  45415
Surgery at Good Samaritan Hospital
2222 Philadelphia Dr. Dayton, OH  45406
Looking for a specific department or phone number?
Visit the Good Samaritan Hospital Directory.

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