Free Preference Card tool you can also download and Print preference card Preference Card Tool Preference Card Tool Surgeon Name: Procedure Name: Select a procedure Endoscopy Colonoscopy MRI Scan Ultrasound Dialysis Physical Therapy Chemotherapy Radiation Therapy Appendectomy Cholecystectomy Coronary Artery Bypass Grafting (CABG) Hernia Repair Hip Replacement Knee Replacement Mastectomy Cataract Surgery Cesarean Section Date: Surgical Team Members: Surgeon: First Assistant: Anesthesiologist: Nursing Staff: Supplies and Equipment: Instruments: Scalpel Scissors Forceps Needle Holder Other: Sutures Type: Sutures Size: Drapes and Covers: Medications: Miscellaneous: Specimen Containers Suction Devices Other: Procedure Steps: Special Notes: Download PDF Print